SURGICAL TREATMENT FOR OBESITY: WHATS THE BEST OPTION? Natan Zundel, MD, FACS

Size: px
Start display at page:

Download "SURGICAL TREATMENT FOR OBESITY: WHATS THE BEST OPTION? Natan Zundel, MD, FACS"

Transcription

1 SURGICAL TREATMENT FOR OBESITY: WHATS THE BEST OPTION? Natan Zundel, MD, FACS Professor of Surgery Vice-Chairman Department of Surgery Florida International University Herbert Wertheim College of Medicine Consultant MIS and Bariatric Surgery FSFB,Colombia. Page 1 of 26

2 Page 2 of 26

3 WORLDWIDE OBESITY PROBLEM Worldwatch Institute, Paganelli 2000 China Switzerland Austria Italy Brazil Colombia Gernany UK Russia US 0% 10% 20% 30% 40% 50% 60% 70% % of Overweight Adults Page 3 of 26

4 Page 4 of 26

5 The Obesity Epidemic spreading worldwide Surgery: The Problem? The only treatment option with sustained weight loss in long term follow up studies The only treatment option that achieves long term remission of co morbidities Buchwald H. 2004, Obesity Surgery 14: Therapeutic Options for Metabolic Syndrome -Mediterranean-style diet -Cardiac-prudent diet with a fat intake of <30% of total calories -Rimonabant -Metformin -Rosiglitazone -Gastric bypass -Vertical banded gastroplasty Are there specific treatments for the metabolic syndrome? Giugliano, D. et al. Am J Clin Nutr 2008;87:8-11 Page 5 of 26

6 GROWTH OF BARIATRIC SURGERY NEJM ; Page 6 of 26

7 Why are we doing so many operations? 4 decades of obesity epidemic being ignored Failure of conventional treatments Improved outcomes of surgical procedures Introduction of laparoscopic surgery Buchwald H. 2004, Obesity Surgery 14: Types of Surgeries done in USA ( ) Gastric Bypass 70 % ( 50%) Adjustable Gastric Band 25 % (10%) Vertical Banded (VBG) 2 % (0%) BPD / DS 2.5 % (1.5%) Sleeve Gastrectomy (45-55%) Buchwald H. 2004, Obesity Surgery 4: Page 7 of 26

8 Banding Sleeve Gastrectomy Gastric bypass Your Decision Invasiveness Least Middle Most Excess Weight Loss 40-60% 50-60% 50-70% Rate of Weight Loss Slower Faster Faster Risk of Death Lowest (1/1000) Middle (1/500) Highest (1/100) Complications Occur later Occur early Occur early or late Adjustable Yes No No Reversible Yes No Very difficult Implanted Device Yes No No Hospital Stay <1 day 1 day 2 days Time off work 1 week 1-2 weeks 2 weeks US track record Since 1991 Since ~2000 Since 1960 s Anti Inflammatory OK OK NOT OK Follow up Most frequent Less frequent Less frequent Bariatric Surgery Complication & Mortality Rates Comparable to Common Surgical Procedures (CMS) Page 8 of 26

9 The New England Journal of Medicine 357;8, August 23, 2007, 753 Original Article Long-Term Mortality after Gastric Bypass Surgery Ted D. Adams, Ph.D.,et al Background Although gastric bypass surgery accounts for 80% of bariatric surgery in the United States, Long-Term only limited long-term data Mortality are available on mortality after among Gastric patients who have undergone this procedure compared with severely obese persons from a general population. Bypass Surgery Methods In this retrospective cohort study, we determined the long-term mortality (from 1984 to 2002) among Ted 9949 patients D. Adams, who had undergone Ph.D., gastric bypass surgery and 9628 severely obese persons who applied for driver s licenses. From these subjects, 7925 surgical patients and 7925 severely obese control subjects were matched for age, sex, and body-mass index. We determined the rates of death from any cause and from specific causes with the use of the National Death Index. Results During a mean follow-up of 7.1 years, adjusted long-term mortality from any cause in the surgery 357;8 group decreased, August by 40%, as compared 23, with 2007, that in the control 753group (37.6 vs deaths per 10,000 person-years, P<0.001); cause-specific mortality in the surgery group decreased by 56% for coronary artery disease (2.6 vs. 5.9 per 10,000 person-years, P = 0.006), by Original 92% for diabetes (0.4 Article vs. 3.4 per 10,000 person-years, P = 0.005), and by 60% for cancer (5.5 vs per 10,000 person-years, P<0.001). However, rates of death not caused by disease, such as accidents and suicide, were 58% higher in the surgery group than in the control group (11.1 vs. 6.4 per 10,000 person-years, P = 0.04). Conclusions Long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, group heart disease, by and cancer. 40 However, %!! the rate of death from causes other than disease was higher in the surgery group than in the control group. The New England Journal of Medicine Decreased mortality in the surgical Comparision of Bariatric Operations Meta-analysis of 136 studies, % Excess Weight Loss n = 22,094 patients Lap Band Gastric Bypass Duodenal Switch/BPD 47.5% 61.6% 70.1% Operative Mortality 0.1% 0.5% 1.1% Resolution of Diabetes 47.8% 83.6% 97.9% Bariatric Surgery. A Systematic Review and Meta-analysis. Buchwald et al. JAMA. 2004;292: Page 9 of 26

10 TWO QUESTIONS: 1. TO THE PATIENT 2. TO MYSELF TWO QUESTIONS: 1. TO THE PATIENT WHAT PROCEDURE DO YOU WANT AND WHY? Page 10 of 26

11 Recent Study of 468 patients demonstrated strong preference for LAGB vs. RYGB 2 RYGB LAGB 1.71M About 3 Million patients are likely to have surgery over the next 5 years. 1 (not reimbursed).75 M.88 M 1.36 Even though there are only half as many patients in the BMI 40 category (12 Million) as in the BMI category (21 Million), more BMI 40 are expected to be treated Jul '05 Jul '05 Jul '05 BMI BMI BMI July 05 study of 468 patients interviewed who were in each of three BMI categories. Data were weighted to assure that the total is representative of the market with respect to BMI, age by sex, presence of significant co-morbidities, household income, race/ethnicity and health insurance. Patients were presented with comprehensive description of each procedure. * p < 0.05 Adjustable Gastric Banding Page 11 of 26

