Laparoscopic Adjustable Banding Was, Is, and Should Stay a Valid Treatment Modality for Those Who Suffer from Obesity

Dear Readers,

In this issue, we are pleased to present the 8th Annual Bariatric Times Buyers Guide. We thank each of the industry partners for their support and committement to help us fight the obesity pandemic and take care of those whose lives are affected by it.
Richard Kirkner summarizes for us the 2012 Minimmally Invasive Surgery Symposium (MISS)  that took place last February in Salt Lake City, Utah. As you will read from the synopsis, this meeting has become a must members of the American Society for Metabolic and Bariatric Surgery (ASMBS) to attend. We congratulate Dr. Phil Schauer, founder of MISS, for his vision and success in this 12th annual meeting.

In my editorial message last month, I discussed the United States Food and Drug Administration (FDA) approval of the weight loss medication lorcaserin, which will be commercialized by Arena Pharmaceuticals (San Diego, California) and Eisai Inc. (Woodcliff Lake, New Jersey) under the brand name Belviq. In this issue of Bariatric Times, we are lucky to have an article on two weight loss medications recently approved by the FDA, lorcaserin and phentermine/extended-release topiramate (Qsymia, Vivus, Inc., Mountain View, California). Author Dr. Craig Primack briefly reviews the drugs histories (primarily focusing on locaserin) and discusses their mechanisms of action and potential roles in treating severe obesity.

Dr. Silvia Leite Faria presents a meta-analysis on the importance of nutritional aspects when managing patients who wish to undergo plastic surgery after rapid weight loss. This is certainly a crucial moment in the lives of our patients. Once the obesity resolves and the medical conditions disappear, it is imperative for our patients to reach the next level and reconstruct their body after all the damage made by the obesity disease.

Dr. Jaime Ponce, newly inducted ASMBS President, has been very kind to take the time to answer some critical questions that were posed by members of the Bariatric Times Editorial Advisory Board. In this interview, he addresses questions on the adjustable gastric banding, psychology, medical tourism, and the future of the ASMBS.

I wholeheartedly agree with Dr. Ponce that laparoscopic adjustable gastric banding (LAGB) was, is, and should stay a valid treatment modality for those who suffer from obesity. Nevertheless, if something has to change to keep this procedure alive, that is our role in identifying who is a candidate for it and who is not. With a combination of weight loss medications, I am certain that the patient population with lower body mass indices (BMIs) will certainly be the right target for LAGB.

I would like to call your attention to something that I learned in the last two years, which has become a very important subject in our daily practice: Do not underestimate a patient who expresses fear of death. At Cleveland Clinic Florida, Weston, Florida, having performed close to 5,000 cases, we lost two lives in the perioperative period. Both deaths were due to massive pulmonary embolisms and both patients had expressed a fear of death before surgery. I remember having the privilege to review a paper (Dr. Ninh Nguyen was the senior author) years ago describing a patient’s fear of death” when developing an obstructing hematoma at the level of the jejuno-jejunostomy. At that time, I felt that it was a ridiculous and nonscientific observation. I rejected the paper. I still felt that way about the topic until recently, when I had a patient, who was postoperative Day 3 after conversion of laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y gastric bypass (RYGB), become tachycardic with a soft abdomen and express a “fear of death.” On re-laparoscopy we found a large obstructing hematoma at the level of the jejuno-jejunostomy. I remembered Dr. Nguyen’s paper at that time and I now take the opportunity to express my apology for my recommendation to reject. What remains a conundrum to all of us is why this perception of dying when a PE or an obstructing hematoma? In summary, never underestimate a patient’s fear.

For those of you who are lovers of the ecology, I feel compelled to let you know that I am a big supporter of a more ecologic friendly approach to life and our environment. Bariatric Times remains conscientious of the problems generated with non-recyclable products and the creation of garbage. We are proud to present an ecologic oriented magazine that is printed on partially recycled paper using soy ink. The plastic our print journals are delivered in are 100 percent recyclable. We also offer all contents of our journal in digital formats (also compatible with smart phones and tablets) and promote our BT APP, available in the Apple App Store and Android Marketplace.

I hope you will continue to value and support our efforts to be a “green” publication.

Sincerely,

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

Tags: Dr. Raul Rosenthal

Category: Editorial Message, Past Articles