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Anti-Obesity Surgery

Anti-Obesity Surgery. Joint Hospital Surgical Grand Round 17 th May 2008. Dr. YuhMeei Cheng Department of Surgery United Christian Hospital. Obesity Classification. WHO guidelines, Asia Pacific Perspective 2005. Morbid Obesity. Definition BMI > 40

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Anti-Obesity Surgery

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  1. Anti-Obesity Surgery Joint Hospital Surgical Grand Round 17th May 2008 Dr. YuhMeei Cheng Department of Surgery United Christian Hospital

  2. Obesity Classification WHO guidelines, Asia Pacific Perspective 2005

  3. Morbid Obesity Definition • BMI > 40 • BMI ≥ 35 + at least 2 co-morbidities

  4. Metabolic syndrome www.doctorsweightsolutions.com

  5. Obesity Management Aim • Loose weight • Minimize complication • Improve self image • Improve quality of life

  6. Management – Approach • Dieticians • Physiotherapists • Clinical Psychologists/ Psychiatrists • Endocrinologists • Bariatric Surgeons Multidisciplinary

  7. Obesity Management Interventional bariatric procedures Drug therapy Lifestyle change

  8. Indication for Surgery

  9. Bariatric Surgery Options • predominantly Restrictive • BioEnterics Intragastric Balloon • Laparoscopic Adjustable Gastric Banding • Sleeve Gastrectomy • predominantly Malabsorptive • Biliopancreatic Diversion +/- Duodenal Switch • combination • Roux–en–Y Gastric Bypass • Gastric volume • gastric resection • non – gastric resection

  10. Bariatric Surgery Options predominantly Restrictive BioEnterics Intragastric Balloon Laparoscopic Adjustable Gastric Banding Sleeve Gastrectomy predominantly Malabsorptive Biliopancreatic Diversion +/- Duodenal Switch combination Roux–en–Y Gastric Bypass Diversion of GI content • diversion of food from duodenum • diversion of biliopancreatic secretions

  11. Intragastric Balloon • Restrictive procedure • Endoscopic placement • stomach volume • ↓ dietary intake • ↑ satiety • modify eating habit BioEnterics Intragastric Balloon • Doldi BS et.al, Intragastric balloon: 4-year experience. Obesity Surgery 2002;2:477 • W mui et. al, Intragastric Balloon in ethnic obese Chinese: • initial experience. Obesity Surgery 2006;16:308-313

  12. Intragastric Balloon Doldi et.al, Intragastric balloon in obese patients. Obese Surg 2000; 10: 578-81W mui et. al, Intragastric Balloon in ethnic obese Chinese: Initial experience. Obesity Surgery 2006;16:308-313

  13. Adjustable Gastric Banding • Restrictive procedure • Laparoscopic operation Lap-band system • most common procedure in Asia-Pacific

  14. Laparoscopic Adjustable Gastric Banding • Consensus Conference Statement: Bariatric surgery for morbid obesity: Health implications for patients, health professionals. H. Buchwald, J Am Coll Surg 2005; 200: 593-604 • Gastroenterology. Klein et.al. 2002; 123: 883-932

  15. Sleeve Gastrectomy • Restrictive procedure • Laparoscopic or open approach • Increasing popularity • 4th most common surgery in Asia-Pacific regions www.gastricsleevepatient.com

  16. Sleeve Gastrectomy Himpens J et al. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006; 16(11):1450-6

  17. Roux-en-Y Gastric Bypass • Restrictive + malabsorptive • Diversion of food passage • Gold standard procedure in USA • 2nd most common in Asia-Pacific region Roux -limb Common limb www.healthsystem.Virginia.edu Asia-Pacific Perspective 2005

  18. Roux-en-Y Gastric Bypass

  19. Other- Biliopancreatic Diversion • Predominantly malaborptive • Gastrectomy • Food passage diverted from duodenum • Mostly done in Europe 100-150ml 200cm 300-400cm ~ 60% SB 50-100cm from IC valve www.weightlosssurgery.com.au

  20. American Modification • Preserve pylorus • Normal food passage to duodenum

  21. Biliopancreatic Diversion +/- Duodenal Switch Consensus Conference Statement: Bariatric surgery for morbid obesity: Health implications for patients, health professionals. H. Buchwald, J Am Coll Surg 2005; 200: 593-604

  22. Comparisons • Efficacy in reducing weight • Effective in improving co-morbidities • Risks and complications

  23. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for • super-obese patients (BMI > or =50). L. Milone et.al, Obes Surg 2005; 15(5):612-7. • Bariatric Surgery. A systemic Review and meta-analysis. H. Buchwald et.al, JAMA 2004-Vol 292, No.14 • Meta-Analysis: Surgical Treatments of Obesity. M. Maggard et.al, Ann Intern Med 2005; 142: 547-59 • A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results • after 1 and 3 years. J. Himpens et.al, Obes Surg 2006; 16(11):1450-6.

  24. Co-morbidity Outcome • Effectiveness of Laparoscopic Sleeve Gastrectomy (First Stage of Biliopancreatic Diversion with Duodenal Switch) on • Co-Morbidities in Super-Obese High-Risk Patients. G. Silecchia et.al, Obes Surg • Bariatric Surgery. A systemic Review and meta-analysis. H. Buchwald et.al, JAMA 2004-Vol 292, No.14 • BioEnterics Intragastric Balloon: The Italian Experience with 2515 patients. A Genco et.al, Obes Surg 15, 1161-64

  25. Conclusions • Bariatric surgery is effective in weight reduction and resolving co-morbidities. • Needs careful patient selection to achieve optimal outcome. • Multidisciplinary approach is essential for successful treatment. • Treatments should be tailored to individual needs, as there are no universal protocols yet.

  26. Thank you 5-6 June 2008

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