WEIGHT LOSS SURGERY A Primer on Current Options and Outcomes. Caitlin A. Halbert DO, MS, FACS, FASMBS April 5, 2018

Transcription

1 WEIGHT LOSS SURGERY A Primer on Current Options and Outcomes Caitlin A. Halbert DO, MS, FACS, FASMBS April 5, 2018

2 A Little Bit About Me Bariatric Surgical Services Reflux Surgery General Surgery

3 Overview Definitions and Epidemiology Surgical/Procedural Options Outcomes Associated Risks New Procedures Long-term Post Operative Care Special Guest Speaker

4 What is OBESITY? DISEASE OF EXCESSIVE FAT ACCUMULATION BECOMES A HEALTH ISSUE ABOVE 20% OF IDEAL BODY WEIGHT 78.6 MILLION AMERICANS ARE OBESE (34.9%) Delaware 30.7% (17 th in the nation)

5 Epidemiology Non-Hispanic blacks have the highest ageadjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-hispanic whites (32.6%), and non-hispanic Asians (10.8%) Obesity is higher among middle age adults, years old (39.5%) than among younger adults, age (30.3%) or adults over 60 or above (35.4%) adults.

6 What is MORBID OBESITY? 100 LBS OVER IDEAL BODY WEIGHT BODY MASS INDEX (BMI) OF 40 OR ABOVE KNOWN AS CLINICALLY SEVERE OBESITY RISK OF OTHER ILLNESSES/DEATH

7 WHAT CAUSES MORBID OBESITY? GENETIC FACTORS EATING HABITS LACK OF EXERCISE ENVIRONMENT

8 DANGERS OF OBESITY Pulmonary Disease Abnormal Function Obstructive Sleep Apnea Hypoventilation Syndrome Non-alcoholic Fatty Liver Disease Steatosis Steatohepatitis Cirrhosis Gall Bladder Disease Gynecologic Abnormalities Abnormal Menses Infertility Polycystic Ovarian Syndrome Urine leak Osteoarthritis Gout EARLY DEATH Idiopathic Intracranial Hypertension Stroke Cataracts Coronary Disease Diabetes Dyslipidemia Hypertension Severe Pancreatitis Cancer Breast, Uterus, Cervix, Colon, Esophagus, Pancreas, Kidney, Prostate Phlebitis Venous Stasis Blood Clots 10-41% increase

9 SOLUTION LOSE WEIGHT HOW??

10 Success Rate of Weight Loss Treatments for Morbid Obesity Treatment Average Weight Loss (% Total) % Excess Weight Loss at Five Years Placebo 4 6% 0% Diet/Behavior Modification 8 12% 1.6% (10 Years) Drug Therapy < 10% 10% Gastric Bypass 65 85% 65-85% Gastric Sleeve 60 80% 60-85% Gastric Band 45 50% 50%

11 WEIGHT LOSS SURGERY BEST MOST EFFECTIVE LONG LASTING TREATMENT

12 Who is a CANDIDATE? BMI > 40 BMI > 35 and 1 or 2 significant medical problems Failure of Non surgical means to lose weight COMMITTED to a lifetime of changes

13 Types of Bariatric Surgeries Roux-en-Y (RNY) Gastric Bypass Sleeve Gastrectomy Adjustable Gastric Banding (Lap-Band ) Duodenal Switch Revisional Surgery Band to bypass/sleeve Band over gastric bypass Bypass or sleeve to duodenal switch

14 Prevalence of Bariatric Surgery

15 GASTRIC BYPASS

16 GASTRIC BYPASS

17 SLEEVE GASTRECTOMY

18 SLEEVE GASTRECTOMY

19 GASTRIC BAND

20 DUODENAL SWITCH (DS)

21 GASTRIC BYPASS RISKS INFECTION BLEEDING LEAKS BLOOD CLOT ULCER HERNIA PAIN NAUSEA VOMITING DUMPING HAIR LOSS LACK OF VITAMINS 21

