Editorial Message—United States Food and Drug Administration Recommends Extending Gastric Band Use to Patients with Body Mass Index Between 30 and 35kg/m2

Dear Readers:

I have some great news to share with you as we finish the year 2010. The 10-member United States Food and Drug Administration (FDA) advisory committee voted overwhelmingly to recommend the agency grant the request from Allergan Inc. (Irvine, California) to market its Lap-Band device to individuals with a body mass index (BMI) between 30 and 35kg/m2 (Read the press release in this month’s News and Trends, page 28). This is an important indication for adjustable gastric banding. In my opinion, the most meaningful aspect of this decision is that an official United States agency has endorsed the surgical treatment of obesity and its associated medical conditions. I am not sure how medical insurance companies will react to this news, and I am hesitant to believe that the number of cases we perform will increase because of it. However, the fact that the FDA approves the “surgical treatment” of obesity at its early stage will relate to the public the outstanding success of surgery and the importance of treating the disease and preventing it from progressing. Kudos to the American Society for Metabolic and Bariatric Surgery (ASMBS) for this important milestone. For another perspective on this topic, read “Goodbye to the BMI,” a commentary by Walter Pories, MD, FACS, FASMBS, including an original cartoon, in our Letters to the Editor section, page 6.

I just returned from New York where I attended the 3rd International Consensus Summit for Sleeve Gastrectomy (ICSSG-3), organized Michel Gagner, MD. Close to 500 surgeons from around the globe gathered at the Crowne Plaza Hotel in Times Square, New York City, to discuss the implementation of only one surgical procedure—sleeve gastrectomy—as a treatment option for morbid obesity. This was an excellent meeting. In my opinion, the meeting showed that the indications and contraindications, techniques, and outcomes of sleeve gastrectomy are still not clearly defined. Considering that not all insurance companies have yet endorsed sleeve gastrectomy, the procedure is still rapidly gaining popularity worldwide, and I believe that in 2011 close to 40 percent of bariatric procedures will be sleeve gastrectomies.

This issue of Bariatric Times contains articles on several important topics. First, there is a letter to the editor highlighting early mobilization by Neff et al from Kennedy University Hospital, Stratford, New Jersey. In the letter, Neff et al share how their bariatric center encourages patients to move after surgery by introducing a contest of who can complete the most laps around the nursing floor. I like the idea of encouraging patients to compete as they did at Kennedy University Hospital, but unfortunately, due to Health Insurance Portability and Accountability Act (HIPAA) guidelines, we cannot post patient names on a board. My recipe for early ambulation is to do a routine gastrographin swallow on Postoperative Day 1. This definitely gets patients out of bed and moving around 24 hours after surgery, if for no other reason then to use the bathroom frequently!

In this issue of Bariatric Times, we also feature an article on deep vein thrombosis (DVT) prophylaxis and thromboembolism by my former fellow and good friend Amir Mehran, MD, Chief of Bariatric Surgery at University of California, Los Angeles (UCLA). If we could have a magic wand to make DVT and pulmonary embolism (PE) disappear, what a wonderful world this would be. I still give my patients unfractionated heparin every eight hours for the first 24 hours and switch them to low molecular once I see that there are no complications on the horizon. Since the only mortality we have experienced at our clinic in performing close to 5,000 cases in 11 years was a massive PE on Postoperative Day 3, I also routinely perform a duplex ultrasound of the lower extremities before discharging patients. I would estimate that I find one DVT in 1,000 duplex exams to be positive, and for me, these results are outstanding. He who saves a life, saves the world—I saved five lives!

Also in this issue, we debut our Clinical Nursing Education Series with “Rethinking Lift Teams” by Gallagher et al. This new series will feature articles on important topics, such as safe patient handling, privacy and sensitivity, and wound care considerations in the bariatric patient. Each article in the series will be continuing-education accredited as nursing credits.

As this year comes to an end, I would like to personally thank Robert Dougherty, Publisher of Bariatric Times, for giving me the privilege to edit this magnificent magazine. I also would like to highlight the terrific job done by Elizabeth Klumpp, Executive Editor, and Angela Hayes, Associate Editor. As we go international and digital, the New Year will include new and exciting sections. In 2011, readers will be introduced to special sections highlighting technical pearls in bariatric surgery, the bariatric checklist, and digitally, the Innovations Case Theatre. Stay tuned for details.

We all wish you a great finish to 2010 and a better start to 2011. Merry Christmas, Happy Kwanza, and Happy Chanukah. May God bless you, your families, and our patients in this New Year.

Sincerely,

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

Tags: Dr. Raul Rosenthal

Category: Editorial Message, Past Articles