Two Gastric Balloon Products Get Approval in the United States: The Multidisciplinary Team Remains Important for This New Patient Population

| August 24, 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 Readers:
Welcome to the August issue of Bariatric Times.

In this issue, we present the 11th Annual Buyers Guide, which highlights products and services of many companies that have become an integral part of our specialty. Access the Buyers Guide via the BT APP or e-Edition to get the full interactive experience of easily linking directly to the company websites.

In this month’s “The History of Bariatric Surgery,” edited by Drs. George Blackburn and Daniel Jones, Dr. Mathias A.L. (“Mal” for short) Fobi discusses his contributions and perspectives of the field of bariatric surgery. Dr. Fobi spent his early career at King/Drew UCLA Medical Center in Los Angeles, California. I had the privilege to interview with Dr. Joseph Alexander in 1992 at King/Drew for a position as a surgical intern. Unfortunately, I did not qualify (bummer) and missed the opportunity to work near the great Mal Fobi. So, I decided to try my luck in New York and took a position as preliminary intern at Beth Israel New York /Mount Sinai Medical Center where I met those who would become my mentors in bariatric surgery: Drs. Peter Benotti, Michel Gagner, and Robert Greenstein. You will hear from them in future issues as well.

This month, we resume our column, “Anesthetic Aspects of Bariatric Surgery,” edited by Dr. Stephanie Jones. Dr. Vilma Ortiz presents an interesting case of a woman with severe obesity and associated comorbid conditions that required general anesthesia for a complex vaginal delivery.

In June’s issue, we featured an exclusive report and accompanying reader survey on a recent court case in the news. The case is of a patient who had a body mass index (BMI) above 40kg/m2 without comorbidity when referred for a weight loss surgery consultation. After completing a preoperative weight loss program, the patient’s BMI fell to below 40kg/m2. The BMI was also below 40kg/m2 on the day a Roux-en-Y gastric bypass (RYGB) procedure was performed. After the operation, the patient experienced multiple complications. In the end, the United States Federal Court ruled in favor of the patient. Here, we present the results of our survey separated in three parts: 1) bariatric surgeons based in the United States, 2) bariatric surgeons outside of the United States, and 3) members of integrated health both inside and outside the United States.

The survey results show that the standards for bariatric surgery are split between those who do and those who do not require preoperative weight loss. I personally do a one-week liquid protein diet, mainly because it has been my observation that preoperative weight loss helps in the following ways: 1) it reduces the patient’s liver size, 2) it helps to make the liver softer and, thus, easier to retract, and 3) it gives our patients a great jumpstart to losing weight. Thank you to everyone who took the time to participate in this survey. We hope to offer more opportunities for reader interaction and discussion in the future.

By the time you will read this, balloons will be flying all over the United States after the US Food and Drug Administration (FDA) approved two intragastric balloon systems within a one-week period (ReShape Integrated Dual Balloon System by ReShape Medical, San Clemente, California, and the ORBERA™ Managed Weight Loss System by Apollo Endosurgery, Austin, Texas). I am excited to see another treatment modality for the obesity disease. I hope that both companies understand that the treatment of severely obese subjects should be done through accredited bariatric and metabolic centers as these facilities have a good understanding of how to choose the best treatment modality for a patient’s needs. Accredited centers are also structured to provide better follow up, and, in many cases of unforeseen complications or conversions, these patients will end up in our clinics for salvage procedures regardless. If this new treatment modality is released to anyone capable of implanting or explanting an endoscopic balloon without a comprehensive team to support our patients, I believe that we will see similar results to other FDA approved devices that have fallen in favor.

Currently, I am booking my travel to visit beautiful Vienna, Austria, to attend the The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 20th World Congress conference. Vienna is one of my favorite cities in Europe. If you haven’t yet read The Third Man, by Graham Greene, I recommend it. It will give you a great overview of Austria. I cannot wait to try the Sachertorte (a certain kind of chocolate cake), a good apfelstrudel with sahne (apple strudel with ice cream). I also plan to visit the beautiful Vienna State Opera house, the National Theater, and Hofburg Palace, which is where the congress will take place. If you visit this wonderful city, don’t miss the famed Lipizzan Stallions performance at the Spanish Riding School near Hofburg Palace. These horses are born white and turn black or brown as they grow older. General Patton saved these stallions at the end of World War 2. Vienna has many areas for site seeing, but while there, don’t forget to attend the IFSO Congress—the scientific program is sure to be outstanding.

I’m looking forward to seeing many of you in Vienna.

Sincerely,
Raul J. Rosenthal, MD, FACS, FASMBS

 

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