Editorial Message: Laparoscopic sleeve gastrctomy “failure”— a “first step” to a second long-term final approach

| July 22, 2010

Dear Readers:

Welcome to the July 2010 issue of Bariatric Times. I hope that all who attended this year’s meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS), which took place June 21–26 in Las Vegas, Nevada, enjoyed the presentations and exhibits.

As in previous years, attendees were exposed to multiple new treatment modalities that are being developed by industry partners. To my knowledge, at least six new United States Food and Drug Administration (FDA) trials are getting ready to be launched between 2010 and 2011. I’ve seen balloons, sleeves, baskets, suturing scopes, and other devices that will be delivered with a laparoscope or endoscope. I look forward the availablity of these new devices and hope they will work on our patients.

Once again, I congratulate ASMBS Executive Director Georgeann Mallory, RD and her staff on the wonderful organization of the conference and wish ASMBS incoming president Bruce Wolfe a wonderful year in office.

This month’s issue of Bariatric Times begins with an article by Dr. Vasudevan on pregnancy in patients with obesity. Those readers who work with this patient population will enjoy reading it. It has been my observation that pregnancy more—than a problem—has become a trigger for obesity in our patient population. Much more work and attention should be devoted to preventing the development of obesity in the pregnant patient and encouraging behavior modification in the years that follow delivery when most women change their lifestyles.

Next, I would like to highlight Dr. Mehran’s article on laparoscopic sleeve gastrectomy (LSG) with interest and enthusiasm. I cannot agree more with him when it comes to informed consent. Patients need to know that LSG is not necessarily better, but different to the other well-established procedures. Patients also should be aware that, since LSG is still a new procedure, long-term outcomes and complication rates are still being studied. However, if I am to describe any clear advantage of LSG over biliopancreatic diversion-duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB), it is the significant lower incidence of short- and long-term morbidity and follow up. Having said that, if we assume that 30 percent of patients who undergo LSG will experience weight regain and require a second step approach, I still believe that we prevented that 70 percent of our patients from having a RYGB or DS, which I consider highly efficacious but at the same time a procedure that has a high incidence of morbidity. In these cases, I do not see the LSG as a failure but more as a “first step” to a second long-term final approach.

Finally, we have an article on preoperative weight loss by Ms. Goldenberg. Weight loss before bariatric surgery has been a matter of discussion and controversy for a long time in our bariatric conferences. It is a very efficacious tool used by some insurance companies to prevent patients from getting weight loss surgery. While I agree that no patient should get bariatric surgery without having first attempted nonsurgical weight loss, I am questioning why we should put our patients through  another “supervised diet” if we know that they have a 98-percent chance of failing by not being able to maintain the weight loss achieved. In my practice, all patients are started on a high-protein, low-fat and low-carb diet two weeks preoperatively. This is done to attempt to get shrink the liver to allow better visualization the gastroesophageal (GE) junction during surgery. However, I do not make weight loss an issue or requirement for my patients to have bariatric surgery.

I hope that you will enjoy reading this month’s issue of Bariatric Times as much as I did. Enjoy your summer!

Sincerely,

Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

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