12 Procedure Mortality* Morbidity LAGB 0.05% 11.3% RYGB 0.50% 23.6% VBG 0.31% 25.7% LAGB Safety Chapman, et al. A systematic literature review. Surgery March 2004; 135: World literature review-comparison study 121 studies *LAGB 10 times safer than RYGB, and 6 times safer than VBG Mean EWL% 61.2% for all patients; 47.5% (40.7%-54.2%) LAGB; 61.6% (56.7%-66.5%), RYGB; 70.1% (66.3%-73.9%), BPD. Bariatric Surgery. A Systematic Review and Metaanalysis. Henry Buchwald, MD, PhD. Jama JAMA, October 13, 2004 Vol 292, No Page 12 of 26

13 OUR OUTCOMES OR Early Female time Conversion N Complications Hosp. Reop Follow EWL Autor N (%) BMI (min) (%) (%) Stay (d) (%) Up (%) Zimmermann (0.11) 3 (0.33) y 40 Belachew * (1.1) 2 (0.4) NI 56 5 y 50 Dargent NI NI 4 (0.8) NI mo 65 (2 y) Fielding (0.9) 7 (2.1) y 62 O'Brian (1.8) 12 (4.3) * 4 y 70 Favretti (3.8) NI NI NI Greenstein 250 NI 48.0 NI NI 14 (5.6) NI 5.2 * 5 y 42 Surgical Clinics of North America Volume 81 Number 5 October 2001 OR Early Female time Conversion N Complications Hosp. Reop Follow EWL Autor N (%) BMI (min) (%) (%) Stay (d) (%) Up (%) Zundel First 100 (14%) y 42% Next (0.28%) LAGB Complications Chapman, et al. A systematic literature review. Surgery March 2004; 135: Complication Band displacement Pouch dilatation LAGB (n=8,504) n % Erosion Port dislocation Catheter rupture/ disconnection/leak Infection band/port Page 13 of 26

14 BAND EROSION/MIGRATION/PENETRATION Sleeve Gastrectomy Procedure Page 14 of 26

15 SLEEVE GASTRECTOMY RESULTS SLEEVE GASTRECTOMY RESULTS Page 15 of 26

16 Jossart et al Sleeve Gastrectomy Is considered more invasive than GB Does not have the possibility of restitutio ad integrum. But Cummings DE et al. Physiol Behav 2006, 89:71-84 Himpens J et al. Obes Surg 2006; 16: Page 16 of 26

17 Long Term Complications 1. GERD 2. Gastric atony 3. Weight loss failure 4. Vitamin Deficiency 5. Slippage of the reduced stomach 6. Sleeve dilation 7. Other Page 17 of 26

18 Sleeve vs Traditional Bariatric Procedures (* p vs GBP) VG n=68 Lap Band n=156 GBP n=245 DS n=66 Reoperations 1.5* Major complications Total complications 1.5* 2.6* Readmissions Lee C Presented at the 90 th Annual Clinical Congress Page 18 of 26

19 TWO QUESTIONS: 2. TO MYSELF: WHY I SHOULD NOT DO WHAT THE PATIENT WANTS? LAGB / LSG NO INDICATIONS. WHY IS SO IMPORTANT? Page 19 of 26

20 1. Diabetes??????? 2. Super Super Obese???? 3. Significant Hiatal Hernias??? 4. Sweet Eaters, Greasers?????? 5. GERD / BARRETT S IS THE LSG THE NEXT BAND?? BETTER PATIENT SELECTION LESS WEIGHT LOSS FAILURE LESS MORBIDITY BETTER RESULTS Page 20 of 26

21 ROUX-EN-Y GASTRIC BYPASS LONG TERM PERSISTENT RESULTS pts 93% follow-up %EWL Poiries et al, Ann Surg 1995;222: % DMT2 normal Glucose levels up to 14 years Page 21 of 26

22 Gastric bypass for DMT2 Author Procedure Pories et al 1995 Gastric Bypass 89% Torquati et al 2005 Gastric Bypass 74% Schauer et al 2003 Gastric Bypass 82% Sugerman et al 2003 Gastric Bypass 86% Cohen et al 2006 Gastric Bypass 100% LAGB Vs LSG Vs LRYGB in Special Situations Children and Adolescents Elderly (In the US age greater than 65) As a primary bariatric for a second non-bariatric In low BMI s Transplant Candidates Cirrhotic Patients Extensive gastrointestinal surgery Inflammatory bowel disease Page 22 of 26

23 Data suggest that the morbidity of bariatric operations performed in adolescents is significantly lower when compared to adults. However the Mortality is comparable. Varela JE et al, SOARD 2007 Elderly The clinical benefits of weight loss in elderly patients are often less dramatic than in younger patients AGB or LSG provides a safe alternative to surgical weight loss. LAGB combined with shorter operating times Absorption of vitamins, minerals and medications usually is not affected Page 23 of 26

24 As a primary bariatric for a second non-bariatric procedure Complex oncologic procedures (Szymanski et al. Obes Surg Feb 24) Preoperatively in transplant patients (Koshy et al. Am J Kidney Dis Oct;52(4):e15-7) But Postop Rejection after ( Unes K et al, J Cardivasc Med,Nov 2009) Transplantation Foreign Body Vs Absorption Vs Side effects of medications Vs Anatomic changes Page 24 of 26

25 Transplant Candidates Severe obesity is associated with increased incidence of graft failure Transplant patient frequently require multiple medications, procedures that include malabsorption, interfere with the bioavailability of these drugs Obesity worsens after transplantation Campsen etal. Obes Surg. Dec 2008 LAGB NO INDICATIONS. WHY IS SO IMPORTANT? THE BAND WAS NOT FOR EVERYBODY LIKE THE BYPASS, THE SLEEVE,ETC ARE NOT FOR EVERYBODY Page 25 of 26

26 Diet and exercise Minimally Intraluminal Invasive Devices procedures and procedures Gastric banding Gastric bypass Medications Effectiveness Invasiveness We really need options: 1. For Low BMIs 2. For the Obese population 3. For Revisions 4. More acceptable for patients Page 26 of 26

SURGICAL TREATMENT FOR OBESITY: WHAT S THE BEST OPTION? Natan Zundel, MD, FACS, FASMBS

SURGICAL TREATMENT FOR OBESITY: WHAT S THE BEST OPTION? Natan Zundel, MD, FACS, FASMBS SURGICAL TREATMENT FOR OBESITY: WHAT S THE BEST OPTION? Natan Zundel, MD, FACS, FASMBS Professor of Surgery Vice-Chairman Department of Surgery Florida International University Herbert Wertheim College

More information

Current Trends in Bariatric Surgery

Current Trends in Bariatric Surgery Current Trends in Bariatric Surgery 9.28.2017 Abraham Krikhely, MD, FACS, FASMBS Assistant Professor of Surgery, CUMC Center of Minimal Access, Metabolic and Weight Loss Surgery Outline Why consider surgery

