Weight Loss Surgery News Blog

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In gastric bypass surgery, the surgeon basically cut your small intestine in two and then hooks it back up again in such a way that it's much shorter than before. With the first section of your small intestine out of commission, food flows directly from your stomach to the middle of your small intestine. When less intestine is available to absorb food, less food is absorbed.

GI Dynamics, a medical company in Massachusetts, has invented an impermeable intestine liner. It looks like a long clear plastic stocking, and it's simply threaded through the patient's mouth down the stomach to the small intestine, where it lines the upper section (the same part that is bypassed in traditional surgery).

Results of a current clinical trial, released on September 28, 2008, show that patients fitted with an EndoBarrier lost about 30 pounds in 12 weeks, while controls lost only about 10 pounds. Not only that, but EndoBarrier patients with type 2 experienced lower blood sugar levels and/or reduced need for medication. This According to a GI Dynamics press release.

The EndoBarrier is not yet available to the public because it is still in clinical trials.

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In Mexico and Europe over the past two to three years, 98 patients have had the new weight-loss surgery, named Toga (for transoral gastroplasty).

On average, those who have passed the one-year mark have lost about 40 percent of their excess weight.

The operation resembled others done for weight loss, with one huge difference, no cutting. Instead, the surgeons passes the stapler down the throat and staples the stomach from the inside.

The procedure is part of a trend to make surgery less painful and invasive, to minimize risks and speed recovery. Many operations that once required big incisions are now performed through small slits, with cameras inserted to let surgeons see what they are doing on video screens. This might become the next step: using a natural opening to avoid cutting through the abdominal wall. Surgeons have used similar techniques to remove the appendix through the mouth, and the gallbladder through the vagina.

Bariatric operations typically work far better than diet, exercise or drugs, and they often cure diabetes and reduce the risk of dying from heart disease or cancer. But there is also a risk — albeit small, less than 1 percent at experienced centers — of dying from the surgery itself.

The idea behind Toga is to offer something safer and less invasive.
Other companies are also developing new devices and minimally invasive operations to cash in on America’s booming obesity epidemic, but Satiety is among the first to start testing its products in people.

Link: http://www.robertorizzi.com/obesity-surgery.htm

Gastric banding, a surgical procedure designed to combat obesity, appears to boost the risk for developing or exacerbating symptoms of gastro-esophageal reflux disease (GERD).

Experts concluded that gastric bypass may help reduce GERD, but gastric banding does not -- a finding patients may want to consider when choosing one form of weight-loss surgery over another.

The finding (published in The American Journal of Gastroenterology) stems from a review of research on the link between obesity and reflux. The gastric bypass procedure appears to be effective not only for weight loss, but also for the control of reflux symptoms. Most of the acid from the stomach is being partitioned away, so it doesn't have exposure to the esophagus.

With gastric banding (lap band), the problem is that a pocket is created where acid has the ability to fill from the remainder portion of the stomach. This acid can just sit there above the band, and make its way back up to the esophagus. This can cause reflux disease to develop, or make it worse than it had been if it was a problem before the procedure. The lap band (gastric banding) which involves the placement of a band to divide and reduce the size of the stomach, initially debuted in 1993. It has proven effective in helping patients feel satiated earlier, spurring weight loss. This reduction in weight did not immediately encourage GERD. In fact, in some cases, post-procedure weight loss appeared to moderately reduce some reflux disease symptoms. Sometimes the inserted gastric band seems to shift in place over time, leading to a reversal of any initial benefit and a gradual worsening of GERD symptoms.

Gastroesophageal reflux disease (GERD) occurs when a muscle at the end of the esophagus does not close properly, allowing irritating stomach contents to leak back into the esophagus. Symptoms include heartburn and acid indigestion.

The procedure known as Roux-en-Y gastric bypass -- which involves the creation of a small gastric pouch walled off from (or bypassing) the rest of the stomach and intestinal track -- consistently appeared to help patients shed pounds and eliminate or reduce GERD symptoms.

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Diabetes Surgery and New Interventional Treatments Offer New Hope to Patients With Type 2 Diabetes

The 1st World Congress on Interventional Therapies for Type 2 Diabetes will bring together leading experts in diabetes, endocrinology, surgery and public health to discuss the role of surgery and novel interventional therapies in the treatment of type 2 diabetes. The World Congress has been formed to address this emerging approach to diabetes and its implications for health care systems and patient care.

Led by Congress Director Dr. Francesco Rubino, surgeon-scientist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the Congress includes a faculty of more than 80 international leaders in endocrinology, surgery, and basic sciences, as well as public health specialists, insurers and top health authorities from the United States and worldwide. Dr. Rubino cited his reasons behind organizing the Congress this year, saying, "The epidemic growth of type 2 diabetes has created a race against time to find new approaches to treat and understand the disease. Diabetes surgery and other novel interventional techniques are not only a promising therapeutic option for selected patients with type 2 diabetes but also an unprecedented opportunity to shed light on the origin of the disease. To ensure a timely, scientific and safe development of this emerging discipline it is necessary to balance enthusiasm with caution. This is possible only with the immediate attention and responsible, urgent actions from the global diabetes community."

