This week I am at the SAGES, (Society of Gastrointestinal Endoscopic Surgeons), here in Washington, DC. Many bariatric surgeons belong to this organization. I took two bariatric surgery courses today. It is always instructive to hear the point-counterpoint arguments between many of the various speakers. There has not been any earth shattering items but the following are some of my conclusions:
1). The Roux en-Y Gastric Bypass is still the operation all others are compared to.
2). The Gastric Sleeve Operation is gaining momentum as a frequently chosen operation but in many parts of the country insurance companies are still not approving it.
3). The Adjustable Gastric Band is still a popular choice but there are increasing concerns about how ofter the band needs to be removed or revised.In some areas of Europe where band operations have been done for much longer than in the US the band is very infrequently done and the sleeve is much more frequently performed. The optimal result with the adjustable gastric band is most strongly related to the frequency and quality of the followup.
3). The Duodenal Switch or Bileo-pancreatic Bypass is being performed by only a few surgeons attending this meeting.
4). Single incision surgery is being performed by a few bariatric surgeons but most are concerned it could bring more risk and may not provide additional value to our patients.
5). Best revision for those that do not do well with a gastric band is probably a conversion to a gastric bypass.
6). Best revision for a person who has not done well with a gastric bypass is probably a "adjustable gastric band over bypass"
7). For those people who have not done well after a gastric bypass,(5-15% of patients), endoscopic suturing without operation to cause narrowing of the outlet of the gastric pouch has not been shown to be helpful long term. Injection of a material,(called sodium moruate), that causes scarring and narrowing may hold some promise in narrowing the outlet of the gastric pouch appears to have some short term benefit but the long term results are still not available.
All of these items are consistent with my understanding even prior to this conference but I will "keep you posted".
Tomorrow I will present my research and I will explain that to you tomorrow.
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Dr. Myers,
ReplyDeleteWhat reasons would someone not do well with a gastric bypass?
Thank you for your response.
I believe only 5% or less of the patients that have a gastric bypass in our practice stuggle with significant weight gain after a gasrtic bypass. The average is about 15%. Why a preson does not do well can be because they have not worked through a traumatic situation from their childhood that make them self destructive, a person may have a binge eating disorder that they have not been refferred to an eating disorder specialist to resolve before surgery or someone is lost to followup and does not maintain the lifestyle changes in food portions and food selections necessary to get the best result frome bariatric surgery. This is why at Fresh Start we have a moltidisciplinary system and a person does not go to surgery unless they have approval fron our psychologist, the dietitian and the doctors involved. We insist that a person is ready for surgery before we move forward to do their operation.
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