Letter to the Editor: A Response to “Are We Missing Another Opportunity?”

| November 1, 2023

by Edward H. Phillips, MD, FACS

Dr. Phillips is Professor of Surgery; Vice Chair, Department of Surgery; Chair Holder, Dolly Parton Chair in Surgical Innovation, Cedars Sinai Medical Center in Los Angeles, California.

Funding: No funding was provided for this article.

Disclosures: The author has no conflicts of interest relevant to the contents of this article.

Bariatric Times. 2023;20(7–12):35.

I think that 10 years ago I would have been 100-percent behind the main points in this commentary. Then, I was involved in a lot of endoscopic procedures, such as transoral incisionless fundoplication (TIF), endobarrier, overstitch, and balloons; none of them work. I was trained on endoscopic sleeves and kept thinking to myself, how can I ethically let myself do this procedure? It won’t be durable and will have complications, and I can just do a laparoscopic or robotic sleeve. I think it is important to be an endoscopist as a gastrointestinal surgeon and especially as a bariatric surgeon, but in analyzing new treatments, it is critical to remember that each new modality is just another tool in our ever-increasing toolbox. We, as surgeons, have to analyze the risk-benefit ratio and pick the right procedures for our patients; not often will it be the endoscopic approach if there is a surgical option. 

I remember when they started doing transvaginal choles. Dr. Marc Bessler presented his case series at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) or American College of Surgeons (ACS) meeting, and because no one wants to be the bad guy, there was not a single question. However, we must question why, to what benefit, and to what end? Patient safety and outcomes come first.

See the original commentary titled “Are We Missing Another Opportunity?” by Adam B. Smith, DO, DFACOS, FASMBS, and Robert G. Snow, DO, FACOS, FASMBS here.

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Category: Current Issue, Letters to the Editor

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