Commonly Performed Bariatric Procedures in Singapore. Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital
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1 Commonly Performed Bariatric Procedures in Singapore Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital
2 Scope 1. Introduction 2. Principles of bariatric surgery 3. Roux-en-Y gastric bypass 4. Sleeve gastrectomy 5. Other procedures 6. Conclusion
3 Introduction Obesity has become a global epidemic, and is on the rise in Singapore. This is contributed by an increasingly sedentary lifestyle and easy access to calorie-dense processed foods.
4 Introduction Many studies have shown that bariatric surgery provides safe, effective and durable weight loss compared to dietary modification and exercise
5 Principles of Bariatric Surgery 1. Restriction Limits caloric intake by reducing the stomach s reservoir capacity Induces a sense of satiety with reduced amount of food ingested 2. Malabsorption Decreases effectiveness of nutrient and caloric absorption by surgically decreasing the length of functional small bowel 3. Combination 4. Other effects Neuro-hormonal effects that act both on the gastrointestinal (GI) and extra-gi systems Not entirely well understood
6 Principles of Bariatric Surgery All surgeries are performed laparoscopically under general anaesthesia
7 Types of Bariatric Procedures Restrictive Malabsorptive Combination Sleeve gastrectomy Adjustable gastric banding Vertical banded gastroplasty Biliopancreatic diversion (with duodenal switch) Jejunal-ileal bypass Roux-en-Y gastric bypass Single loop gastric bypass Sleeve gastrectomy and Roux-en-Y gastric bypass are the 2 most commonly performed bariatric procedures in Singapore
8 Roux-en-Y Gastric Bypass One of the first few bariatric procedures to be proven to be safe and effective Gold standard procedure against which newer procedures are compared against One of the most common procedures performed worldwide, though numbers are on a downward trend
9 Roux-en-Y Gastric Bypass Restriction Malabsorption
10 Gastric pouch formation Gastric pouch Excluded stomach Gastro-jejunal Completed Gastro-jejunal anastomosis anastomosis Gastric pouch Gastric pouch Biliopancreatic limb Small bowel anastomosis Small bowel Small bowel Common Channel Roux limb
11 Roux-en-Y Gastric Bypass More effective and sustained weight loss, with higher rate of diabetic resolution compared to sleeve gastrectomy Suitable for patient with hiatus hernia / symptomatic reflux disease (which may worsen after sleeve gastrectomy) Longer surgery time, higher complication rates
12 Sleeve Gastrectomy Initially offered as a first-stage procedure for patients who are super obese (BMI >60) to induce weight loss before undergoing Roux-en-Y gastric bypass Weight loss from procedure was so effective that many patients who underwent sleeve gastrectomy did not require second procedure Increasing popularity to become the most commonly performed bariatric procedure worldwide in the last 5 years
13 Greater curve mobilisation Stomach Omentum Greater curve resection Gastric sleeve Resected stomach Completed sleeve gastrectomy Gastric sleeve Stapling device
14 Sleeve Gastrectomy Mainly a restrictive procedure Also has effects on gastric emptying and hormones secreted by gastric fundus affecting satiety Increasing popularity due to simplicity of procedure, short operating time, effectiveness in weight loss and lower complication rates
15 Other procedures Other procedures that are less commonly performed in Singapore include: 1. Single loop gastric bypass ( mini gastric bypass) 2. Biliopancreatic diversion with duodenal switch 3. Adjustable gastric band
16 Single Loop ( Mini ) Gastric Bypass
17 Adjustable Gastric Band
18 Biliopancreatic Diversion With Duodenal Switch Resected stomach Duodenal-jejunal anastamosis Long length bypassed small bowel / alimentary limb Short common channel cm
19 Conclusion Many procedures have been proposed in an effort to induce effective, durable and safe weight loss for obese patients. Procedure selected for patients has to be individualized based on patient profile, disease factor and surgeon expertise. The obese patient has to be managed by an experienced and dedicated multidisciplinary team, in order to achieve the best outcome.
20 Thank You!
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Bariatric Procedures and Mechanisms of Weight Loss September 22 nd, 2018 Aryan Modasi MD MSc FRCSC Disclosures Nothing to Disclose Traditional View Restriction vs Malabsorption Traditional View Adjustable