The Numbers Are In: Sleeve Represents 51% of All Bariatric Procedures Performed in the U.S. in 2014

| July 1, 2015

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 Colleagues,
I’d like to start my editorial by congratulating Drs. Rory Pryor and Michel Gagner on the outstanding scientific program that they put together at the Obesity Weekend meeting in Las Vegas, Nevada. We had close to 560 attendees, nearly double the attendees of last year’s spring event in Miami, Florida. We are planning to hold this meeting  in Las Vegas again in hopes to repeat this year’s success.

Months ago, I asked Dr. John Morton, President of the American Society for Metabolic and Bariatric Surgery (ASMBS), to grant me some space during Obesity Weekend to organize a dedicated session on gastroparesis (GP). GP is probably the most devastating disease with which I am confronted on a daily basis and I consider it a metabolic one. We had close to 70 registrants attend the GP session, which, in my opinion, was a phenomenal program. We discussed medical, endoscopic, and surgical treatment modalities that ranged from gastric bypass and gastric sleeve to pyloroplasty for this disabled patient population. I returned home after listening to Dr. Matthew Bregman’s presentation on pyloroplasty and after 15 years of treating patients with GP, I decided to change my approach. We will repeat this session during Obesity Week 2015, November 2 to 7, 2015 in Los Angeles, California. I hope you will come and join us as we continue to embrace this disease into our society.

This month, we present another excellent issue of Bariatric Times. I really enjoyed reading this month’s installment of “The History of Bariatric Surgery,” a column edited by Drs. George Blackburn and Daniel Jones. Here, Dr. Henry Buchwald explains the evolution of the term “metabolic surgery.” I have always been under the impression that metabolic surgery is not new, and that we have been performing metabolic surgery for the last 50 years. As mentioned by Dr. Ed Mason, Theodore Billroth was probably the first metabolic and bariatric surgeon, although he perished without knowing it. In Ed Mason’s first publication on the effects of bariatric surgery, he commented on a large group of morbidly obese patients that underwent gastric bypass who saw their diabetes go into remission. The only change we have seen between then and now is the ability to better measure the hormonal and metabolic effects of our procedures. Terms like GLP-1, HbA1C, Farsenoid receptor, and ghrelin were non-existent in those days. I am sure you will enjoy reading this excellent contribution.

Dr. Natalia et al presents a case report and literature review on Guillain Barre’s Syndrome (GBS). GBS is a rare but devastating complication of Vitamin B12 deficiency in patients undergoing gastric bypass. I have been involved as an expert reviewer in a mortality case due to the lack of prevention and recognition of this terrible complication. A demyelinizing ascending neuropathy can result in paralysis and respiratory failure, requiring mechanical ventilatory support. As gastric bypass becomes less popular, I am certain we will see less of this complication.

Drs. Allison Barrett and Jonathan Klonsky present a case in which a patient experienced gastric band erosion into the colon and stomach. This case is certainly unusual but not unheard of when dealing with complications of implantable devices. I had a case of port site infection that was the result of the band catheter eroding into multiple loops of small bowel.

Also in this issue, we talk with Dr. David E. Cummings who is on the organizing committee for both the 3rd World Congress on Interventional Therapies for Type 2 Diabetes and the 2nd Diabetes Surgery Summit (DSS-2), September 28 to 30, 2015, London, United Kingdom. He discusses the path that led him to bariatric and metabolic research, including his role in the ghrelin studies. Dr. Cummings, who was involved in the first DSS, explains why he believes we need new guidelines for treating T2DM.

One of the highlights of Obesity Weekend was the session on State Chapters. ASMBS announced that we have finally reached 100 percent representation. All 50 states now have an ASMBS State Chapter. We should all be proud and also thankful for the outstanding work done by Chris Joyce, current Chair of the ASMBS State Chapter committee) and Lloyd Stengeman, Past Chair of the committee.

Dr. Morton and Dr. Jaime Ponce, ASMBS Past President, presented the latest statistics on bariatric procedures performed in the United States in 2014. As predicted, sleeve gastrectomy continues to gain in popularity representing 51 percent of all bariatric procedures followed by gastric bypass (27%), revisions (11.5%), bands (9.5%), and “other procedures” (.1%).

The trend of LSG and RYBP are not surprising to me. I was indeed surprised to see the number of so called “Mini Gastric Bypass” that were performed in the U.S. as well as the extremely low number (0.4%) of biliopancreatic diversion with duodenal switch (BPD/DS). I look forward to sharing more news about this topic in next month’s issue.

Wishing you all a great summer.
Best,
Raul J. Rosenthal, MD, FACS, FASMBS

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