The future of bariatric surgery


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  • 11/09/11
  • The future of bariatric surgery

    1. 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. 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. 3. The Future <ul><li>Revisional Surgery </li></ul><ul><li>Endoscopic Procedures </li></ul><ul><li>Gastric Neuromodulation </li></ul>
    4. 4. Sleeve Gastrectomy: The Rise…
    5. 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. 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. 7. What is Success in Bariatric Surgery? <ul><li>Durable </li></ul><ul><li>Excess Weight Loss > 50% </li></ul>
    8. 8. Success & Failure Sleeve Gastrectomy Failure Success: Sleeve with >50% EWL Revisional Surgery Lost to Follow-Up Sleeve with <50% EWL
    9. 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. 10. Evolution of Surgery Open Surgery (big cuts) Laparoscopic Surgery (key-hole sized cuts) Natural Orifice Surgery (no cuts)
    11. 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. 12. TOGA
    13. 13. TOGA: ex-vivo Anatomy
    14. 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. 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. 16. Implantable Gastric Electrical Stimulators
    17. 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. 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. 19. IntraPace: abiliti ™ GSA102 Analyzer P102 Programmer W102 Programmer Wand LGS102 Stimulator LGL102 Lead
    20. 20. Endoscopy 6 Months Post-Implant
    21. 21. Abiliti ™: Weight Loss Unpublished data
    22. 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>