More information

A Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications

A Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications A Bariatric Patient in my Waiting Room: Choosing the Right Patient for the Right Operation: Bariatric Surgery Indications Shahzeer Karmali MD FRCSC FACS Associate Professor Surgery University of Alberta

More information

Choice Critria in Bariatric Surgery. Giovanni Camerini

Choice Critria in Bariatric Surgery. Giovanni Camerini Choice Critria in Bariatric Surgery Giovanni Camerini Surgical vs Medical treatment Indications for Bariatric Surgery (WHO 1992) BMI of at least 40; BMI of 35 in case of serious diseases related to obesity;

More information

Benefits of Bariatric Surgery

Benefits of Bariatric Surgery Benefits of Bariatric Surgery Dr Tan Bo Chuan Registrar, Department of Surgery GP Forum 27 May 2017 Improvements of Co-morbidities Type 2 diabetes mellitus Hypertension Hyperlipidemia Degenerative joint

More information

Adjustable Gastric Band Surgery: Review of Current Practice. Dr. Chris Cobourn The Surgical Weight Loss Centre Mississauga, Ontario Canada

Adjustable Gastric Band Surgery: Review of Current Practice. Dr. Chris Cobourn The Surgical Weight Loss Centre Mississauga, Ontario Canada Adjustable Gastric Band Surgery: Review of Current Practice Dr. Chris Cobourn The Surgical Weight Loss Centre Mississauga, Ontario Canada March 31, 2012 Disclosures Allergan Canada Unrestricted Research

More information

Disclosure. consultant to Ethicon Endosurgery. case mix disclosure. LRYGB sleeve BPD revisions OAGB ( minibp ), SADI: 0% 19% 55% 23%

Disclosure. consultant to Ethicon Endosurgery. case mix disclosure. LRYGB sleeve BPD revisions OAGB ( minibp ), SADI: 0% 19% 55% 23% Disclosure consultant to Ethicon Endosurgery case mix disclosure 3% 19% 23% 55% LRYGB sleeve BPD revisions OAGB ( minibp ), SADI: 0% Disclosure consultant to Ethicon Endosurgery case mix disclosure 3%

More information

Surgical Treatment of Obesity. 1. Understand who is an appropriate candidate for referral for surgical weight loss.

Surgical Treatment of Obesity. 1. Understand who is an appropriate candidate for referral for surgical weight loss. Surgical Treatment of Obesity Learning Objectives: 1. Understand who is an appropriate candidate for referral for surgical weight loss. 2. Appreciate impact of operative weight reduction to improve co-morbid

More information

Bariatric Surgery. The Oregon Bariatric Center Surgical Team

Bariatric Surgery. The Oregon Bariatric Center Surgical Team Bariatric Surgery The Oregon Bariatric Center Surgical Team Colin MacColl, MD, Medical Director, Bariatric Surgeon Jessica Folek, MD, Bariatric Surgeon I have no disclosures Disclosures Objectives What

More information

Bariatric Surgery For Patients With End-Organ Failure

Bariatric Surgery For Patients With End-Organ Failure Bariatric Surgery For Patients With End-Organ Failure Arnold D. Salzberg, M.D. Andrew M. Posselt, M.D., PhD Divisions of Transplant and Minimally Invasive Surgery University of California, San Francisco

More information

Other Ways to Achieve Metabolic Control

Other Ways to Achieve Metabolic Control Other Ways to Achieve Metabolic Control Nestor de la Cruz- Muñoz, MD, FACS Associate Professor of Clinical Surgery Chief, Division of Laparoendoscopic and Bariatric Surgery DeWitt Daughtry Family Department

More information

Commonly Performed Bariatric Procedures in Singapore. Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital

Commonly Performed Bariatric Procedures in Singapore. Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital Commonly Performed Bariatric Procedures in Singapore Lin Jinlin Associate Consultant General, Upper GI and Bariatric Surgery Changi General Hospital Scope 1. Introduction 2. Principles of bariatric surgery

More information

Welche Operation für welchen Patienten: Sleeve, Bypass oder?

Welche Operation für welchen Patienten: Sleeve, Bypass oder? Welche Operation für welchen Patienten: Sleeve, Bypass oder?? Prof. Dr. med. Ralph Peterli Stv. Chefarzt Clarunis Leiter Forschungsplattform Viszeralchirurgie und bariatrisches Referenzzentrum Präsident

More information

Surgical Therapy for Morbid Obesity. Janeen Jordan, PGY 5 Surgical Grand Rounds April 7, 2008

Surgical Therapy for Morbid Obesity. Janeen Jordan, PGY 5 Surgical Grand Rounds April 7, 2008 Surgical Therapy for Morbid Obesity Janeen Jordan, PGY 5 Surgical Grand Rounds April 7, 28 Obesity BMI > 3 kg/m 2 Moderate 35-4 kg/m 2 Morbid >4 kg/m 2 1.7 BILLION Overweight Adults in the world 63 MILLION

More information

Goals 1/9/2018. Obesity over the last decade Surgery has become a safer management strategy Surgical options for management

Goals 1/9/2018. Obesity over the last decade Surgery has become a safer management strategy Surgical options for management The Current State of Surgical Intervention in Management of Morbid Obesity Goals Obesity over the last decade Surgery has become a safer management strategy Surgical options for management 1 Goals Obesity

More information

OBESITY/OVERWEIGHT. Fastest spreading disaster of the century- Bariatric Surgical treatment. By Dr. Vladimir Shchukin Consultant General Surgeon

OBESITY/OVERWEIGHT. Fastest spreading disaster of the century- Bariatric Surgical treatment. By Dr. Vladimir Shchukin Consultant General Surgeon OBESITY/OVERWEIGHT Fastest spreading disaster of the century- Bariatric Surgical treatment By Dr. Vladimir Shchukin Consultant General Surgeon Indications for surgical treatment Indication for Gastric

More information

Bariatric Surgery: The Primary Care Approach

Bariatric Surgery: The Primary Care Approach The 8 th Annual Conference of the Lebanese Society of Family Medicine October 25 th 2009 Bariatric Surgery: The Primary Care Approach Bassem Y. Safadi, MD, FACS Associate Professor of Clinical Surgery

More information

Medical Policy Bariatric Surgery. Document Number: 042 Commercial and Qualified Health Plans MassHealth Authorization required X X

Medical Policy Bariatric Surgery. Document Number: 042 Commercial and Qualified Health Plans MassHealth Authorization required X X Medical Policy Bariatric Surgery Document Number: 042 Commercial and Qualified Health Plans MassHealth Authorization required X X No Prior Authorization Overview The purpose of this document is to describe