22 SLEEVE GASTRECTOMY RISKS INFECTIONS BLEEDING LEAKS BLOOD CLOT ULCER PAIN NAUSEA VOMITING HAIR LOSS REFLUX DILATION

23 ADJUSTABLE BAND RISKS INFECTION BLEEDING BLOOD CLOT DEVICE FAILURE SLIPPAGE EROSION POUCH DILATION POOR WEIGHT LOSS 20 % ADDITIONAL SURGERY W/IN 5 YEARS 33% REMOVAL RATE AT 10 YEARS 23

24 FANTASTIC RESULTS >50% EXCESS WEIGHT LOSS IMPROVEMENT IN QUALITY OF LIFE IMPROVEMENT IN SELF ESTEEM IMPROVEMENT IN ILLNESSES 24

25

26 New Options for Weight Loss

27 ReShape, Orbera, Obalon INTRAGASTRIC BALLOONS

28 What is it?

29 How is it performed?

30 How is it performed?

31 Does it Work? Balloon EWL 24%, Sham EWL 11% (p = 0.004) 66% of average weight loss achieved maintained for the 6 months after the Integrated Dual Balloon was removed 66% of trial patients said they would have SMART the Pivotal ReShape Trial Procedure again 75% said they would recommend it to 419 a friend subjects, in a 387 follow-up able to swallow capsule survey Balloon 198, Sham 189 Obalon Balloon System lost an average of 14.4 pounds (6.6% of their total body weight) Sham device lost an average of 7.4 pounds (3.42% of their total body weight).

32 Maestro Rechargeable System vbloc VAGUS NEUROMODULATOR

33 What is it? vbloc Therapy is a neurometabolic therapy delivered through an implantable device called the Maestro System Intermittently blocks the signals between your stomach and your brain, effectively controlling appetite. Still able to eat a normal variety of foods Non-anatomy altering Customizable, adjustable and reversible

34 What is it? vbloc Therapy intermittently blocks those signals, delivering consistent therapy to control hunger. Signals from the gut to the brain Affects perceptions of hunger satiety Satiation (Fullness) Energy metabolism Blood pressure regulation Signals from the brain to the gut Gastric acid secretion Digestive enzyme secretion Limits gastric expansion which reduces the amount of food that can be eaten Glucose regulation

35 How is it Performed? Laparoscopic, outpatient procedure Devices wires placed around the anterior and posterior vagus Neuroregulator implanted under the skin Titrate setting to reach goals Patients learn to charge their neuroregulator

36 Does it Work? EMPOWER Trial (N=294) ReCharge Trial (N=239) Clinically significant weight loss, 28% EWL at 12 months 10 Significant weight loss maintained across all trials up to 36 months

37 AspireAssist GASTRIC EMPTYING SYSTEM

38 What is it? Endoscopic placement of A tube that connects the inside of the stomach to a port (Skin-Port) outside of the abdomen About minutes after eating, the patient attaches the external components including the Companion, connector, tubing, and a water-filled reservoir, and drains the stomach s contents

39 What is it? Outpatient, anatomy-sparing, reversible procedure Intended for long-term use in conjunction with continuous medical monitoring and lifestyle therapy to help patients develop healthier eating habits and reduce caloric intake

40 How is it Performed? Endoscopic pull technique

41 LONG-TERM POST OPERATIVE BARIATRIC CARE

42 Post-operative visits 1 month, 3 months, 6 months, yearly (6 months for DS) Labs BMP, CBC, lipids, vit B12, vit D, calcium, vit A, folic acid, iron studies Consider copper, zinc, selenium, thiamine based on symptoms Bone density at 2 years Re-evaluation for ongoing medication Evaluate need for support groups Consider body contouring surgery

43 Vitamin Requirements

44 SUCCESS AFTER WEIGHT LOSS SURGERY COMMITMENT COMMITMENT COMMITMENT

45