A growing body of evidence shows that bariatric surgery can improve type 2 diabetes, often resulting in normalization of blood glucose levels, discontinuation of diabetes-related medications, and reduction of diabetes-specific mortality. Experimental studies show that surgical control of type 2 diabetes is not only a secondary effect of weight loss, but also occurs as a consequence of the re-arrangement of gastrointestinal anatomy and the resulting hormonal changes. Not surprisingly, the interest for diabetes surgery is growing both in the scientific community and among the public at large.

As with any medical innovation, however, there are both opportunities and challenges. Although animal studies and early reports from clinical trials suggest that mildly obese or overweight patients with diabetes might benefit from diabetes surgery, long-term data in these patients are still limited and more studies are necessary to identify the ideal candidates. In spite of the limited evidence, diabetes surgery is already being utilized throughout the world, even in non-obese patients. "Implementation of widely accepted, international recommendations to avoid an inappropriate use of surgery and ensure respect of safety standards has become top priority," says Dr Rubino.

Despite the increasing evidence that bariatric surgery achieves long-term control of type 2 diabetes in patients who are severely obese (BMI over 35), only a few of these patients actually have access to this type of treatment. "While these procedures may be life-saving, less than 2 percent of those patients already eligible under current NIH recommendations are offered a surgical option in the U.S.," says Dr. Philip Schauer, past president of the American Society for Metabolic and Bariatric Surgery, Congress faculty member and surgeon at Cleveland Clinic. "This may be because of limited awareness among primary care physicians, surgeons and diabetes specialists, and insufficient insurance coverage."

Last year an International Consensus Conference (Diabetes Surgery Summit) was held in Rome, Italy, where international scientific authorities established a set of recommendations and called for a multidisciplinary effort to prioritize research in this emerging field.

To continue the multidisciplinary dialogue and translate scientific findings into policy changes, the 1st World Congress will bring together, for the first time, clinicians, scientists and policy makers. Together, they will craft an agenda of health policy initiatives in order to ensure access to approved treatments and prioritize further research in this field.

The Congress has received endorsements from the International Diabetes Federation (IDF) through its Taskforce on Epidemiology and Prevention, the European Association for the Study of Diabetes (EASD), the American Association of Clinical Endocrinologists (AACE), Diabetes-U.K., the American Society for Metabolic and Bariatric Surgery (ASMBS), the International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO) and many other prestigious organizations from Latin America, Europe, Asia and the United States.

"It is very timely and appropriate that major scientific organizations start to carefully evaluate available evidence and to encourage initiatives such as the World Congress that promote a rigorous, multidisciplinary approach to this field," says Professor Sir George Alberti, diabetologist at the Imperial College in London, U.K., and Congress faculty member. "There are opportunities and risks that cannot be ignored, and both need to be adequately addressed."

The emerging field of diabetes surgery is receiving increasing attention worldwide not only for its clinical implications but also for bringing about an entirely new way to look at diabetes. Dr. David Cummings, endocrinologist at the University of Washington and Congress faculty member, states, "The insights already beginning to be gained by studying surgical interventions may be the most profound since the discovery of insulin."

"Surgery has arrived like a comet across the firmament of diabetes and obesity — unexpected, brilliant, with great promise for the future. Teams of talented researchers are moving ahead to define the role of surgery in the treatment of both of these scourges," says Dr. Jesse Roth, Congress faculty member, researcher, and diabetologist at the Feinstein Institute for Medical Research and the Albert Einstein College of Medicine of Yeshiva University in New York.

Diabetes surgery might also be a way to reduce health care spending across private and public health sectors. At the 1st World Congress, cost-effectiveness analysis and public health implications of diabetes surgery will be discussed for the first time with policy makers and top health authorities from the U.S., U.K. and worldwide.

"Diabetes is growing at epidemic rates worldwide and places a severe burden on the economy and society," says Dr. Paul Zimmet, Congress faculty member, diabetologist and director emeritus and director of International Research, Baker IDI Heart and Diabetes Institute in Melbourne, Australia. "However, issues may be very different in developed versus developing regions of the world. Organizing a World Congress to discuss the potential role of an emerging and yet-controversial approach to diabetes is very appropriate, and there are both global and regional perspectives that must be considered."

Diabetes affects an estimated 24 million Americans and 246 million people worldwide, a number that is expected to grow to 380 million by 2025. According to the American Diabetes Association (ADA), the disease could lower the average life expectancy of Americans for the first time in more than a century. Costs to treat diabetes are skyrocketing as well. According to a recent study commissioned by the ADA, diabetes costs Americans $174 billion annually, an increase of 32 percent since 2002. Health experts predict that one of every three children born after the year 2000 will have diabetes in their lifetime. In some communities like New York City, that number is one of every two in certain ethnic groups. Even with good medical management, diabetes often leads to cardiovascular disease, kidney failure, and premature death.