More information

Gastric bypass vs. Sleeve gastrectomy

Gastric bypass vs. Sleeve gastrectomy Gastric bypass vs. Sleeve gastrectomy SLEEVEPASS-study Sleeve gastrectomy Paulina Salminen, M.D., PhD Turku University Hospital Department of Surgery Stockholms Obesitasdagar 19.4.2012 Swedish Obese Subjects

More information

Current Status of Bariatric Surgery in Asia

Current Status of Bariatric Surgery in Asia Emerald hall A, 1:2-1:5, November 7, 213 Current Status of Bariatric Surgery in Asia Go Wakabayashi, MD, PhD, FACS Professor and Chairman Department of Surgery Iwate Medical University Numbers of bariatric

More information

DISCLOSURES. Laparoscopic Adjustable Gastric Banding (LAGB) As An Option For Failed Gastric Bypass Procedure In Obese Patients

DISCLOSURES. Laparoscopic Adjustable Gastric Banding (LAGB) As An Option For Failed Gastric Bypass Procedure In Obese Patients Laparoscopic Adjustable Gastric Banding (LAGB) As An Option For Failed Gastric Bypass Procedure In Obese Patients Presented By: Ali Hazrati, Md, Msc, FRCSC Co-authors: Patrick Yau, MD, Jamie Cyriac, MD

More information

Bariatric Surgery Update

Bariatric Surgery Update Bariatric Surgery Update Alexander Perez, MD, FACS Professor of Surgery Chief, Division Minimally Invasive and Foregut Surgery Speaker Disclosure Dr. Perez has disclosed that the has no actual or potential

More information

Bariatric Surgery: A Cost-effective Treatment of Obesity?

Bariatric Surgery: A Cost-effective Treatment of Obesity? Bariatric Surgery: A Cost-effective Treatment of Obesity? Shaneeta M. Johnson MD FACS FASMBS 2018 NMA Professional Development Seminar Congressional Black Caucus Foundation Annual Legislative Conference

More information

Morbid Obesity A Curable Disease?

Morbid Obesity A Curable Disease? Morbid Obesity A Curable Disease? Piotr Gorecki, M.D. F.A.C.S. Associate Professor of Clinical Surgery Weill Medical College of Cornell University Chief of Laparoscopic Surgery New York Methodist Hospital

More information

LONG TERM OUTCOMES OF SLEEVE GASTRECTOMY (LSG) Jacques Himpens, Gustavo Arman The European School of Laparoscopic Surgery Brussels Belgium

LONG TERM OUTCOMES OF SLEEVE GASTRECTOMY (LSG) Jacques Himpens, Gustavo Arman The European School of Laparoscopic Surgery Brussels Belgium LONG TERM OUTCOMES OF SLEEVE GASTRECTOMY (LSG) Jacques Himpens, Gustavo Arman The European School of Laparoscopic Surgery Brussels Belgium DISCLOSURE DR HIMPENS IS A CONSULTANT WITH ETHICON ENDOSURGERY

More information

Long-Term Follow Up: The Burning Platform

Long-Term Follow Up: The Burning Platform Long-Term Follow Up: The Burning Platform John Morton, MD, MPH, FACS, FASMBS Chief, Bariatric & Minimally Invasive Surgery Stanford School of Medicine Past-President, American Society of Metabolic and

More information

Laparoscopic Adjustable Gastric Band The Safest, Effective Procedure for Treating Obesity and Obesity Related Disease

Laparoscopic Adjustable Gastric Band The Safest, Effective Procedure for Treating Obesity and Obesity Related Disease Laparoscopic Adjustable Gastric Band The Safest, Effective Procedure for Treating Obesity and Obesity Related Disease Erik Peltz, D.O. April 7 th, 2008 University of Colorado Health Science Center Department

More information

ADVANCE AT YOUR OWN PACE

ADVANCE AT YOUR OWN PACE ADVANCE AT YOUR OWN PACE Welcome and Introductions Obesity and Its Impact on Health Surgeon Introduction Surgical Weight Loss Options AGENDA OSVALDO ANEZ, MD 28 years of experience Performed approximately

More information

Bariatric Surgery. Options & Outcomes

Bariatric Surgery. Options & Outcomes Bariatric Surgery Options & Outcomes Obesity Obesity now leading cause of premature death & illness in Australia 67% of Australians are overweight or obese Australia 4 th fattest nation in OECD Obesity

More information

Bariatric surgery: Impact on Co-morbidities and Weight Loss Expectations ALIYAH KANJI, MD FRCSC MIS AND BARIATRIC SURGERY SEPTEMBER 22, 2018

Bariatric surgery: Impact on Co-morbidities and Weight Loss Expectations ALIYAH KANJI, MD FRCSC MIS AND BARIATRIC SURGERY SEPTEMBER 22, 2018 Bariatric surgery: Impact on Co-morbidities and Weight Loss Expectations ALIYAH KANJI, MD FRCSC MIS AND BARIATRIC SURGERY SEPTEMBER 22, 2018 Disclosures None Objectives Review expected weight loss from

More information

Sleeve Gastrectomy: Harmful. John C. Eun, PGY-5 General Surgery Grand Rounds University of Colorado Denver 11/22/10

Sleeve Gastrectomy: Harmful. John C. Eun, PGY-5 General Surgery Grand Rounds University of Colorado Denver 11/22/10 Sleeve Gastrectomy: Harmful John C. Eun, PGY-5 General Surgery Grand Rounds University of Colorado Denver 11/22/10 Background Obesity: Body Mass Index >30 Risk factor for CAD, DM, Cancers Obesity Trends*

More information

Bariatric Surgery. Overview of Procedural Options

Bariatric Surgery. Overview of Procedural Options Bariatric Surgery Overview of Procedural Options The Obesity Epidemic In 1991, NO state had an obesity rate above 20% 1 As of 2010, more than two-thirds of states (38) now have adult obesity rates above

More information

Policy Specific Section: April 14, 1970 June 28, 2013

Policy Specific Section: April 14, 1970 June 28, 2013 Medical Policy Bariatric Surgery Type: Medical Necessity and Investigational / Experimental Policy Specific Section: Surgery Original Policy Date: Effective Date: April 14, 1970 June 28, 2013 Definitions

More information

Overview. Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco

Overview. Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco GASTROINTESTINAL COMPLICATIONS AFTER BARIATRIC SURGERY Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco UCSF DEPARTMENT OF SURGERY Original Article

More information

JAMA February 10, 2010 Laparoscopic Adjustable Banding in Severely Obese Adolescents: A Randomized Trial

