Weight Loss Surgery News Blog

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A consensus statement on diabetes surgery is published online today in the Annals of Surgery. This appears the first statement towards a concenus of surgery for diabetes type 2.

At present, bariatric surgery is only available as a treatment for severe obesity, defined as having a body mass index (BMI) of 35 kg/m2 or more, according to National Institutes of Health (NIH) guidelines established in 1991. The DSS consensus statement acknowledges that the cutoff is arbitrary and not supported by scientific evidence, and recognizes the need to use more appropriate criteria for surgery in patients with diabetes.

The report illustrates the findings of the first international consensus conference -- Diabetes Surgery Summit (DSS) -- where an international group of more than 50 scientific and medical experts agreed on a set of evidence-based guidelines and definitions that are meant to guide the use and study of gastrointestinal surgery to treat type 2 diabetes. The document is considered to be the foundation of diabetes surgery as a medical discipline of its own.

In its position statement, the Diabetes Surgery Summit states: "Surgery should be considered for the treatment of type 2 diabetes" in patients with a BMI of 35 or more "who are inadequately controlled by lifestyle and medical therapy." The statement goes on to state that diabetes surgery may also be appropriate for treatment of people with type 2 diabetes and merely mild-to-moderate obesity (BMI 30-35). This goes beyond parameters established by the NIH for bariatric surgery in 1991, which reserved bariatric surgery for people with a BMI of 35 or more with an obesity-related condition, or a BMI of 40 or more with or without any obesity-related condition. These parameters are still adhered to by most insurance companies in determining coverage of the surgery.

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Obese patients with uncontrolled type 2 diabetes who were treated with an investigational endoscopic duodenal-jejunal bypass liner achieved near normalization of glycemic control in one week, as compared with a sham group. Implantation of the liner was also associated with reductions in fasting blood glucose levels and weight loss.

The EndoBarrier (GI Dynamics) is a non-surgical therapeutic device that is implanted in the gastrointestinal tract through an endoscopic outpatient procedure. It creates a barrier between food and the wall of the small intestine and thereby changes metabolic pathways by controlling how food moves through the digestive system.

In clinical studies conducted to date with the EndoBarrier, patients have experienced immediate resolution of type 2 diabetes while the EndoBarrier is implanted, and continued resolution of their diabetes after the device is removed, as well as the important benefit of weight loss.

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An ad in the November 15, 2009, edition of Parade magazine may be the opening salvo in a campaign to push adjustable gastric bands as a weight loss aid to help overweight type 2s dramatically improve their symptoms or even go into remission.

The ad for the LAP-BAND AP® System from Allergan, Inc., shows a pretty, overweight, young woman saying, "If I lost the weight, maybe I could improve, or even resolve, my type 2 diabetes." The ad text then discusses the product, which is a device that's placed around the upper part of the stomach and slowly inflated to create a sense of fullness that comes on faster and lasts longer than without the band.

By eating less, a patient fitted with the band can lose a large amount of weight without needing to resort to diets or sheer willpower. The benefit for type 2s is that dramatic weight loss often causes diabetic symptoms to lessen or even disappear

The band, which can be placed in an outpatient procedure, has an advantage over gastric bypass surgery in that it doesn't involve cutting and stapling. This means that the band can be removed relatively easily or adjusted post-procedure without intrusive surgery.

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A new device called “StomaphyX” gained FDA approval in 2007. The stomach stretches over the years and can gradually undo the benefits of the bariatric surgery. For those who may need a secondary gastric bypass surgery, this new procedure — which uses a device called StomaphyX — is noteworthy.

It is a tiny sewing machine lowered from the mouth to the stomach. Using an endoscope, the doctor can guide the StomaphyX to stitch together folds in the stomach, and again reduce the size of the stomach. There is no official certification for bariatric surgeons.

In 2007, 205,000 obese Americans underwent bariatric bypass surgery. The cost of bariatric surgery is in the $25,000 range with insurance covering none or some of the procedure and after care. Pre and post -care for bariatric patients requires assistance of a nutritionist, physiotherapist, gastroenterologist and psychologist.

Due to potential bleeding, infection, intestinal obstruction, hernias, nutritional deficiency and gallstones, to name a few complications, bariatric surgery can contain real risks. Less invasive alternatives reduces the risks and are being further developed and clinical trials are done in Brazil and other countries

NOTES, natural orifice translumenal endoscopic surgery, eliminates the need for a scalpel and reduces recovery time, as well as patient pain and infection.

A non-surgical option awaiting FDA approval is the Endo-Barrier. This might be of interest for the obese and as well those with diabetes, type 2. This gastrointestinal liner is inserted through the patient’s mouth and into the first two feet of the small intestine. The Endo-Barrier can be removed and may provide a safer alternative with more rapid recovery and lower costs by eliminating hospital stays. The Endo-Barrier prevents food from coming in contact with the wall of the intestine. This may have an effect on the patient’s uptake of both nutrients and calories. It may also have a metabolic effect similar to Roux-en-Y gastric bypass surgery.

Endo VX and Maestro are two devices that can block the vagus nerve to assist in dropping 20 to 30 percent of excess weight. The Maestro, similar to a pacemaker, sends tiny electrical signals to the nerve that regulates digestion in the stomach and pancreatic fluid release. These products are only used in clinical trials, and nine of these products will be available until 2010 id trials are positive.

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

A new type of abdominal surgery — natural orifice translumenal endoscopic surgery (or NOTES) — eliminates the need for a scalpel and reduces recovery time, as well as patient pain and infection.

For those patients of Americans who may need a secondary gastric bypass surgery, this new procedure — which uses a device called StomaphyX — is noteworthy because the transoral incisionless insertion has surgeons entering the body through the mouth, not anywhere in the abdomen.

Only a few doctors are experimenting with the Stomaphyx technique around the country. It was approved in March 2007 by the U.S. Food and Drug Administration, and physicians started training with the Stomaphyx device that fall. Research is being done to see if Stomaphyx can become a primary surgery in the future.

Laparoscopic Roux-en-Y Gastric Bypass Surgery, is the most common and proven successful procedure. All other procedures are not having the same proven results, do not have good track records, are not reversible or do have an higher risk of complications. Surgical procedures such as NOTES and Stomaphyx are still being analyzed and are not commonly performed.