The Shrinking World of Bariatric Surgery – new endoscopic solutions to old surgical problems: Elliot R Goodman MD Bariatri...
Background <ul><li>150,000-200,000 bariatric operations done a year </li></ul><ul><li>Weight loss of 67-75% EBWL in 80% of...
Background <ul><li>Estimated 10% - 20%  will regain some weight at 5 and 10 years </li></ul><ul><li>Usually a nadir weight...
Background <ul><li>Review of Literature on Reoperative Bariatric Surgery </li></ul><ul><ul><li>17 open papers (838 patient...
Endoluminal Gastric Pouch Reduction StomaphyX TM
Endoluminal Gastric Pouch Reduction <ul><li>StomaphyX TM   (EndoGastric Solutions, Redmond Washington) </li></ul><ul><ul><...
Endoluminal Gastric Pouch Reduction <ul><li>Procedure </li></ul><ul><ul><li>12-20 fasteners per case </li></ul></ul><ul><u...
Diagram for fasteners H H H H H H
Endoluminal Gastric Pouch Reduction
Endoluminal Gastric Pouch Reduction Pre anastomosis Post anastomosis
Endoluminal Gastric Pouch Reduction Gastro-esophageal Junction
Endoluminal Gastric Pouch Reduction <ul><li>26 patients have undergone the endoluminal pouch reduction since April 12, 200...
Endoluminal Gastric Pouch Reduction   The Ohio State University Data 54.9 % % EBWL- gastric bypass 31.8 Ave. wt. loss- gas...
Endoluminal Gastric Pouch Reduction  The Ohio State University Data 8.6  (7.2-9.5) 12 week weight loss (kg) 10.7  (9.5-11....
Endoluminal Gastric Pouch Reduction  The Ohio State University Data 20.8  (7.9-30.9) 12 week % EBWL 29.5  (21-38) 16 week ...
Endoluminal Gastric Pouch Reduction <ul><li>Unexpected Results </li></ul><ul><ul><li>Postprandial diarrhea resolved in 3 p...
Endoluminal Gastric Pouch Reduction <ul><li>Mechanism of Weight loss </li></ul><ul><ul><li>Reduce size of gastric pouch </...
On The Drawing Board <ul><li>TOGA gastroplasty: </li></ul>
 
 
 
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Endoluminal bariatric surgery grand rounds

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Beth Israel grand rounds on endoluminal bariatric surgery

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Transcript of "Endoluminal bariatric surgery grand rounds"