JAMA February 10, 2010 Laparoscopic Adjustable Banding in Severely Obese Adolescents: A Randomized Trial JAMA February 10, 2010 Laparoscopic Adjustable Banding in Severely Obese Adolescents: A Randomized Trial Daniel DeUgarte, MD Division of Pediatric Surgery Surgical Director, UCLA FIT Program Bariatric

More information

Technique. Matthew Bettendorf, MD Essentia Health Duluth Clinic. Laparoscopic approach One 12mm port, Four 5mm ports

Technique. Matthew Bettendorf, MD Essentia Health Duluth Clinic. Laparoscopic approach One 12mm port, Four 5mm ports Matthew Bettendorf, MD Essentia Health Duluth Clinic Technique Laparoscopic approach One 12mm port, Four 5mm ports Single staple line with no anastamosis 85% gastrectomy Goal to remove

More information

Morbid Obesity The Surgical Approach. Jonathan A. Schoen, M.D. Assistant Professor of Surgery University of Colorado Health Sciences Center

Morbid Obesity The Surgical Approach. Jonathan A. Schoen, M.D. Assistant Professor of Surgery University of Colorado Health Sciences Center Morbid Obesity The Surgical Approach Jonathan A. Schoen, M.D. Assistant Professor of Surgery University of Colorado Health Sciences Center Today s s Lineup Definition Population Statistics Childhood Obesity

More information

Lecture Goals. Body Mass Index. Obesity Definitions. Bariatric Surgery What the PCP Needs to Know 11/17/2009. Indications for bariatric Surgeries

Lecture Goals. Body Mass Index. Obesity Definitions. Bariatric Surgery What the PCP Needs to Know 11/17/2009. Indications for bariatric Surgeries Bariatric Surgery What the PCP Needs to Know Mouna Abouamara Assistant Professor Internal Medicine James H Quillen College Of Medicine Lecture Goals Indications for bariatric Surgeries Different types

More information

Endorsed by Executive Council June 17, American Society for Metabolic and Bariatric Surgery

Endorsed by Executive Council June 17, American Society for Metabolic and Bariatric Surgery Endorsed by Executive Council June 17, 2007 American Society for Metabolic and Bariatric Surgery POSITION STATEMENT ON SLEEVE GASTRECTOMY AS A BARIATRIC PROCEDURE Clinical Issues Committee Preamble. The

More information

Viriato Fiallo, MD Ursula McMillian, MD

Viriato Fiallo, MD Ursula McMillian, MD Viriato Fiallo, MD Ursula McMillian, MD Objectives Define obesity and effects on society and healthcare Define bariatric surgery Discuss recent medical management versus surgery research Evaluate different

More information

American Society for Metabolic & Bariatric Surgery

American Society for Metabolic & Bariatric Surgery American Society for Metabolic & Bariatric Surgery April 27, 2012 Louis Jacques, MD Director, Coverage and Analysis Group Centers for Medicare and Medicaid Services Mail Stop S3-02-01 7500 Security Boulevard

More information

Gastrointestinal Surgery for Severe Obesity 2.0 Contact Hours Presented by: CEU Professor

Gastrointestinal Surgery for Severe Obesity 2.0 Contact Hours Presented by: CEU Professor Gastrointestinal Surgery for Severe Obesity 2.0 Contact Hours Presented by: CEU Professor 7 www.ceuprofessoronline.com Copyright 8 2007 The Magellan Group, LLC All Rights Reserved. Reproduction and distribution

More information

Revision For Weight Regain

Revision For Weight Regain Revision For Weight Regain When? Why? What? Ahmad Aly ANZMOSS Dietetics Workshop 2018 Reoperative Surgery What Is Reoperative? Reversal Correction Conversion } Revisional Surgery Revisional Surgery 4000

More information

ANZMOSS 2018 Melbourne Bariatric Surgery Masterclass

ANZMOSS 2018 Melbourne Bariatric Surgery Masterclass ANZMOSS 2018 Melbourne Bariatric Surgery Masterclass WHICH OPERATION TO CHOOSE ANTHONY CLOUGH The options SURGICAL OPTIONS? - A MINEFIELD An explosion of operative variants Local technical variations Local

More information

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

Sleeve Gastrectomy Debate: Everyone Needs a Sleeve!!! Dana Portenier, MD Assistant Professor of Surgery Duke University Medical Center Sleeve Gastrectomy Debate: Everyone Needs a Sleeve!!! Dana Portenier, MD Assistant Professor of Surgery Duke University Medical Center 1. Safety Two Year Excess Weight Loss Two Year Weight Loss and Mortality

More information

Disclosures. Weight Regain After Bariatric Surgery & Future Therapies. Objectives

Disclosures. Weight Regain After Bariatric Surgery & Future Therapies. Objectives Weight Regain After Bariatric Surgery & Future Therapies Matthew Kroh, MD Assistant Professor of Surgery Cleveland Clinic Center for Surgical Innovation, Technology, and Education Digestive Disease Institute

More information

OBESITY MANAGEMENT: DIET/EXERCISE, NEW DRUGS AND/OR SURGERY?

OBESITY MANAGEMENT: DIET/EXERCISE, NEW DRUGS AND/OR SURGERY? OBESITY MANAGEMENT: DIET/EXERCISE, NEW DRUGS AND/OR SURGERY? ERIC VOLCKMANN, MD DIRECTOR OF BARIATRIC SURGERY OCTOBER 20, 2017 OBJECTIVES Define prevalence and health effects of obesity Discuss different

More information

Obesity and Bariatric Surgery Michel M. Murr, MD, FACS

Obesity and Bariatric Surgery Michel M. Murr, MD, FACS Obesity and Bariatric Surgery Michel M. Murr, MD, FACS Director of Bariatric Center Chief of Surgery, TGH Professor of Surgery, USF Disclosure Covidien: educational grants Obesity and Bariatric Surgery

More information

Bariatric Surgery: Indications and Ethical Concerns

Bariatric Surgery: Indications and Ethical Concerns Bariatric Surgery: Indications and Ethical Concerns Ramzi Alami, M.D. F.A.C.S Assistant Professor of Surgery American University of Beirut Medical Center Beirut, Lebanon Nothing to Disclose Determined

More information

FRESH START. Time For A BARIATRIC SURGERY! WHAT IS BARIATRIC SURGERY? UHS Medical Times EVERYTHING YOU NEED TO KNOW ABOUT علاج ال دانة وجراحة السمنة

