Bariatric Surgery. The Oregon Bariatric Center Surgical Team

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1 Bariatric Surgery The Oregon Bariatric Center Surgical Team Colin MacColl, MD, Medical Director, Bariatric Surgeon Jessica Folek, MD, Bariatric Surgeon

2 I have no disclosures Disclosures

3 Objectives What is sleeve gastrectomy What are the indications for sleeve gastrectomy How is sleeve gastrectomy different from roux-en-y gastric bypass

4 Laparoscopic Surgery Several small incisions rather than a large incision Very few wound infections Very few hernias Short hospital stay Less pain, faster return to work

5 Sleeve Gastrectomy Generates weight loss by restricting the amount of food that can be eaten. Stomach is stapled and divided vertically, which removes 80-85% of the stomach. Remaining pouch, or sleeve, is about the size of a banana. It allows for normal digestion and absorption. Food consumed passes through the digestive tract in the usual fashion which allows it to be absorbed.

6 Evolution of Sleeve Gastrectomy Sleeve is first part of Duodenal Switch operation In high risk and super-obese DS was done in 2 stages completing sleeve gastrectomy first Weight loss results with sleeve alone obviated need to complete 2 nd stage in majority of patients Restriction alone not sole mechanism at play resulting in superior weight loss Removal of gastric fundus which contains ghrelin producing cells thought to play a major role

7 Indications for Sleeve High risk pts 2 0 to medical comorbidities Super-obese pts Pts who need to be on lifelong steroids Pts dependant on NSAIDS/ASA Pre- or post-transplant pts, or pts on immunomodulating drugs.and others

8 Sleeve Gastrectomy Results 60-75% excess weight loss Weight loss occurs within 1 to 2 years 65% remission of diabetes 80% remission of sleep apnea 87% remission of hypertension 80% remission of dyslipidemia Qualify for joint replacement

9 Sleeve Gastrectomy Complications Mortality 0.2% Deep vein thrombosis/ pulmonary embolism 1-3% Bleeding 1-3% Staple line leak.5-1% Wound infection 1% Re-operations <1% Re-admissions <5% GERD 5-30%

10 Bariatric Surgery Gastric Bypass 1. A small pouch is separated from the top of the stomach and sealed. 2. Staples are used to create the seals. 3. The small intestine is cut and attached to the new stomach pouch. 4. The section of small intestine that descends from the bypassed stomach is reconnected to the small intestine that descends from the new pouch to create a Y shape

11 Roux-en-Y Gastric Bypass Restrictive Egg-sized gastric pouch Creates satiety Enforces proper portion size Malabsorption Decreased nutritional calorie absorption Dumping Horrible but not dangerous feeling Self-limiting

12 Gastric Bypass Results 60-75% excess weight loss Weight loss occurs within 1 to 2 years 80% remission of diabetes 80% remission of sleep apnea 87% remission of hypertension 80% remission of dyslipidemia Qualify for joint replacement

13 Gastric Bypass Complications Mortality 0.4% Deep vein thrombosis/ pulmonary embolism 1-3% Anastomotic leak 1-3% Bleeding 1-3% Wound infection 1% Marginal ulcer 5% Internal hernia 5% Re-operations 5-10% Re-admissions <5% Vitamin and mineral deficiencies up to 90%

14 Advantages of Sleeve vs LRYGB No risk of marginal ulcers No risk of malabsorption No risk of internal hernia Fewer complications overall Quicker procedure, less OR time

15 Our Results

16 References Higa K, Ho T, Tercero F, Yunus T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7: Cunneen SA, Phillips E, Fielding G, Banel D, Estok R, Fahrbach K, Sledge I. Studies of Swedish adjustable gastric band and Lap-Band: systematic review and meta-analysis. Surg Obes Relat Dis Mar-Apr;4(2): Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 2010;20: Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 2010;252: Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis.2010;6:1 5.

17 Questions?

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