  1. 1. The Shrinking World of Bariatric Surgery – new endoscopic solutions to old surgical problems: Elliot R Goodman MD Bariatric Surgery Service Beth Israel Medical Center New York, NY
  2. 2. Background <ul><li>150,000-200,000 bariatric operations done a year </li></ul><ul><li>Weight loss of 67-75% EBWL in 80% of patients in 2 years </li></ul><ul><li>14 year follow up study: 95% of patients maintained at least 50% EBWL </li></ul>Pories WJ, Swanson MS, MacDonald KG. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222:339-350.
  3. 3. Background <ul><li>Estimated 10% - 20% will regain some weight at 5 and 10 years </li></ul><ul><li>Usually a nadir weight is reached at 2 years </li></ul><ul><li>Weight regain = ????? </li></ul><ul><ul><li>20% of weight gain above nadir weight </li></ul></ul><ul><ul><li>Dropping below 50% of % EBWL after primary surgery </li></ul></ul><ul><li>12% incidence of revision after gastric bypass surgery </li></ul>Gagner M., et al. Laparoscopic Reoperative Bariatric Surgery : Experience from 27 consecutive patients. Obes Surg, (12) 254-260, 2002.
  4. 4. Background <ul><li>Review of Literature on Reoperative Bariatric Surgery </li></ul><ul><ul><li>17 open papers (838 patients) </li></ul></ul><ul><ul><ul><li>118 major complications (14%) </li></ul></ul></ul><ul><ul><ul><li>11 deaths (1.3%) </li></ul></ul></ul><ul><ul><li>64 patients - laparoscopic reoperation </li></ul></ul><ul><ul><ul><li>6 major complications (9%) </li></ul></ul></ul><ul><ul><ul><li>Average OR time 4.5 hours </li></ul></ul></ul>Jones KB. Revisional bariatric Surgery-potentially safe and effective. SOARDS 1 (2005) 599-603
  5. 5. Endoluminal Gastric Pouch Reduction StomaphyX TM
  6. 6. Endoluminal Gastric Pouch Reduction <ul><li>StomaphyX TM (EndoGastric Solutions, Redmond Washington) </li></ul><ul><ul><li>Cleared in the United States and Europe for endoluminal tissue approximation </li></ul></ul><ul><ul><li>Patients who want further weight loss </li></ul></ul><ul><ul><li>Patients with rapid gastric gastric emptying or dumping syndrome associated with diarrhea </li></ul></ul>
  7. 7. Endoluminal Gastric Pouch Reduction <ul><li>Procedure </li></ul><ul><ul><li>12-20 fasteners per case </li></ul></ul><ul><ul><li>Start 1 cm proximal to stoma- 6 fasteners </li></ul></ul><ul><ul><li>1-2 cm proximal to first row- 6 fasteners </li></ul></ul><ul><ul><li>Additional fasteners </li></ul></ul>
  8. 8. Diagram for fasteners H H H H H H
  9. 9. Endoluminal Gastric Pouch Reduction
  10. 10. Endoluminal Gastric Pouch Reduction Pre anastomosis Post anastomosis
  11. 11. Endoluminal Gastric Pouch Reduction Gastro-esophageal Junction
  12. 12. Endoluminal Gastric Pouch Reduction <ul><li>26 patients have undergone the endoluminal pouch reduction since April 12, 2007 at The Ohio State University (Columbus, Ohio) </li></ul><ul><li>200 other patients have undergone the endoluminal pouch reduction procedure in the US </li></ul>
  13. 13. Endoluminal Gastric Pouch Reduction The Ohio State University Data 54.9 % % EBWL- gastric bypass 31.8 Ave. wt. loss- gastric bypass (kg) 96% female Female / Male 64.3 Height (inches) 40.4 (32.6-63.2) BMI 107.7 (75-172.2) Pre StomaphyX Weight (kg) 47 (29-57) AGE
  14. 14. Endoluminal Gastric Pouch Reduction The Ohio State University Data 8.6 (7.2-9.5) 12 week weight loss (kg) 10.7 (9.5-11.8) 16 week weight loss (kg) 6.6 (2.3-15) 8 week weight loss (kg) 4.9 (1.3-19) 4 week weight loss (kg) 4.1 (1.2-17.7) 2 week weight loss (kg)
  15. 15. Endoluminal Gastric Pouch Reduction The Ohio State University Data 20.8 (7.9-30.9) 12 week % EBWL 29.5 (21-38) 16 week % EBWL 16.8 (5.1-51) 8 week % EBWL 11.3 (3.0-41.5) 4 week % EBWL 8.4 (2.5-26.8) 2 week % EBWL
  16. 16. Endoluminal Gastric Pouch Reduction <ul><li>Unexpected Results </li></ul><ul><ul><li>Postprandial diarrhea resolved in 3 patients. </li></ul></ul><ul><ul><ul><li>Slowed gastric emptying </li></ul></ul></ul><ul><ul><ul><li>Obliteration of the gastric colic reflex </li></ul></ul></ul><ul><ul><li>GERD completely resolved in 2 patient. </li></ul></ul><ul><ul><ul><li>New valve created just distal to GE junction </li></ul></ul></ul>
  17. 17. Endoluminal Gastric Pouch Reduction <ul><li>Mechanism of Weight loss </li></ul><ul><ul><li>Reduce size of gastric pouch </li></ul></ul><ul><ul><li>Possible to reduce size of stoma </li></ul></ul><ul><ul><li>Reduce compliance in the gastric pouch </li></ul></ul><ul><ul><li>Slows gastric emptying </li></ul></ul>
  18. 18. On The Drawing Board <ul><li>TOGA gastroplasty: </li></ul>
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