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 balloon: Overweight and Class- 1 Obesity Indication for Bariatric Surgery: BMI > 40 BMI >35 + 2 Comorbid conditions
LAPAROSCOPIC BARIATRIC SURGERY Restrictive: LAGB Laparoscopic adjusted Gastric Band, VGB Vertical Banded Gastroplasty, GB - Gastric Banding, SG - Sleeve Gastrectomy, SRVG Silastic Ring Vertical Gastroplasty, Malabsorptive: 1970 Dr. Nikola Scopinora; BPD Biliopancreatic Diversion, DS Duodenal Switch Malabsorptive and restrictive: Early 60 s Dr. Mason; RYGB Ru and Y Gastric Bypass classic NonM/a- Non Restr: IGS Implantable Gastric Stimulation
Biliopancreatic diversion
Gastric by-pass
Gasrtroplasty
Gastric Balloon
History 1992, Guy Cadiere Performed a laparoscopic gastric banding with the first generation original Adjustable Gastric Band Invented by Dr. Kuzmak (patent 3.6.1986 ) Sep. 1993 Metica Belachew - first preliminary results >500,000 band placements worldwide (2009)
Gastric banding
Gastric Band
Gastric bands
Laparoscopic Adjustable Gastric Banding (LAGB) Involves: Creation of a 15 cc gastric pouch by placing an inflatable band around the stomach. Stomach outlet is later adjusted by injection of saline through an injection port.
Advantages of LAGB No cutting of the stomach No staple line to disrupt Ability to individualize stoma outlet Stoma size - ambulatory manipulation Laparoscopically reversible operation Stomach anatomy remains intact Short hospital stay ( day case)
Disadvantages of LAGB Surgical procedure vs. BIB (Bioenteric Intragastric Balloon) Complications and repeated operations Close long term follow up Human resources / team commitment Patient driven (easy to cheat)
Complications of LGB Complications requiring surgical revision / removal Slippage / gastric pouch dilatation Infection / abscess Erosion Patient intolerance Mechanical band failure
Operative tips Pars flaccida -technique No gastro-gastric (crural) suture Band placement- as high, as possible Small gastric pouch Presternal port location
Laparoscopic Gastric Banding Section of the Pars Flaccida Dissection of the left crus behind the Esophagus
Laparoscopic Gastric Banding Dissection through the less omentum Taking the catheter
Laproscopic Adjustable Gastric Banding
Conclusions Laparoscopic banding and re-banding for failed GB is a strategy of choice: Zero mortality Low morbidity Short duration: procedure/ hospital stay Acceptable efficacy, in respect to excessive body weight reduction Fast track surgery
COST Gastric Band 380000/= Hospital fees 1-2 days in the ward Surgical fees about 160000/= Total cost in Kenya about 600000 /= In India cost is similar In Europe cost is around 750000/= Gastric Balloon 105000/= Hospital fees Day case Professional fees about 110000/= Medical treatment for 3 month 75000/=
Thank you for your attention
In 2005, for the first time in European history, an extraordinary Expert panel named The BSCG (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO International Federation for the Surgery of Obesity, IFSO-EC International Federation for the Surgery of Obesity European Chapter, EASO European Association for Study of Obesity, ECOG European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective Scientific Societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past two years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertize and evidence based data on morbid obesity treatment.