Disclosure Medtronic - Speaker/ Research Grant/ Robotics Advisory Board Gore - Education Grant/ Speaker Teleflex - Consultant Da Vinci - Proctor
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- Laureen Hines
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1 Sleeve Plus Options
2 Disclosure Medtronic - Speaker/ Research Grant/ Robotics Advisory Board Gore - Education Grant/ Speaker Teleflex - Consultant Da Vinci - Proctor Mederi - Speaker Novadaq - Advisory Board Levita Magnetics - Advisory Board
3 Obesity is a Chronic Disease
4 Dr. Viktor Henrikson (1952) credited with first operation to induce weight loss Resected a 105 cm segment of small intestine Saber Obes Surg 2008;18:
5 +
6 Saber Obes Surg 2008;18: =
7 Saber Obes Surg 2008;18:
8
9
10 ?
11 Can you name that Sleeve Plus Procedure?
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13 Sleeve Plus Band
14 Unknown Common Channel Length
15 Sleeve Plus Roux- en Y Duodenojejunal Bypass (DJB) Unknown Common Channel Length
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17 Sleeve Plus Loop Duodenojejunal anastomosis Anastomosis (Loop DJB)
18 100cm common channel
19 Duodenal Switch 100cm common channel
20 Scopinaro Biliopancreatic Diversion
21 Scopinaro Biliopancreatic Diversion
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23 Single Anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S)
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25 Stomach Intestinal Pylorus - Sparing Surgery (SIPS)
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27 Sleeve Plus Jejuno-ileal Bypass
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29 Blind Loop Syndrome Bacterial overgrowth in the defunctionalized limb Abdominal bloating, arthralgias, eventual liver disease in 25% (5% cirrhosis) Diarrhea significant problems with anal burning, dehydration, electrolye issues Protein caloric depletion and vitamin diff
30 Long
31 Sleeve Plus Jejuno-jejunal Anastomosis Long
32 Short
33 Sleeve Plus Jejuno-ileal Anastomosis Short
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37 Sleeve Plus Transit Bipartition
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39 Single Anastomosis Sleeve Ileal Bypass (SASI)
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41 Sleeve Plus Ileal Transposition
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43 Laparoscopic Diverted Sleeve Gastrectomy with Ileal Transposition (DSIT)
44 Conclusion Surgery is the best treatment for obesity Its safe and effective but perhaps not safe enough or effective enough to attract the masses Need parallel pathways to highlight our great data without but also continue to evolve our procedures
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56 Rea the paper bc high complication
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67 Weight Loss Variation among Patients 20 Diet (Low Carbohydrate) 30 Drug (Liraglutide) Patients (%) 10 Patients (%) Gain 5-10 Gain 0-5 Gain 0-5 Loss Gain 5-10 Gain 0-5 Gain 0-5 Loss Device (Duodenal Liner) 25 Surgery (Gastric Bypass) Patients (%) Patients (%) Gain 5-10 Gain 0-5 Gain 0-5 Loss Gain 5-10 Gain 0-5 Gain 0-5 Loss >50
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70 50% EWL Gastric Bypass 20% *( 34% if BMI >50) 80% Duodenal Switch 6% 94% Sleeve Gastrectomy unknown *(higher than gastric bypass after 1 year) unknown
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73 Drive Growth in Bariatrics Risk Reduction Expand Access to care Push Metabolic Syndrome with obesity just one of the co-morbidities improved Change our messaging around obesity
74 Dr. Viktor Henrikson (1952) credited with first operation to induce weight loss Resected a 105 cm segment of small intestine Saber Obes Surg 2008;18:
75 Restrictive Malabsorption
76 Set Point or Set Range
77 Thermostat
78 350 Set Point Food Restricted Control Influences on Set Point Genetics Environment Developmental Days Bernstein, IL. Proc Soc Exp Biol Med; 1975 Nov; 150(2):546-8
79 Set Range 3000 Energy Intake Energy Expenditure (+) Energy Balance (-) Energy Balance BMI Weigle DS FASEB Journal 1994, 8:
80 2200 kcal/day - Average calories we consume daily 1300 kcal/day - Average calories we need daily 900 kcal/day - Excess daily
81 Genetic Influences on Set Range
82 Weight Loss Variation among Patients 20 Diet (Low Carbohydrate) 30 Drug (Liraglutide) Patients (%) 10 Patients (%) Gain 5-10 Gain 0-5 Gain 0-5 Loss Gain 5-10 Gain 0-5 Gain 0-5 Loss Device (Duodenal Liner) 25 Surgery (Gastric Bypass) Patients (%) Patients (%) Gain 5-10 Gain 0-5 Gain 0-5 Loss Gain 5-10 Gain 0-5 Gain 0-5 Loss >50
83 Weight Loss Variation among Patients 20 Diet (Low Carbohydrate) 30 Drug (Liraglutide) Patients (%) 10 Patients (%) Gain 5-10 Gain 0-5 Gain 0-5 Loss Gain 5-10 Gain 0-5 Gain 0-5 Loss Device (Duodenal Liner) 25 Surgery (Gastric Bypass) Patients (%) Patients (%) Gain 5-10 Gain 0-5 Gain 0-5 Loss Gain 5-10 Gain 0-5 Gain 0-5 Loss >50
84 BMI
85 EveryOne Responds Differently due to differences in Genetics
86 Energy Intake (+) Energy Balance (-) Energy Balance Energy Expenditure BMI Weigle DS FASEB Journal 1994, 8:
87 Lower Set Point with Surgery Aging and Environmental Influences (No Intervention) Fat Mass Set Point Surgery Aging and Environmental Influences (Post Intervention) Time (years)
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90 Lifelong Multi-Modal Therapy Surgery Treatment Unhealthy Foods Stress Lack of Sleep Medications that cause weight gain Exercise Rx1 Medication #1 Weight (lbs) Rx2 Medication #2 Time After Surgery
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92 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Weight Loss Curve Preop Weight Loss Regular Followup No Follow Up Dx Fibromyalgia Several Courses of Steroids Medications Regular Followup Off Meds Revision Surgery Nadir...
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