Bariatric surgery: has anything changed in the last few years?
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1 Bariatric surgery: has anything changed in the last few years? Mauro Toppino University of Turin Digestive and Colorectal Surgery Minimal Invasive Surgery Center (Head:Prof. Mario Morino) XIV Annual Conference ESS, Turin, November 25-27, 2010
2 Bariatric surgery: has anything changed in the last few years? The past The present The future?
3 Bariatric surgery: has anything changed in the last few years? The past
4 70s Jejuno-ileal By-pass
5 Gastric Bypass (GBP) 80s Transected Roux-en-Y gastric by-pass Torres lesser curve pouch gastric by-pass
6 80s VERTICAL BANDED GASTROPLASTY (VBG) (MASON) MacLean
7 80s Bilio-Pancreatic Diversion (BPD) (Scopinaro)
8 80s GASTRIC BANDING (ASGB)
9 Obesity Surgery at the end of the 80s Many discussions about the best technique: the simpler (with lesser results on weight loss) or the more complex (with better results)?
10 Change in the 90s LAPAROSCOPY * Real revolution * Widespreading obesity surgery
11 FEASIBILITY BY LAPAROSCOPY Simple and easy techniques
12 ADJUSTABLE SILICONE GASTRIC BANDING Widespread (Europe) New surgeons (without bariatric experience) Many failures and complications Wrong indications
13 Evolution of the laparoscopic techniques
14
15 BARIATRIC SURGERY BARIATRIC SURGERY WORLDWIDE WORLDWIDE Henry Buchwald
16 BARIATRIC SURGERY WORLDWIDE 2003 Weighted Percentages (Open and Laparoscopic Pooled) 70% 65,11% 60% 50% 40% 30% 24,41% 20% 10% 5,43% 4,85% 0% RYGB ASGB VBG BPD/DS
17 Italian Registry * for bariatric surgery * Official Registry of S.I.C.OB. (Italian Society Obesity Surgery)
18 10250 Interventions ASGB 4437 (43.3 %) VBG 3405 (33.2 %) BPD 1741 (17 %) GBP 427 (4.2 %) Others 240 (2.4 %)
19 Bariatric surgery: has anything changed in the last few years? The present
20 Improvement of techniques (more details for safety)
21 New technique 2 steps procedure (p. with BMI > 60) (M. Gagner) Sleeve gastrectomy Duodenal switch (after 1 year)
22 Sleeve gastrectomy Later proposed as a single procedure (due to good results on weight loss)
23 METABOLIC BARIATRIC SURGERY WORLDWIDE 2008 Buchwald H., Obes. Surg., % 45% Weighted Percentages (Open and Laparoscopic Pooled) 49,0% 42,3% 40% 35% 30% 25% 20% 15% 10% 5% 1,1% 1,7% 5,3% 0% RYGB ASGB VBG BPD/DS Sleeve Gastrectomy
24 METABOLIC BARIATRIC SURGERY WORLDWIDE 2008 USA / Canada Buchwald H., Obes. Surg., 2009 Weighted Percentages (Open and Laparoscopic Pooled) 90% 80% 70% 85% % 50% 40% 51% 44% 30% 20% 10% 0% 9% 4,5% 1% 0% 4% RYGB ASGB BPD/DS Sleeve G.
25 METABOLIC BARIATRIC SURGERY WORLDWIDE 2008 Europe Buchwald H., Obes. Surg., 2009 Weighted Percentages (Open and Laparoscopic Pooled) 70% 60% 63,7% % 40% 39,0% 43,2% 30% 20% 10% 11,1% 6,1% 4,9% 0,0% 7,0% 0% RYGB ASGB BPD/DS Sleeve G.
26 Italian Obesity Surgery Registry interventions Gastric banding 49.4% 4% (6208) Gastric bypass 22.4% (2810) Gastroplasty 10.3% (1288) Sleeve gastrectomy 8.4% (1053) Bilio-pancr. Diversion 7.1% (890)
27 New!!! Metabolic Surgery
28 Obesity Surgery Literature Data (patients with BMI > 40 Kg/m2 or with comorbidities) Bariatric operations lead to important weight loss and comorbidities improvement (type 2 diabetes too)
29 Excellent effects of biliopancreatic diversion on type 2 diabetes Scopinaro Noya Mingrone- Castagneto
30 Buchwald, JAMA 2004 Metanalysis 136 papers patients Type 2 Diabetes - disappeared: 76.8% of cases - disappeared or improved: 86% of cases
31 Buchwald, JAMA 2004 Recovery from type 2 diabetes * No need for medical therapies * Glycemia and glycosylated hemoglobin normal values 98.9% Bilio-pancreatic diversion 83.7% Gastric bypass 71.6% Vertical Banded Gastroplasty 47.9% Adjustable Gastric Banding
32 Experimental studies on rats Francesco Rubino Ann. Surg., 2004
33 Specific effect of gastro-intestinal bypass surgery Endocrine mechanism Incretins secerning cells Anti-incretins secerning cells
34 Type 2 Diabetes can be cured by surgery
35 Consensus Conference Diabetes Surgery Summit Roma, Marzo 2007 Gastrointestinal Surgery for Type 2 Diabetes, in patients with BMI < 35, has to be considered a research priority
36
37 European Workshop on Metabolic Surgery for Type 2 Diabetes Rome, Italy September 27-28, 2010 Universita Cattolica S. Cuore Rome, Italy
38 Need for randomized studies Dixon J.B., JAMA 2008 Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial
39 Studies on bariatric operations on diabetic patients Bilio-pancreatic Diversion (Scopinaro, Obes. Surg., 2007) (BMI < 35) Gastric Bypass (Alexandrides, Obes. Surg., 2007) Sleeve Gastrectomy (Lacy, Obes. Surg., 2007)
