Date post: | 16-Jan-2015 |
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Health & Medicine |
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Abeezar I. Sarela MSc MS MD FRCSConsultant in Upper GI & Bariatric SurgerySt 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 GastrectomyCurrent 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 GastrectomyAvailable 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 studySOARD 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
FailureSuccess:
Sleeve with >50% EWL
Revisional Surgery Lost to Follow-UpSleeve with <50% EWL
Sleeve Gastrectomy: Long-Term Follow-Up (…and ? Fall)
Author Follow-Up No. of patients
Failure
Himpens et al
Brussels, 2010
6+ years 53 64%
Sarela et al
Leeds, 2010
8+ years 20 45%
Evolution of Surgery
Open Surgery (big cuts)
Laparoscopic Surgery (key-hole sized cuts)
Natural Orifice Surgery (no cuts)
Technique Product
Sclerotherapy
Suturing EndoCinch (Bard)
Spiderman (J&J)
Anchors ROSE, POSE (USGI)
T-Fasteners StomaphyX (Endogastric Solutions)
Staplers TOGa (Satiety Inc.)
Sleeves EndoBarrier (GI Dynamics)
ValenTx
Endoscopic Bariatric Procedures
TOGA
TOGA: ex-vivo Anatomy
TOGATransOral 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™ SystemTransneuronix - Medtronics
•800 patients world-wide•10 years follow-up•35% excess weight loss
Consumption - Expenditure Wt Change=
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™
GSA102 Analyzer
P102 Programmer
W102 Programmer
Wand
LGS102 Stimulator
LGL102
Lead
IntraPace: abiliti™
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/m2
• Gastric Electrical Stimulation
• Endoscopic Bariatric Procedures