THE 1ST WORLD CONGRESS ON INTERVENTIONAL THERAPIES FOR TYPE 2 DIABETES
The 1st World Congress on Interventional Therapies for Type 2 Diabetes is a comprehensive and multidisciplinary forum where leaders in the global health community will conduct an organized review and discussion of the latest scientific data and theories on the use of bariatric surgery for the treatment of type 2 diabetes. The Congress, hosted by Weill Cornell Medical College and NewYork-Presbyterian Hospital, aims to create a forum for the medical community to work with health policy makers, including top public health authorities and insurers from the U.S. and around the world. The overarching aim is to craft an agenda of health policy initiatives to seize the opportunity offered by gastrointestinal surgery and novel interventional therapies for the understanding and treatment of diabetes. For more information, visit www.interventionaldiabetology.org.

NEWYORK-PRESBYTERIAN HOSPITAL/WEILL CORNELL MEDICAL CENTER
NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and Weill Cornell Medical College, the medical school of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, education, research and community service. Weill Cornell physician-scientists have been responsible for many medical advances — from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial for gene therapy for Parkinson's disease, the first indication of bone marrow's critical role in tumor growth, and, most recently, the world's first successful use of deep brain stimulation to treat a minimally-conscious brain-injured patient. NewYork-Presbyterian, which is ranked sixth on the U.S.News & World Report list of top hospitals, also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian Hospital/The Allen Pavilion. Weill Cornell Medical College is the first U.S. medical college to offer a medical degree overseas and maintains a strong global presence in Austria, Brazil, Haiti, Tanzania, Turkey and Qatar. For more information, visit www.nyp.org and www.med.cornell.edu.

The 1st World Congress will be held on September 15-16, 2008, at the New York Marriot Marquis in Times Square. To register for the Congress and for more information, visit http://www.interventionaldiabetology.org.

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Five-star (top-rated) hospitals performed almost twice the volume of procedures compared with one-star and three-star facilities -- an average of 526 procedures from 2004 through 2006, compared with 266 and 283 respectively.

Weight-loss surgery patients treated at highly rated hospitals have, on average, a 65% lower chance of experiencing serious complications compared with patients who undergo surgery at poorly rated hospitals, according to a study released today by HealthGrades, a leading independent health care ratings organization.

Higher volume was associated with fewer risk-adjusted complications. Facilities with an annual case volume of 125 procedures or more had the lowest risk-adjusted complications. Facilities performing less than 25 cases per year had the highest rate of risk-adjusted complications.

The challenge is that more and more surgeons and hospitals are looking at completing bariatric surgery, and they don't necessarily have the experience. Ideally you will see the current good hospitals growing in volume, as more low-volume providers could produce more complications.

If all patients had received their bariatric surgery procedure at five-star hospitals (from 2004 through 2006), 5,125 in-hospital complications could have been potentially avoided in the 17 states studied.

The highest-risk patients need to find the best possible provider. The American Society for Metabolic and Bariatric Surgery requires its members to have operated as the principal surgeon in a minimum of 25 procedures in a two-year period.

HealthGrades Bariatric Surgery Ratings
HealthGrades' quality ratings for bariatric surgery at individual hospitals in 17 states were posted today. Each hospital receives a star rating on the basis of its patient outcomes for bariatric surgery. Hospitals with above-average outcomes receive a five-star rating (93 hospitals). Hospitals with average outcomes receive a three-star rating (263 hospitals), and hospitals with outcomes that are below average receive a one-star rating (99 hospitals).

The study included a total of 154,451 bariatric inpatient surgery procedures performed in 680 hospitals in 17 states from 2004 through 2006. The majority of procedures were performed in four states: New York, Texas, Pennsylvania and California, and the five-star hospitals in those states represented in the top 10% in the country are shown in the table below.

Individuals who are contemplating bariatric surgery will find both quality and cost information at Healthgrades.com. In addition to the free hospital-quality ratings, Web site visitors can also research surgeons who perform bariatric surgery, as well as reports that detail all of the costs, including out-of-pocket expenses, for the procedure.

The HealthGrades study found a significant shift toward laparoscopic bariatric procedures. From 2004 through 2006, open gastric bypass procedures declined by 82%; during the same time period, laparoscopic procedures increased more than fivefold.

The total volume of bariatric surgical procedures in the U.S. continues to grow rapidly. The American Society for Bariatric Surgery estimates that such surgeries have increased 1,431% in the last decade, to more than 250,000 annually.

The study found that the complication rate for these surgeries continues to rise, increasing 6% from 2004 to 2006. One possible reason: Lower-volume facilities have higher complication rates.

Importance of Ratings
A typical patient having a bariatric surgical procedure at a five-star-rated hospital in one of the 17 states studied has, on average, a 65% lower chance of experiencing one or more in-hospital complications than at a one-star-rated hospital, and a 41% lower chance than at a three-star-rated hospital during 2004 to 2006.

Gastric bypass surgery patients accounted for the highest rise in complications, increasing 17%. Complications from less-invasive laparoscopic surgery increased by just more than 1%. Complications associated with bariatric surgery include heart attack, kidney failure, stroke and post-surgical infections.

Laparoscopy lowers complications, especially around the time of the surgery. With open bypass surgery you can do more complicated procedures. But laparoscopy isn't the best option for all patients -- a surgeon will help figure out which are the best options for each patient.