Morbid Obesity Management Overview of 1000 Sleeve Gastrectomies Munich / Cairo / Winterthur

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2 Morbid Obesity Management Overview of 1000 Sleeve Gastrectomies Munich / Cairo / Winterthur published 20012,Dec,Bariatric News London presented 2013,Cairo University/Lyon International Congress laparoscopic surgery Resume Prof. Dr.med. Ralf Konstantin Senner International School of Gastric Surgery Hospital 122 St. Petersburg

3 Comorbidity risk associated to morbid obesity The death risk increases per 5 Kg/m2 BMI scale by 29 % 1 of 14 cancer death cases is related to obesity Each year the average age of obese people decreases 20 % of female overweight increases 160 % of the cardiovascular risk Male obesity (over 40 BMI )increases the cancer risk up to 52 % 60 % of all obese people fall ill with Diabetes Typ 2

4 The evolution From resignation, to final liberation

5 Time frame Indication Morbid Obesity Female/Male 70%-30% highest BMI 74 highest weight 240 kg Comorbidities associated Diabetes typ II High bood pressure Coronar disease Sleep apnea Infertility Surgery Location solo surgery laparoscpic robot assisted Sleeve Gastrectomy Munich, Institute for surgical treatment of Adiposity Cairo, Al Safwa Hospital Winterthur, Lindberg Klinik

6 Post surgery overview of comorbidities 43% Diabetes Type II (68% oral antidiabetica,32% insulin) Before surgery After surgery insulin 32% oral antidiabetica 68 %

7 Post surgery overview of comorbidities Before surgery After surgery 37% 63% high blood pressure

8 33% Sleep apnea, CPAP controlled before surgery after surgery no need for CPAP therapy/support. 22% Infertility because of overweight desired to have children after surgery after surgery pregnancy in 100 % Change of nutrition after surgery having intensiv eat coaching / eat training / nutritional programs

9 Post surgery overview of complication Bleeding 2% leackage 2% Breaking 2% bleeding leackage breaking without complication without complication 94 %

10 2% bleeding Veneus usually on the cut line (sometimes in case of increasing of blood pressure/ bed management of pain after surgery) 4 conversions from laparoscopic to open surgery (no found of activ bleeding) 2% leakage on the critical point eso gastro jonction. general peritonitis/sepsis open surgery / intensive care local subfrenic abscess/withaut sepsis controlled punction drainage stenting / klipping 5% diagostic of leakage after 4 days 96% diagnostic after 5/7 days (no found to the standart x-ray control after surgery) 0% organ injury during the surgery ( kg)

11 0 % respiration assisted after the surgery ( kilograms) 0% conversion from laparoscopic to open surgery ( kg) because difficult anatomical situation (big lever / spleen, fat, another surgery before, high BMI) 2% breaking of surgery because hepatomegaly! BMI conversion therapy for 4 / 6 months with ballon

12 Other post surgical complications Two cases post incisional hernia One pacient died because massive cerebral bleeding One pacient died because massive pulmonary emboly 7 % pseudo diverticula : 30% symptomatic reflux weight increasing Therapy: Resection 70% asymptomatic

13 How the low level of complication can be reduced By respecting all state of art principes for bariatric surgery: Very strict selection of patients/interdisciplinary evaluation ESCOS evaluation standard program By implementing of: High performance anestesia ( experience, performance equipment ) High performance surgery Robotic assisted surgery Risk management during the surgery

14 How the low level of complication can be reduced No further using of one way instruments : following consequences no standard cleaning processing no standard sterilise processing no performance guaranty for second using no responsability of complications ( leackage, bleeding ) By implementing of: high competence coaching after surgery 5 Steps Morbid Obesity Program of Prof. Dr. Ralf Senner

15 Thank you for your attention Prof. Dr.med. Ralf Senner ESCOS SWISS