Archive September 2017 XVIII, No. 9

Time to Add Bariatric Surgery?

Weight-loss surgery can be your gain.

Bill Donahue

BIO

bariatric surgery GASTRIC SLEEVE It's estimated that 60% of U.S. bariatric patients opt for sleeve gastrectomy, 30% have gastric bypass and the remaining 10% choose from among other bariatric procedures.

Patients now have more surgical weight-loss options than ever: sleeve gastrectomy, laparoscopic gastric banding and intragastric balloon, as well as endoscopic gastric plication and stomach aspiration — all are considered safe and reliable outpatient bariatric procedures. Then there's gastric bypass, a major surgical procedure that reduces the size of the stomach and lets food bypass part of the small intestine. Although once considered inpatient only, this surgery has slowly made inroads into "avant-garde" outpatient settings, says Scott A. Cunneen, MD, FACS, FASMBS.

"Usually it's performed on lower-risk patients, with 23-hour outpatient monitoring or some other aftercare," says Dr. Cunneen, the director of metabolic and bariatric surgery at Cedars-Sinai Medical Center in Los Angeles, Calif. "It's primarily being done by people who are pushing the boundaries, and the patients tend to be young and relatively healthy."

The sleeve gastrectomy has become the figurative gold standard, according to Dimitrios Stefanidis, MD, PhD, the medical director of the bariatric program at Indiana University Health in Indianapolis. By his estimate, 60% of U.S. bariatric patients opt for sleeve gastrectomy; 30% have gastric bypass, and the remaining 10% choose from among the other bariatric procedures. The sleeve gastrectomy involves removing most of the stomach and shaping the remainder into a tubular pouch. He says patients like it because of its favorable safety profile as a means of predictable, long-term weight loss.

Intragastric balloon and endoscopic suturing also work well in the outpatient setting. Although these endoscopic procedures have less risk than surgery and often require only sedation, they are "still emerging" in the U.S. market, says Stacy Brethauer, MD, a bariatric surgeon with the Cleveland (Ohio) Clinic.

There's also stomach aspiration, a nonsurgical and reversible procedure that lets patients eat as they normally do and then lavage their stomach with saline to evacuate some of the stomach's contents through a port in the abdominal wall. One surgeon says the procedure could take off if patients can "get over the gross factor of flushing out the contents of their stomach, almost like medical bulimia."

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