Archive July 2017 XVIII, No. 7

Bullish on Bariatric Surgery

Could these 5 procedures revitalize weight-loss surgery?

Stacy Brethauer

Stacy Brethauer, MD


Stacy Brethauer, MD PLENTY OF OPTIONS Stacy Brethauer, MD, seen here performing a gastric bypass at the Cleveland Clinic, says less invasive weight-loss procedures bridge the gap between medical treatments and complex surgery.

The bariatric surgery boom? It's pretty much gone belly-up. Even as the nation's obesity problem continues to expand, surgical weight-loss procedures have remained flat. Over the past 4 years, annual case volumes have increased by just 5%, a barely perceptible rise. Surgeons perform about 200,000 weight-loss procedures each year — that's only 1% to 2% of obese patients who are eligible for surgery. But where some see a sagging market, others see a renaissance. The reason for their optimism? Their excitement over these 5 relatively new and promising treatment options.

1 Sleeve gastrectomy
This safe and effective laparoscopic procedure involves removing 80% of the stomach and turning it into a tubular banana-shaped pouch. The procedure does not involve intestinal bypass. After surgery, patients have very good hunger control, feel full after eating small portions and typically experience 80 to 100 pounds of weight loss within a year. Most patients keep the weight off long term, although some struggle with chronic progressive disease and will regain some weight over time.

Sleeve gastrectomy has evolved into today's most popular weight-loss surgery, mostly because patients easily understand the concept, the procedure has an excellent safety profile with very few long-term associated complications, and it results in predictable and relatively fast weight loss. The majority of patients who undergo sleeve gastrectomy want to manage their weight and metabolic disease, but the procedure can also prepare patients for other needed procedures. For that reason, it's a great bridge to additional treatment for patients who are too heavy to undergo, for example, large hernia repair or joint replacement surgery. It's also ideally suited for patients who are ineligible for gastric bypass due to prior surgery or other conditions that would make the bypass unsafe. With this procedure, surgeons have been able to help patients who otherwise wouldn't be able to effectively treat their obesity.

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