The future of bariatric surgeryPresentation Transcript
Abeezar I. Sarela MSc MS MD FRCS Consultant in Upper GI & Bariatric Surgery St James’s University Hospital, Leeds, UK PN Hinduja National Hospital, Mumbai, India Bariatric Surgery: What Does The Future Hold?
Surgery for Obesity
Global epidemic of obesity
Bariatric surgery is the only effective and sustained treatment for morbid obesity
Bariatric surgery resolves diabetes and other co-morbidity and saves lives
Laparoscopic surgery has significant advantages over open procedures
Surgical morbidity and mortality are very low in experienced units
Sleeve Gastrectomy: The Rise…
Sleeve Gastrectomy Current Status
Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure
Clinical Issues Committee of the ASMBS. SOARD 2010 .
Systematic review of sleeve gastrectomy as staging and primary bariatric procedure.
Brethauer, Hammel, Shauer. SOARD 2009;5:469-475
Sleeve Gastrectomy Available Long-Term Follow-Up Data
36 studies-2570 patients
BMI 37-69 (51.2)
% EWL 33-85 (55)
12 studies >100 patients
FU>36 months –3 studies
FU>60 months –1 study
3 y 123 patients
4 y 26 patients
5 y 8 patients
What is Success in Bariatric Surgery?
Excess Weight Loss > 50%
Success & Failure Sleeve Gastrectomy Failure Success: Sleeve with >50% EWL Revisional Surgery Lost to Follow-Up Sleeve with <50% EWL
Sleeve Gastrectomy: Long-Term Follow-Up (…and ? Fall) 45% 20 8+ years Sarela et al Leeds, 2010 64% 53 6+ years Himpens et al Brussels, 2010 Failure No. of patients Follow-Up Author
Evolution of Surgery Open Surgery (big cuts) Laparoscopic Surgery (key-hole sized cuts) Natural Orifice Surgery (no cuts)