Surgeons specializing in bariatric procedures shared the latest research on revision surgery, debated what makes the biggest difference in helping patients who regain weight and experience complications, and reviewed new techniques during a conference at Fresno Heart & Surgical Hospital on Oct. 21.  
 

“I think we’ll see half a million of these patients walking around in the U.S. – and that’s a lot,” said Dr. Michel Gagner, predicting a rise in the need for bariatric revision surgery. Gagner, one of the conference lecturers, was the inventor of the sleeve gastrectomy in which 85% of the stomach is permanently removed but intestines are left unaltered.

The two-day seminar at Fresno Heart & Surgical included lectures, demonstration of the latest in laparoscopic equipment, a simulation tissue lab and observation of a gastric bypass revision surgery done by Dr. Kelvin Higa, medical director of the hospital's Metabolic & Bariatric Surgery Program. Dr. Higa and Dr. Gagner were joined by guest lecturers Dr. Daniel Swartz, bariatric surgeon at Clovis Community Medical Center; Dr. Jaime Ponce, principal investigator for five FDA clinical studies in lap bands; and Dr. Eric DeMaria, a pioneer of the gastric banding procedure.

This year much of the discussion at the conference was about how to help patients who fall back into poor eating habits and stretch their stomachs to original size. Surgeons shared their results with various revision techniques.

“I find the worse the anatomy, it seems like the better the results,” said Dr. Higa, showing how patients who started out with larger stomach pouches had more favorable weight loss and additional weight loss the second time around. “There’s debate about whether it’s satiety or absorption that’s the issue in revisions,” he added, asking others if they found better results with reducing the stomach size or in reducing the intestine which reduces the amount of food that’s then absorbed into the body.

Surgeons in attendance said they saw differences in extraordinarily obese patients and those who had just crept up again over the 35 BMI, or body mass index, threshold for bariatric surgery.

“On patients with a BMI of more than 50, many surgeons do a sleeve gastrectomy rather than a gastric bypass,” said Dr. Gagner, “because that’s all insurance will pay for and that’s terrible. Many will end up with another duodenal switch eventually,” he added, referring to the procedure that bypasses a long section of the small intestine. A gastric bypass reduces the size of the stomach and also bypasses the top part of the intestine.

Many times discussion after lectures wasn’t about what techniques or methods to use, but whether additional surgery was even warranted when patients’ impulses around food weren’t well controlled.

“When someone has cancer or they’re smoking we don’t withdraw medical therapy from them because the cancer surgery doesn’t work the first time or because people can’t stop smoking,” Dr. Higa said.

During breaks in the lectures, Ethicon Endo-Surgery representatives demonstrated some of the company’s newest equipment for minimally invasive surgeries with laparoscopic instruments. Vendor representatives said there had been a waiting list to get into the conference because of Fresno Heart & Surgical Hospital’s program, the reputation of its surgeons and its ability to gather so many pioneers and world-renowned experts to participate in the bariatric conference.

Fresno Heart & Surgical is accredited as a Bariatric Center of Excellence by the American Society of Metabolic and Bariatric Surgeons and for three years in row has received HealthGrades’^® top 5-star rating for bariatric surgery. It also has received HealthGrades’ Outstanding Patient Experience Award for the past four years.
Erin Kennedy reported this story. She can be reached at MedWatchToday@CommunityMedical.org.