2015 Minimally Invasive Surgery Symposium
I had the pleasure to attend a recent surgical symposium where a number of scientific discussions pertaining to weight loss surgery occurred. In attendance where some of the world’s foremost experts in the field of weight loss surgery so the educational content was extraordinary. These are priceless opportunities for surgeon’s from different countries to share information and ideas allowing us to then offer to our patients’ the most up to date and innovative treatment approaches. I will briefly now discuss some of the symposium highlights.
The types of procedures being offered continues to develop as we gain more insight into the mechanisms by which surgery assists in weight loss as well as a better understanding of the biochemical causes for obesity.
A solely restrictive procedure such as the laparoscopic adjustable band has declined significantly in both popularity and frequency. Now accounting for less than 5% of surgical weight loss procedures, it appears best suited for those with significant medical contraindications to the other procedures, the very young, those of lower BMI with limited weight loss requirements, or those unwilling to accept a permanent procedure. It is reversible and it appears to be more temporary then was initially intended.
The gastric bypass, although still considered by many to be the gold standard weight loss operation, is not without its’ challenges. The short term risk of the procedure in expert hands is at a historic low, being safer than another common procedure, the laparoscopic cholecystectomy. Despite its’ safety, long term weight regain, carbohydrate addiction, reactive hypoglycemia, ulcers, intestinal obstruction, nutritional deficiencies, and limitations for revision if required has lead surgeon researchers to continue to consider other options.
The sleeve gastrectomy has now become the most commonly performed procedure. The reliable initial weight loss results, less dramatic effect on absorption and eating behavior, significant early improvement in medical conditions seen, and perceived lower risk compared to the bypass have made it popular with surgeons and patients alike. The enthusiasm should be tempered by the fact that the early complication rates being reported are not significantly less than gastric bypass and the weight loss and comorbid condition improvement is somewhat less than the bypass long term. That being said, many patients have and are doing quite well with sleeve gastrectomy and many of the issues seen with gastric bypass are avoided. If required, the option to revise a sleeve gastrectomy to either a gastric bypass or duodenal switch is usually available.
The most vibrant discussions at the symposium focused on a newer approach to a previously performed procedure, the duodenal switch. The most aggressive of presently performed weight loss operations, the classic duodenal switch does carry the highest risk of long term nutritional complications and short term surgical complications. It accounts for less than 2% of weight loss surgical procedures for that reason but with newer approaches that appears to be changing. With the introduction of laparoscopic techniques, modification of the way the intestines are reconnected, and improved surgeon skill, the procedural risks and nutritional consequences are being reduced. The weight loss and overall improvement of medical conditions, particularly diabetes, surpasses the other procedures currently available. The sleeve gastrectomy, a component of the duodenal switch, is readily converted to it if required. More data and experience with this procedure is forthcoming but it is anticipated that the volume of these will continue to increase.
The take home message from the symposium is that the field of weight loss surgery continues to evolve. The short and long term risks of the procedures are at historic lows and new technology and research will likely improve it further. Staying abreast of these developments are essential to providing state of the art patient care which will ultimately be reflected in excellent patient outcomes and satisfaction.