FRESH START. Time For A BARIATRIC SURGERY! WHAT IS BARIATRIC SURGERY? UHS Medical Times EVERYTHING YOU NEED TO KNOW ABOUT علاج ال دانة وجراحة السمنة UHS Medical Times 1 Newsletter September 2018 علاج ال دانة وجراحة السمنة MINIMALLY INVASIVE Time For A FRESH START EVERYTHING YOU NEED TO KNOW ABOUT BARIATRIC SURGERY! While any surgical procedure carries

More information

BARIATRIC SURGERY AND TYPE 2 DIABETES MELLITUS

BARIATRIC SURGERY AND TYPE 2 DIABETES MELLITUS BARIATRIC SURGERY AND TYPE 2 DIABETES MELLITUS George Vl Valsamakis European Scope Fellow Obesity Visiting iti Associate Prof Warwick Medical School Diabetes is an increasing healthcare epidemic throughout

More information

Bariatric Surgery Update

Bariatric Surgery Update Friday General Session Bariatric Surgery Update Alex Perez, MD Chief, Division of Minimally Invasive and Foregut Surgery James E. Thompson, MD Family Distinguished Professor in Surgical Simulation Co Director,

More information

Bariatric surgery. KHALAJ A.R. M.D Obesity Clinic Mostafa Khomini Hospital Shahed University Tehran

Bariatric surgery. KHALAJ A.R. M.D Obesity Clinic Mostafa Khomini Hospital Shahed University Tehran Bariatric surgery KHALAJ A.R. M.D Obesity Clinic Mostafa Khomini Hospital Shahed University Tehran WWW.IRANOBESITY.COM Why Surgery? What is Indication of Surgery? What is ContraIndication of surgery? What

More information

Bariatric Surgery for Obesity: A Systematic Review and Meta-Analysis

Bariatric Surgery for Obesity: A Systematic Review and Meta-Analysis Bariatric Surgery for Obesity: A Systematic Review and Meta-Analysis Abdulhakeem Alobaid Thesis submitted to the Faculty of Graduate and Postdoctoral studies in partial fulfillment of the requirements

More information

Bariatric Surgery Outcomes

Bariatric Surgery Outcomes Bariatric Surgery Outcomes Kristoffel R. Dumon, MD a, Kenric M. Murayama, MD b, * KEYWORDS Bariatric surgery Outcomes Obesity Obesity is a global health problem and the exponential increase in obesity

More information

The Surgical Management of Obesity

The Surgical Management of Obesity The Surgical Management of Obesity Omar al noubani MD,MRCS وك ل وا و اش ز ب وا و ال ت س رف وا األعراف ما مأل ابن آدم وعاء شر ا من بطنه Persons who are naturally fat are apt to die earlier than those who

More information

Safety of Laparoscopic Vs Open Bariatric Surgery. Dr. Kishore Nadkarni Director Nadkarni Group of Hospitals Killa Pardi, Vapi, Valsad, Surat

Safety of Laparoscopic Vs Open Bariatric Surgery. Dr. Kishore Nadkarni Director Nadkarni Group of Hospitals Killa Pardi, Vapi, Valsad, Surat Safety of Laparoscopic Vs Open Bariatric Surgery 1 Dr. Kishore Nadkarni Director Nadkarni Group of Hospitals Killa Pardi, Vapi, Valsad, Surat Surgical Treatment of Obesity 2 Bariatrics is the branch of

More information

type 2 diabetes is a surgical disease

type 2 diabetes is a surgical disease M. Lannoo, MD, University Hospitals Leuven Walter Pories claimed in 1992 type 2 diabetes is a surgical disease Buchwald et al. conducted a large meta-analysis THE FIRST OBSERVATIONS W. Pories 500 patients

More information

* Assit. prof., *** Prof. & Head of deptt., Deptt. of Surgery, MGIMS ** Asstt prof Deptt. of Medicine. REVIEW ARTICLE

* Assit. prof., *** Prof. & Head of deptt., Deptt. of Surgery, MGIMS ** Asstt prof Deptt. of Medicine. REVIEW ARTICLE REVIEW ARTICLE TYPE 2 DIABETES MELLITUS - EXPLORING THE AVENUE OF BARIATRIC SURGERY. S RAO*, JAIN VV**, GUPTA DO***. Diabetes is a growing public health problem world-wide and especially in India which

More information

The Obesity Epidemic: Is There A Surgical Solution? Mr Roger Ackroyd Consultant Surgeon Northern General Hospital Sheffield UK

The Obesity Epidemic: Is There A Surgical Solution? Mr Roger Ackroyd Consultant Surgeon Northern General Hospital Sheffield UK The Obesity Epidemic: Is There A Surgical Solution? Mr Roger Ackroyd Consultant Surgeon Northern General Hospital Sheffield UK The right patient NICE Guidance (2002)Indications for surgery BMI >40

More information

Bariatric surgery. An updated systematic review and meta-analysis,

Bariatric surgery. An updated systematic review and meta-analysis, ITC Bariatric surgery An updated systematic review and meta-analysis, 2003-2012 Chang S-H, Stoll CRT, Song J, Varela JE, Eagon CJ, Colditz GA 11/16/2011 0 T A B L E O F C O N T E N T S HEADER...............................................

More information

Removal of a lap band and revision to an alternative bariatric procedure in one procedure.

Removal of a lap band and revision to an alternative bariatric procedure in one procedure. How to Discuss the Case with Insurance Plan Medical Director, Letter of Medical Necessity, and Increasing the Chance of Letters of Medical Necessity are a well-known requirement when requesting authorization

More information

Effect of Bariatric Surgery on Cardio-Metabolic Outcomes

Effect of Bariatric Surgery on Cardio-Metabolic Outcomes Effect of Bariatric Surgery on Cardio-Metabolic Outcomes Disclosure Research support from Bariatric Advantage (supplements donated for research study) Anne Schafer, MD Associate Professor of Medicine and

More information

Chapter 4 Section 13.2

Chapter 4 Section 13.2 TRICARE Policy Manual 6010.60-M, April 1, 2015 Surgery Chapter 4 Section 13.2 Issue Date: November 9, 1982 Authority: 32 CFR 199.2(b) and 32 CFR 199.4(e)(15) Copyright: CPT only 2006 American Medical Association

More information

Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery

Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery Considering Bariatric Surgery? Learn about minimally invasive da Vinci Surgery The Surgery: Bariatric Surgery There are many non-surgical treatments for obesity such as dieting, exercise, and medicine.