40 Duodenal Jejunal Bypass (DJB)
41 Ileal interposition (IT) Ileal interposition (De Paula, Surg. Endosc., 2007) (BMI < 35)
42 Bariatric surgery: has anything changed in the last few years? The future?
43 NOTES Swanström LL, Khajanchee Y, Abbas MA. Natural Orifice Transluminal Endoscopic Surgery: The Future of Gastrointestinal Surgery. The Permanente Journal/ Spring 2008/ Volume 12 No. 2:42-7
44 NOTES Surgical Access Natural Orifice Surgery Trans-vaginal, parietal, umbilical access SA-NOS Endoscopic Access Natural Orifice Surgery Trans-gastric, colic, vescical access EA-NOS
45
46 SA-NOS: TRANSUMBILICAL ACCESS (E-NOTES or SILS)
47 SA-NOS: TRANSUMBILICAL ACCESS (E-NOTES or SILS)
48 Transvaginal Sleeve Gastrectomy
49
50 Endocinch (BBraun) Endoluminal Vertical Gastroplasty
51
52 TOGa Trans Oral Gastroplasty STOMAPHYX
53
54
55 EndoBarrier TM Liner
56
57 ValenTx Endo-Bypass Pass System ValenTx Endo Bypass
58 Bariatric surgery CONCLUSIONS Something is changed in the last few years New technique: sleeve gastrectomy Improvement of safety Metabolic Surgery
59 Bariatric surgery Future Will NOTES demonstrate efficacy and safety?? The major part of the medical community had the same doubt at the beginning of laparoscopy
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NOTE: This policy is not effective until May 1, To view the current policy, click here. IMPORTANT REMINDER
NOTE: This policy is not effective until May 1, 2018. To view the current policy, click here. Medical Policy Manual Surgery, Policy No. 58 Bariatric Surgery Next Review: December 2018 Last Review: January
Weight Loss Surgery. Outline 3/30/12. What Every GI Nurse Needs to Know. Define Morbid Obesity & its Medical Consequences. Treatments for Obesity
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RESEARCH CLINICAL. Gitana Scozzari & Eleonora Farinella & Gisella Bonnet & Mauro Toppino & Mario Morino
OBES SURG (2009) 19:1108 1115 DOI 10.1007/s11695-009-9871-1 RESEARCH CLINICAL Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term
SURGICAL TREATMENT FOR OBESITY: WHAT S THE BEST OPTION? Natan Zundel, MD, FACS, FASMBS
SURGICAL TREATMENT FOR OBESITY: WHAT S THE BEST OPTION? Natan Zundel, MD, FACS, FASMBS Professor of Surgery Vice-Chairman Department of Surgery Florida International University Herbert Wertheim College
Metabolic Outcomes of Laparoscopic Diverted Sleeve Gastrectomy with Ileal Transposition (DSIT) in Obese Type 2 Diabetic Patients
OBES SURG (2015) 25:2018 2022 DOI 10.1007/s11695-015-1671-1 ORIGINAL CONTRIBUTIONS Metabolic Outcomes of Laparoscopic Diverted Sleeve Gastrectomy with Ileal Transposition (DSIT) in Obese Type 2 Diabetic
Safety of Laparoscopic Vs Open Bariatric Surgery. Dr. Kishore Nadkarni Director Nadkarni Group of Hospitals Killa Pardi, Vapi, Valsad, Surat
Safety of Laparoscopic Vs Open Bariatric Surgery 1 Dr. Kishore Nadkarni Director Nadkarni Group of Hospitals Killa Pardi, Vapi, Valsad, Surat Surgical Treatment of Obesity 2 Bariatrics is the branch of
Wei-Jei Lee, M.D., Ph.D. Dept. of Surg., Min-Sheng General Hospital, National Taiwan University, Taiwan
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Sleeve Gastrectomy Debate: Everyone Needs a Sleeve!!! Dana Portenier, MD Assistant Professor of Surgery Duke University Medical Center
Sleeve Gastrectomy Debate: Everyone Needs a Sleeve!!! Dana Portenier, MD Assistant Professor of Surgery Duke University Medical Center 1. Safety Two Year Excess Weight Loss Two Year Weight Loss and Mortality
Trends in bariatric surgery publications worldwide. Salman Al Sabah, Fatemah Al Marri, Eliana Al Haddad
Trends in bariatric surgery publications worldwide Salman Al Sabah, Fatemah Al Marri, Eliana Al Haddad This is a PDF file of an unedited manuscript that has been accepted for publication. As a service
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Obesity Surgery, 14, pp-pp Nutritional Markers following Duodenal Switch for Morbid Obesity Robert A. Rabkin MD, FACS; John M. Rabkin, MD, FACS; Barbara Metcalf, RN; Myra Lazo, MS, PA-C; Michael Rossi,
Bariatric Surgery AHM
Bariatric Surgery AHM Clinical Indications for Procedure I. INDICATIONS FOR BARIATRIC SURGERY A. Bariatric surgery for morbid obesity is considered medically necessary when ALL of the following are met