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Bariatric Surgery: Options, Trends, and Latest Innovations

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George S. Ferzli
George S. Ferzli

The document summarizes research on the rise of obesity in the United States and treatment options. It finds that over the last two decades, about two-thirds of Americans are overweight or obese. While diet and medication are often ineffective long-term, bariatric surgery has been shown to significantly help with weight loss and resolution of related health conditions like diabetes and hypertension. The risks and outcomes of different bariatric procedures like Roux-en-Y gastric bypass and sleeve gastrectomy are discussed.

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George S. Ferzli, MD Joel Ricci, MD
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. National Center for Health Statistics NHANES IV Report 2. Flegal KM et al: Prevalence and trends in obesity among US adults 1999-2000. JAMA 2002; 288: 1723-1727
Derived from Center for Disease Control and Prevention website www.cdc.gov
Derived from Center for Disease Control and Prevention website www.cdc.gov
Obesity associated conditions Diabetes Hypertension Sleep apnea Congestive heart failure Hyperlipidemia Stroke Coronary Artery Disease Osteoarthritis Gastroesophageal Reflux Disease Non-alcoholic fatty liver Psychological disturbances
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Yanovski SZ, Yanovski JA. Obesity. N Engl J Med 2002;346: 591-602
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Derived from American Society of Bariatric Surgery website: www.asbs.org
[object Object],Diet Exercise Behavior Modification “ Postoperative care, nutritional counseling, and surveillance should continue for an indefinitely long period.”
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Period or Decade Incidence of surgery Reason for change Late 1970’s Early 1980’s 25,000 procedures per year ,[object Object],[object Object],[object Object],[object Object],Late 1980’s 1990’s 5,000 procedures per year ,[object Object],[object Object],[object Object],[object Object],[object Object],2000’s 80,000 to 110,000 procedures per year ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],Study Type and size Effect on weight Effect on comorbidities Buchwald et al. Meta-analysis n = 22,094 pts Mean excess weight loss: 61% ,[object Object],[object Object],[object Object],[object Object],Swedish Obese Subject trial (SOS) Prospective matched cohort n = 4,047 pts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Controversy Study Type and size Results Defunctionalized jejunum limb lenght Brolin et al. Prospective (n = 45) 22 pts: 75 cm length 23 pts: 150 cm length Mean f/u: 43 ± 17 m ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Higa et al. Retrospective (n = 2000) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dallal et al. Prospective (n = 352) No drains or UGI Small complication rate recognized from tachycardia
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[object Object],[object Object],[object Object],[object Object],[object Object],0 10 20 30 40 50 60 70 80 90 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Year Post-Op % EWL )
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Schauer, et al. Ann Surg 2000 Oct;232(4):515-29 N=104 1 year post op Number Pre-op % Worse % No change % Improved % Resolved Osteoarthritis 64 2 10 47 41 Hypercholesterolemia 62 0 4 33 63 GERD 58 0 4 24 72 Hypertension 57 0 12 18 70 Sleep Apnea 44 2 5 19 74 Hypertriglyceridemia 43 0 14 29 57 Peripheral Edema 31 0 4 55 41 Stress Incontinence 18 6 11 39 44 Asthma 18 6 12 69 13 Diabetes 18 0 0 18 82 Average 1.6% 7.8% 35.1% 55.7% 90.8% Improved or Resolved
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Cho M, et al. Laparoscopic Remnant Gastrectomy: A Novel approach to Gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg 2007;4:617-24.
Carbohydrate Lipid Proteins Ca²+ Fe ²+ B 12 A, D, E, K
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Bariatric Surgery: Options, Trends, and Latest Innovations

  • 1. George S. Ferzli, MD Joel Ricci, MD
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  • 3. Derived from Center for Disease Control and Prevention website www.cdc.gov
  • 4. Derived from Center for Disease Control and Prevention website www.cdc.gov
  • 5. Obesity associated conditions Diabetes Hypertension Sleep apnea Congestive heart failure Hyperlipidemia Stroke Coronary Artery Disease Osteoarthritis Gastroesophageal Reflux Disease Non-alcoholic fatty liver Psychological disturbances
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  • 39. Schauer, et al. Ann Surg 2000 Oct;232(4):515-29 N=104 1 year post op Number Pre-op % Worse % No change % Improved % Resolved Osteoarthritis 64 2 10 47 41 Hypercholesterolemia 62 0 4 33 63 GERD 58 0 4 24 72 Hypertension 57 0 12 18 70 Sleep Apnea 44 2 5 19 74 Hypertriglyceridemia 43 0 14 29 57 Peripheral Edema 31 0 4 55 41 Stress Incontinence 18 6 11 39 44 Asthma 18 6 12 69 13 Diabetes 18 0 0 18 82 Average 1.6% 7.8% 35.1% 55.7% 90.8% Improved or Resolved
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  • 68. Carbohydrate Lipid Proteins Ca²+ Fe ²+ B 12 A, D, E, K
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