More information

HOSPITALIZATION OUTCOMES OF PATIENTS UNDERGOING LAPAROSCOPIC SLEEVE GASTRECTOMY

HOSPITALIZATION OUTCOMES OF PATIENTS UNDERGOING LAPAROSCOPIC SLEEVE GASTRECTOMY HOSPITALIZATION OUTCOMES OF PATIENTS UNDERGOING LAPAROSCOPIC SLEEVE GASTRECTOMY By Sarah Mohammed A. Allabun A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor

More information

Management of the Bariatric. Farah A. Husain MD, FACS, FASMBS Division Chief, Bariatric Services. Surgery Patient 2017

Management of the Bariatric. Farah A. Husain MD, FACS, FASMBS Division Chief, Bariatric Services. Surgery Patient 2017 Management of the Bariatric Farah A. Husain MD, FACS, FASMBS Division Chief, Bariatric Services Surgery Patient 2017 Financial Disclosures None Objectives Identify the most commonly performed bariatric

More information

Weight Loss Surgery Program

Weight Loss Surgery Program Weight Loss Surgery Program More than 500,000 Americans die prematurely each year from obesity-related complications, and it is one of the leading causes of preventable death. If you want to do something

More information

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

WEIGHT LOSS SURGERY A Primer on Current Options and Outcomes. Caitlin A. Halbert DO, MS, FACS, FASMBS April 5, 2018 WEIGHT LOSS SURGERY A Primer on Current Options and Outcomes Caitlin A. Halbert DO, MS, FACS, FASMBS April 5, 2018 A Little Bit About Me Bariatric Surgical Services Reflux Surgery General Surgery Overview

More information

The case for reductive surgery: a more efficient and cost-effective option

The case for reductive surgery: a more efficient and cost-effective option Emil Loots MBChB (Pret), FCS (SA) Cert Gastro (SA) Surg PhD Candidate The case for reductive surgery: a more efficient and cost-effective option Big day in Pretoria Controversies Controversy around the

More information

Restrictive Procedures: Band and Sleeve

Restrictive Procedures: Band and Sleeve Restrictive Procedures: Band and Sleeve Jin S. Yoo M.D. Assistant Professor of Surgery Jin.Yoo@duke.edu Disclosures Speaker for Cook Medical, Covidien, W.L. Gore Consultant for Musculoskeletal Transplant

More information

Certified Bariatric Nurse Review Course. Session 1

Certified Bariatric Nurse Review Course. Session 1 Certified Bariatric Nurse Review Course Session 1 Session 1 Review of CBN certification Introduction to Morbid Obesity History of weight loss surgery Objectives The purpose of this program is to inform

More information

National Position Statement

National Position Statement National Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes Background Approximately twenty five per cent (25%) of Australian

More information

Jacek Szopinski MD, PhD. This presentation contains pictures and schemes addopted from lecture by S.Dabrowiecki MD PhD with his kind permission

Jacek Szopinski MD, PhD. This presentation contains pictures and schemes addopted from lecture by S.Dabrowiecki MD PhD with his kind permission Jacek Szopinski MD, PhD This presentation contains pictures and schemes addopted from lecture by S.Dabrowiecki MD PhD with his kind permission The definition of beauty evolves Problem we have to deal

More information

Bariatric surgery: has anything changed in the last few years?

Bariatric surgery: has anything changed in the last few years? Bariatric surgery: has anything changed in the last few years? Mauro Toppino University of Turin Digestive and Colorectal Surgery Minimal Invasive Surgery Center (Head:Prof. Mario Morino) XIV Annual Conference

More information

Roux-and-Y Gastric Bypass and its Metabolic Effects

Roux-and-Y Gastric Bypass and its Metabolic Effects Roux-and-Y Gastric Bypass and its Metabolic Effects Nicola Di Lorenzo President elect of SICOb Italian Society for Bariatric Surgery and Metabolic Diseases Dept. of General Surgery-Università di Roma Tor

More information

OBESITY 2008: DIET, EXERCISE, DRUGS, AND SURGERY

OBESITY 2008: DIET, EXERCISE, DRUGS, AND SURGERY OBESITY 2008: DIET, EXERCISE, DRUGS, AND SURGERY Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest CLASSIFICATION OF OVERWEIGHT

More information

Disclosures. Obesity and Its Challenges: Outline. Outline 5/2/2013. Lan Vu, MD Division of Pediatric Surgery Department of Surgery

Disclosures. Obesity and Its Challenges: Outline. Outline 5/2/2013. Lan Vu, MD Division of Pediatric Surgery Department of Surgery Obesity and Its Challenges: Bariatric Surgery: Why or Why Not I have nothing to disclose Disclosures Lan Vu, MD Division of Pediatric Surgery Department of Surgery Outline Growing obesity epidemic Not

More information

Update on Bariatric Surgery. Learning Objectives: At the end of this lecture you should be able to: Currently Available Options

Update on Bariatric Surgery. Learning Objectives: At the end of this lecture you should be able to: Currently Available Options Update on Bariatric Surgery Dan Bessesen, MD Chief of Endocrinology; Denver Health Medical Center Professor of Medicine, University of Colorado School of Medicine Daniel.Bessesen@ucdenver.edu Learning

More information

Chapter 4 Section 13.2

Chapter 4 Section 13.2 Surgery Chapter 4 Section 13.2 Issue Date: November 9, 1982 Authority: 32 CFR 199.2(b) and 32 CFR 199.4(e)(15) 1.0 CPT 1 PROCEDURE CODES 43644, 43770-43774, 43842, 43846, 43848 2.0 HCPCS PROCEDURE CODES

More information

Metabolic Interventions and the GI Tract: Issues

Metabolic Interventions and the GI Tract: Issues Metabolic Interventions and the GI Tract: Issues Michael L. Kochman, M.D., AGAF Wilmott Family Professor of Medicine Vice-Chair of Medicine for Clinical Affairs University of Pennsylvania Health System

More information

6/10/2016. Bariatric Surgery: Impact on Diabetes and CVD Risk. Disclosures BARIATRIC PROCEDURES

6/10/2016. Bariatric Surgery: Impact on Diabetes and CVD Risk. Disclosures BARIATRIC PROCEDURES Bariatric Surgery: Impact on Diabetes and CVD Risk Anthony M Gonzalez, MD, FACS, FASMBS Medical Director Bariatric Surgery, South Miami Hospital Chief of Surgery, Baptist Hospital of Miami Associate Professor

More information

ENTRY CRITERIA: C. Approved Comorbidities: Diabetes

ENTRY CRITERIA: C. Approved Comorbidities: Diabetes KAISER PERMANENTE OHIO BARIATRIC SURGERY (GASTROPLASTY) Methodology: Expert Opinion Issue Date: 12-05 Champion: Surgery Review Date: 4-10, 4-12 Key Stakeholders: Surgery, IM Depts. Next Update: 4-14 RELEVANCE:

More information

Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results

Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results Obesity Surgery, 17, 168-175 Laparoscopic Adjustable Gastric Banding in 1,791 Consecutive Obese Patients: 12-Year Results Franco Favretti; Gianni Segato; David Ashton 1 ; Luca Busetto 2 ; Maurizio De Luca;

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Abdominal pain, enteral therapy in acute pancreatitis and, 812 Abscess(es), pancreatic, nutritional support for, 814 815 Acute Physiology and

More information

Considering Bariatric Surgery?

