What s New in Bariatric Surgery?
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1 Bariatric Surgery: Update for the General Surgeon What s New in Bariatric Surgery? 2,000 B.C. 2,000 A.D. 1. America keeps getting fatter without an end in sight. 2. Bariatric surgery is not just about weight loss; it s about treating metabolic disease and reducing mortality. 3. Band: out. Sleeve: in Jonathan Carter, MD UCSF Postgraduate Course in General Surgery March Expanding the indications for bariatric surgery BRFSS, 1990 BRFSS, 1991 No Data <10% 10% 14% 1
2 BRFSS, 1992 BRFSS, 1993 BRFSS, 1994 BRFSS,
3 BRFSS, 1996 BRFSS, % BRFSS, 1998 BRFSS, % 20% 3
4 BRFSS, 2000 BRFSS, % 20% 24% 25% BRFSS, 2002 BRFSS, % 24% 25% 20% 24% 25% 4
5 BRFSS, 2004 BRFSS, % 24% 25% BRFSS, 2006 BRFSS,
6 BRFSS, 2008 BRFSS, 2009 BRFSS, 2010 Obesity reduces life expectancy For young men, BMI >45 took off 13 years of life expectancy For young women, BMI >45 took off 8 years of life expectancy 6
7 What s New in Bariatric Surgery? Bariatric surgery has a durable effect on weight obese controls 2. Bariatric surgery is not just about weight loss; it s about treating metabolic disease and reducing mortality. bands VBG bypasses number of patients diet controlled oral agent insulin dependent Metabolic benefits of bariatric surgery HbA1C (%) 8.2% before bypass 5.5% after bypass impaired fasting glucose courtesy of ASMBS 7
8 March 26, 2012 % using medication all 65% 27% All oral agent 64% All insulin dependent 13% 23% 21% 13% 6% 50% of the morbidly obese have hypertension About 40% of those on antihypertensives will be able to wean off medications completely. About 50% of undiagnosed hypertensives will normalize their blood pressure systolic BP diastolic BP Percent change from baseline preoperative value Change in lipid profile 2 years after gastric bypass -7% Total cholesterol -22% LDL cholesterol 40% RYGB dropped percentage of dyslipidemic patients from 95% to 28% HDL cholesterol Number taking medication dropped to 15% -27% Triglycerides 8
9 CANCER INCIDENCE Lancet July, 2009 Prospective, controlled trial Bariatric surgery reduces risk of: colon cancer endometrial cancer breast cancer prostate cancer ovarian cancer obese controls surgery 2010 patients underwent surgery 2037 matched patients underwent conventional Rx Mean 11 years of follow-up 99% of patients were followed Decreased mortality was from decreased myocardial infarction and cancer What s New in Bariatric Surgery? 151 patients who underwent gastric banding from were contacted for follow-up, and 84 patients completed follow-up. 39% experienced major complications (28% had erosions) 49% of the bands were removed 17% required conversion to a gastric bypass 3. Band: out. Sleeve: in 9
10 In France: 10,000 gastric bands are placed each year and 5,000 gastric bands are removed Sleeve gastrectomy band sleeve bypass Change in BMI after bariatric surgery 10
11 What s New in Bariatric Surgery? Surgery for the primary treatment of diabetes?!? 4. Expanding the indications for bariatric surgery FDA approved gastric banding for BMI with co-morbidity in 2011 Bariatric surgery for adolescents? This operation cures diabetes in skinny (BMI <35) about 85% of the time according to DePaula. Questions? 11
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