Bariatric Surgery: Options, Trends, and Latest Innovations

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

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.”

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[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]

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[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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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],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

Bariatric Surgery: Options, Trends, and Latest Innovations

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Bariatric Surgery: Options, Trends, and Latest Innovations