Considering Bariatric Surgery? Considering Bariatric Surgery? minimally invasive LearnLearn aboutabout minimally invasive da Vinci da Vinci Surgery Surgery The Condit io n: Obesity Obesity is defined as having a body mass index (BMI)

More information

Not over when the surgery is done: surgical complications of obesity

Not over when the surgery is done: surgical complications of obesity Not over when the surgery is done: surgical complications of obesity Gianluca Bonanomi, MD, FRCS Consultant Surgeon and Honorary Senior Lecturer Chelsea and Westminster Hospital London The Society for

More information

Long term laparoscopic Sleeve gastrectomy outcomes

Long term laparoscopic Sleeve gastrectomy outcomes Long term laparoscopic Sleeve gastrectomy outcomes Gerhard Prager Department of General Surgery Metabolic and Bariatric Surgery Long-term results of gastric sleeve resection / Gerhard Prager Metabolic

More information

Here are some types of gastric bypass surgery:

Here are some types of gastric bypass surgery: Gastric Bypass- Definition By Mayo Clinic staff Weight-loss (bariatric) surgeries change your digestive system, often limiting the amount of food you can eat. These surgeries help you lose weight and can

More information

See Policy CPT CODE section below for any prior authorization requirements

See Policy CPT CODE section below for any prior authorization requirements Effective Date: 9/1/2018 Section: SUR Policy No: 139 Medical Officer 9/1/2018 Date Technology Assessment Committee Approved Date: 3/04; 3/05; 3/06; 4/12; 4/16 Medical Policy Committee Approved Date: 11/08;

More information

RESEARCH CLINICAL. Gitana Scozzari & Eleonora Farinella & Gisella Bonnet & Mauro Toppino & Mario Morino

RESEARCH CLINICAL. Gitana Scozzari & Eleonora Farinella & Gisella Bonnet & Mauro Toppino & Mario Morino OBES SURG (2009) 19:1108 1115 DOI 10.1007/s11695-009-9871-1 RESEARCH CLINICAL Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term

More information

6/23/2011. Bariatric Surgery: What the Primary Care Provider Should Know. Case Presentation: Rachelle

6/23/2011. Bariatric Surgery: What the Primary Care Provider Should Know. Case Presentation: Rachelle Bariatric Surgery: What the Primary Care Provider Should Know 2,000 B.C. 2,000 A.D. Case Presentation: Rachelle 35 year-old woman with morbid obesity. 5 1 236 lbs BMI 44.5 PMHx: mild depression obstructive

More information

Bariatric Surgery: How complex is this? Pradeep Pallati, MD, FACS, FASMBS

Bariatric Surgery: How complex is this? Pradeep Pallati, MD, FACS, FASMBS Bariatric Surgery: How complex is this? Pradeep Pallati, MD, FACS, FASMBS Nothing to Disclose Types of Bariatric Surgery Restrictive Malabsorptive Combination Restrictive and Malabsorptive Newer Endoluminal

More information

The First Annual GOSS Meeting

The First Annual GOSS Meeting invites you to Featuring The Fifth SKMC-Cleveland Clinic Obesity Symposium & The second Kuwait Society of Metabolic Surgery Meeting Symposia, Debates and Live Surgery Kuwait City, Kuwait December 12-14th

More information

Disclosure Medtronic - Speaker/ Research Grant/ Robotics Advisory Board Gore - Education Grant/ Speaker Teleflex - Consultant Da Vinci - Proctor

Disclosure Medtronic - Speaker/ Research Grant/ Robotics Advisory Board Gore - Education Grant/ Speaker Teleflex - Consultant Da Vinci - Proctor Sleeve Plus Options Disclosure Medtronic - Speaker/ Research Grant/ Robotics Advisory Board Gore - Education Grant/ Speaker Teleflex - Consultant Da Vinci - Proctor Mederi - Speaker Novadaq - Advisory

More information

Medicare Part C Medical Coverage Policy

Medicare Part C Medical Coverage Policy Morbid Obesity Surgery Origination: June 30, 1988 Review Date: October 18, 2017 Next Review: October, 2019 Medicare Part C Medical Coverage Policy DESCRIPTION OF PROCEDURE OR SERVICE Bariatric surgery

More information

BARIATRIC SURGERY. Weight Loss Surgery. A variety of surgical procedures to reduce weight performed on people who have obesity. Therapy Male & Female

BARIATRIC SURGERY. Weight Loss Surgery. A variety of surgical procedures to reduce weight performed on people who have obesity. Therapy Male & Female BARIATRIC SURGERY Weight Loss Surgery A variety of surgical procedures to reduce weight performed on people who have obesity. Therapy Male & Female About Bariatric surgery Bariatric surgery offers a treatment

More information

The Bariatric and Heartburn Center of Northeast Ohio

The Bariatric and Heartburn Center of Northeast Ohio The Bariatric and Heartburn Center of Northeast Ohio A message from Dr. Chlysta: Walter J. Chlysta MD, FACS, FASMBS 1900 23 rd Street, Suite 403 Cuyahoga Falls, OH 44223 Phone 330-926-3443 Fax 330-255-5092

More information

10/16/2014. Normal Weight: BMI Overweight: BMI >25 Obese: BMI >30 Morbidly Obese: BMI >40 or >35 with 2 comorbidities

10/16/2014. Normal Weight: BMI Overweight: BMI >25 Obese: BMI >30 Morbidly Obese: BMI >40 or >35 with 2 comorbidities Brinton Clark, MD, MPH Department of Medical Education Providence Portland Medical Center October 25 th, 2014 Oregon Society of Physician Assistants Fall Conference 45 yo woman with BMI=40kg/m2 (weight

More information

SURGICAL MANAGEMENT OF OBESITY. Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery

SURGICAL MANAGEMENT OF OBESITY. Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery SURGICAL MANAGEMENT OF OBESITY Anne Lidor, MD, MPH Professor of Surgery Chief, Division of Minimally Invasive and Bariatric Surgery Multi-Factorial Causes of Morbid Obesity include: Genetic Environmental

More information