A Case of Bariatric Surgery Revision Reminds Surgeons to Be Suspicious When Congenital Anomalies are Present

| April 1, 2017

A Message from Dr. Raul J. Rosenthal

Raul J. Rosenthal, MD, FACS, FASMBS, Clinical Editor,
Bariatric Times; Chief of Staff, Professor of Surgery and Chairman, Department of General Surgery; Director of Minimally Invasive Surgery and The Bariatric and Metabolic Institute; General Surgery Residency Program Director; and Director, Fellowship in MIS and Bariatric Surgery, Cleveland Clinic Florida, Weston, Florida


Dear Friends and Readers of BT,
In this issue, we present an interview with Ninh T. Nguyen, MD, FACS, FASMBS, and Esteban Varela, MD, FACS, FASMBS, in which they provide a brief overview of the steadily growing field of metabolic surgery. This past year, our specialty celebrated what I consider to be one of the most important milestones when 48 societies worldwide endorsed bariatric surgery as the most efficacious treatment modality for metabolic syndrome. Kudos to Dr. Philip Schauer, who not only had the courage to change the name of “The American Society for Bariatric Surgery” to include the word “metabolic,” but also followed on his actions by encouraging guideline approval. Appreciation should also be expressed toward all of the individuals involved in metabolic surgery research, who were instrumental in guideline approvals.

Recently, final five-year data of the STAMPEDE (Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently) trial was published in New England Journal of Medicine.[1] I believe STAMPEDE is the number one study demonstrating efficacy and safety of surgical versus medical treatment of the metabolic syndrome. The trial shows that at 5 years, both Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy (LSG) are equally effective in controlling HbA1c. In my opinion, this is a significant finding. Based on these results, LSG should be considered as metabolic as RYGB with the advantage of having less short- and long-term morbidity and offering more options for re-interventions in those cases of weight regain or nonresponders.

In “The Medical Student Notebook,” Christopher Murray presents a nice review on why all physicians should undergo a comprehensive training in prevention and treatment of the obesity disease. To that end, the American Society of Metabolic and Bariatric Surgery (ASMBS) has been maximizing its efforts to gather other nonsurgical societies at Obesity Week and the Obesity Summit to have more interaction and collaboration in creating more awareness and education opportunities for all those physicians involved in obesity treatment.

Patel et al provide an update of a case previously reported in 2015 in which midgut malrotation was discovered during single anastomosis gastric bypass. After unsatisfactory weight loss results at two-year follow up, a revision procedure was planned. During the revision, the authors made a discovery that was missed in the original procedure—abnormally long bowel. Such a case represents a challenge not only for the patient, but also for the surgeon on call. Bowel length has been always a matter of discussion and a subject for litigation. Most bariatric surgeons do not run the whole small bowel when performing a standard gastric bypass. The latter can have detrimental consequences for those patients with short small bowel, causing diarrhea and malnutrition. When congenital anomalies are present, one should suspect other unusual anatomical variations, such as duplication and short bowel.

Drs. Mary Lisa Pories and Mary Ann Rose review the timely and delicate topic of stigma and empathy toward individuals with obesity. This topic has been handled at length by the ASMBS Integrated Health leadership and it is imperative that we all support their efforts and help educate all caregivers in our work place. Obesity is not a cosmetic problem but rather a disease, and as any other disease process, should not be utilized as a reason to discriminate.

I would like to conclude this editorial by congratulating ASMBS, Corrigan McBride, MD, FACS, FASMBS, and Ninh T. Nguyen, MD, FACS, FASMBS, for their outstanding work in developing and publishing the new bariatric fellowship training guidelines in Surgery for Obesity and Related Diseases. I believe this is the first curriculum for a module-based fellowship training program in surgery.
I hope you enjoy reading this issue as much as I did!

Sincerely,

Raul J. Rosenthal, MD, FACS, FASMBS

References
1.    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-Year Outcomes. N Engl J Med. 2017;376(7):641–651.
2.    McBride CL, Rosenthal RJ, Brethauer S, et al. Constructing a competency-based bariatric surgery fellowship training curriculum. Surg Obes Relat Dis. 2017;13(3):437–441.

Category: Editorial Message, Past Articles

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