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The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
The future of bariatric surgery
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The future of bariatric surgery

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  • 11/09/11
  • Transcript

    • 1. 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?
    • 2. Surgery for Obesity <ul><li>Global epidemic of obesity </li></ul><ul><li>Bariatric surgery is the only effective and sustained treatment for morbid obesity </li></ul><ul><li>Bariatric surgery resolves diabetes and other co-morbidity and saves lives </li></ul><ul><li>Laparoscopic surgery has significant advantages over open procedures </li></ul><ul><li>Surgical morbidity and mortality are very low in experienced units </li></ul>
    • 3. The Future <ul><li>Revisional Surgery </li></ul><ul><li>Endoscopic Procedures </li></ul><ul><li>Gastric Neuromodulation </li></ul>
    • 4. Sleeve Gastrectomy: The Rise…
    • 5. Sleeve Gastrectomy Current Status <ul><li>Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure </li></ul><ul><ul><li>Clinical Issues Committee of the ASMBS. SOARD 2010 . </li></ul></ul><ul><li>Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. </li></ul><ul><ul><li>Brethauer, Hammel, Shauer. SOARD 2009;5:469-475 </li></ul></ul>
    • 6. Sleeve Gastrectomy Available Long-Term Follow-Up Data <ul><li>36 studies-2570 patients </li></ul><ul><li>BMI 37-69 (51.2) </li></ul><ul><li>% EWL 33-85 (55) </li></ul><ul><li>12 studies >100 patients </li></ul><ul><li>FU>36 months –3 studies </li></ul><ul><li>FU>60 months –1 study </li></ul><ul><li>SOARD 2009;5:469-475 </li></ul><ul><li>Follow-up Intervals </li></ul><ul><li>3 y 123 patients </li></ul><ul><li>4 y 26 patients </li></ul><ul><li>5 y 8 patients </li></ul><ul><ul><li>SOARD 2010 </li></ul></ul>
    • 7. What is Success in Bariatric Surgery? <ul><li>Durable </li></ul><ul><li>Excess Weight Loss > 50% </li></ul>
    • 8. Success & Failure Sleeve Gastrectomy Failure Success: Sleeve with >50% EWL Revisional Surgery Lost to Follow-Up Sleeve with <50% EWL
    • 9. 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
    • 10. Evolution of Surgery Open Surgery (big cuts) Laparoscopic Surgery (key-hole sized cuts) Natural Orifice Surgery (no cuts)
    • 11. Endoscopic Bariatric Procedures ROSE, POSE (USGI) Anchors TOGa (Satiety Inc.) Staplers EndoBarrier (GI Dynamics) ValenTx Sleeves StomaphyX (Endogastric Solutions) T-Fasteners EndoCinch (Bard) Spiderman (J&J) Suturing Sclerotherapy Product Technique
    • 12. TOGA
    • 13. TOGA: ex-vivo Anatomy
    • 14. TOGA TransOral Gastroplasty <ul><li>~ 500 patients in Europe & USA </li></ul><ul><li>Full data-set on 171 patients </li></ul><ul><li>Follow-up </li></ul><ul><ul><li>6 months: 111 patients </li></ul></ul><ul><ul><li>12 months: 76 patients </li></ul></ul><ul><ul><li>24 months: 20 months </li></ul></ul><ul><li>Median 39% EWL at 12 months </li></ul><ul><li>Safety: Adverse events – 3% </li></ul>
    • 15. The Search Continues…… <ul><li>Behaviour modification </li></ul><ul><li>Monitor activity and eating pattern </li></ul><ul><li>Adjustable parameters </li></ul>
    • 16. Implantable Gastric Electrical Stimulators
    • 17. Transcend IGS ™ System Transneuronix - Medtronics <ul><li>800 patients world-wide </li></ul><ul><li>10 years follow-up </li></ul><ul><li>35% excess weight loss </li></ul>
    • 18. <ul><li>Gastric Stimulation </li></ul><ul><ul><li>Creates early sensation of satiety </li></ul></ul><ul><ul><li>Reduces desire to eat between meals </li></ul></ul><ul><ul><li>Reduced meal volume </li></ul></ul><ul><li>Patient Support System </li></ul><ul><ul><li>Tracks & reports eating events </li></ul></ul><ul><ul><li>Tracks & reports exercise trends </li></ul></ul><ul><ul><li>Useful diagnostic for sleep disorders </li></ul></ul><ul><ul><li>Supports behavior modification </li></ul></ul><ul><li>Low Impact </li></ul><ul><ul><li>Excellent safety profile </li></ul></ul><ul><ul><li>Minimal lifestyle changes </li></ul></ul><ul><ul><ul><li>No special diets </li></ul></ul></ul><ul><ul><ul><li>No vitamin supplements </li></ul></ul></ul>IntraPace: Abiliti™ Consumption - Expenditure Wt Change =
    • 19. IntraPace: abiliti ™ GSA102 Analyzer P102 Programmer W102 Programmer Wand LGS102 Stimulator LGL102 Lead
    • 20. Endoscopy 6 Months Post-Implant
    • 21. Abiliti ™: Weight Loss Unpublished data
    • 22. Emerging Paradigms in Obesity Therapy <ul><li>Super-Obesity: Conventional Bariatric Surgery e.g. laparoscopic gastric bypass </li></ul><ul><li>Less Severe Obesity </li></ul><ul><ul><li>Classes 1 and 2 </li></ul></ul><ul><ul><li>Class 3 with BMI<45 kg/m 2 </li></ul></ul><ul><ul><ul><li>Gastric Electrical Stimulation </li></ul></ul></ul><ul><ul><ul><li>Endoscopic Bariatric Procedures </li></ul></ul></ul>

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