Sleeve Gastrectomy Debate: Everyone Needs a Sleeve!!! Dana Portenier, MD Assistant Professor of Surgery Duke University Medical Center

Transcription

1 Sleeve Gastrectomy Debate: Everyone Needs a Sleeve!!! Dana Portenier, MD Assistant Professor of Surgery Duke University Medical Center

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3 1. Safety

4 Two Year Excess Weight Loss Two Year Weight Loss and Mortality 100% Switch Roux-en-Y 50% Banding 10% Day Mortality (log scale %) Adapted from Buckwald H, et al, Bariatric surgery, a systematic review and meta-analysis, JAMA. 2004;292: and Maggard M, et al, Meta-Analysis: Surgical Treatment of Obesity, Ann Intern Med. 2005;142:

5 Two Year Excess Weight Loss Two Year Weight Loss and Mortality 100% Switch Roux-en-Y Gastrectomy 50% Banding 10% Day Mortality (log scale %) Adapted from Buckwald H, et al, Bariatric surgery, a systematic review and meta-analysis, JAMA. 2004;292: and Maggard M, et al, Meta-Analysis: Surgical Treatment of Obesity, Ann Intern Med. 2005;142: and Brethauer et al Systematic review of sleeve gastrectomy as staging and primary bariatric procedure SOARD 2009;5.

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7 Rate (%) Safety of Bariatric Surgery and Gastrectomy Mortality Rate 2.00% 1.50% 1.00% Bariatric Surgery Sleeve Gastrectomy 0.50% 0.00% 1) LABS Reporting Group N Engl J Med 2009;361: ) DeMaria et al Ann Surg Oct;246(4): ) Buckwald et al JAMA. 2004;292: )AHRQ, Healthcare Cost and Utilization Project (HCUP), 2007 data DRG ) Brethouer et all Surg Obes Rel Diseas 2009;5: ) Sanches-Santos et al Obes Surg,

8 Reinsurance for Private Pay Patients

9 2. Effective

10 Two Year Excess Weight Loss Two Year Weight Loss and Mortality 100% Switch Roux-en-Y Gastrectomy 50% Banding 10% Day Mortality (log scale %) Adapted from Buckwald H, et al, Bariatric surgery, a systematic review and meta-analysis, JAMA. 2004;292: and Maggard M, et al, Meta-Analysis: Surgical Treatment of Obesity, Ann Intern Med. 2005;142: and Brethauer et al Systematic review of sleeve gastrectomy as staging and primary bariatric procedure SOARD 2009;5.

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12 Excess Weight Loss Diabetes Resolution Rate Bariatric Surgery Procedures 100% Switch Roux-en-Y Gastrectomy 50% Banding 10% Day Mortality Adapted from Buckwald H, et al, Bariatric surgery, a systematic review and meta-analysis, JAMA. 2004;292: and Maggard M, et al, Meta-Analysis: Surgical Treatment of Obesity, Ann Intern Med. 2005;142: and Brethauer et al Systematic review of sleeve gastrectomy as staging and primary bariatric procedure SOARD 2009;5. 34 January 28, 2010

13 Diabetes Resolution Rate Bariatric Surgery Procedures 100% Switch Roux-en-Y Gastrectomy 50% Banding 10% Day Mortality Adapted from Buckwald H, et al, Bariatric surgery, a systematic review and meta-analysis, JAMA. 2004;292: and Maggard M, et al, Meta-Analysis: Surgical Treatment of Obesity, Ann Intern Med. 2005;142: and Brethauer et al Systematic review of sleeve gastrectomy as staging and primary bariatric procedure SOARD 2009;5. 35 January 28, 2010

14 3. Durability

15 Magenstrasse and Mill Author Patient (n) Preop BMI Follow-up Postop BMI %EWL Complication Rate Bougie Size Perioperative Mortality Johnson et al yrs NR 61% 4% NR 0 Vassallo et al yrs 29 NR 2.9% 36 Fr 0

16 Mid Term Data (3 year) tracks with other covered bariatric procedures

17 4.Useful in high and low risk patients

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19 5. Risk Reduction Strategy/ Staging

20 6. Technically less Demanding (no anastomosis)

21 Technical Pearls Sleeve Gastrectomy is a difficult operation?

22 Technical Pearls

23 7. Maintains Continuity of GI Tract Functional pylorus Doesn't bypass the duodenum

24 8. Revisable Re-Sleeve Conversion to another operation

25 9. Tricky Situations NSAID use Chrons Extensive previous surgeries (multiple small bowel Resections) ventral hernia, severe anemia osteoporosis Less risk of medicine absorption ie severe mental illness

26 10. Evolving Body of Literature Estimated 10,000 procedures in peer reviewed articles have been published since 2006 on Sleeve Gastrectomy that show similar results to other covered Bariatric Procedures for Weight loss, as measured by excess BMI loss (39) Comorbidity resolution (19) Complication rates (16)

27 11. Society Support Societies that endorse Sleeve Gastrectomy American Society for Metabolic and Bariatric Surgery Society of American Gastrointestinal and Endoscopic Surgery American College of Surgeons