• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
The future of bariatric surgery
 

The future of bariatric surgery

on

  • 1,937 views

 

Statistics

Views

Total Views
1,937
Views on SlideShare
1,928
Embed Views
9

Actions

Likes
1
Downloads
66
Comments
0

2 Embeds 9

http://foregutsurgeon.com 8
http://nrip.in 1

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • 11/09/11

The future of bariatric surgery The future of bariatric surgery Presentation 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
  • The Future
    • Revisional Surgery
    • Endoscopic Procedures
    • Gastric Neuromodulation
  • 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
    • SOARD 2009;5:469-475
    • Follow-up Intervals
    • 3 y 123 patients
    • 4 y 26 patients
    • 5 y 8 patients
      • SOARD 2010
  • What is Success in Bariatric Surgery?
    • Durable
    • 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)
  • 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
  • TOGA
  • TOGA: ex-vivo Anatomy
  • TOGA TransOral Gastroplasty
    • ~ 500 patients in Europe & USA
    • Full data-set on 171 patients
    • Follow-up
      • 6 months: 111 patients
      • 12 months: 76 patients
      • 24 months: 20 months
    • Median 39% EWL at 12 months
    • Safety: Adverse events – 3%
  • The Search Continues……
    • Behaviour modification
    • Monitor activity and eating pattern
    • Adjustable parameters
  • Implantable Gastric Electrical Stimulators
  • Transcend IGS ™ System Transneuronix - Medtronics
    • 800 patients world-wide
    • 10 years follow-up
    • 35% excess weight loss
    • Gastric Stimulation
      • Creates early sensation of satiety
      • Reduces desire to eat between meals
      • Reduced meal volume
    • Patient Support System
      • Tracks & reports eating events
      • Tracks & reports exercise trends
      • Useful diagnostic for sleep disorders
      • Supports behavior modification
    • Low Impact
      • Excellent safety profile
      • Minimal lifestyle changes
        • No special diets
        • No vitamin supplements
    IntraPace: Abiliti™ Consumption - Expenditure Wt Change =
  • IntraPace: abiliti ™ GSA102 Analyzer P102 Programmer W102 Programmer Wand LGS102 Stimulator LGL102 Lead
  • Endoscopy 6 Months Post-Implant
  • Abiliti ™: Weight Loss Unpublished data
  • Emerging Paradigms in Obesity Therapy
    • Super-Obesity: Conventional Bariatric Surgery e.g. laparoscopic gastric bypass
    • Less Severe Obesity
      • Classes 1 and 2
      • Class 3 with BMI<45 kg/m 2
        • Gastric Electrical Stimulation
        • Endoscopic Bariatric Procedures