Weight loss surgery safe & effective

Obesity Conquered! Dr. Abeezar I. Sarela MSc (Lon) MS (Bom) MD (Leeds) FRCS (Glasg) Consultant in Bariatric & Metabolic Surgery

What is Obesity? ,[object Object],[object Object],[object Object],[object Object]

What causes obesity? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Why all this fuss about obesity? ,[object Object],[object Object],[object Object],[object Object],[object Object]

Obesity causes life-threatening disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Obesity Impairs Quality of Life ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Do not ignore obesity! Chronic disease that needs scientifically-based medical treatment – like any other chronic disease

Taking control of obesity ,[object Object],[object Object],[object Object],[object Object]

How can the severely obese lose weight? Sjostrom L et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med 2007;357:741-52.

What are the aims of treatment? ,[object Object],[object Object],[object Object],[object Object]

Indications for weight loss surgery? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Story of Bariatric Surgery

Bariatrics (created circa 1965) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Jejuno-Ileal Bypass ,[object Object],[object Object],[object Object],[object Object]

Gastric Bypass ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vertical Banded Gastroplasty (VBG) 1970s

Biliopancreatic Diversion & Duodenal Switch Open Biliopancreatic Diversion Scopinaro, 1970s Biliopancreatic Diversion+ Duodenal Switch Open: Hess, 1986 Laparoscopic: Gagner, 2002

Magenstrasse & Mill Operation Prof David Johnston The General Infirmary at Leeds 1980s

Laparoscopic Sleeve Gastrectomy

Adjustable Gastric Banding Open- Kuzmak,1986 Laparoscopic - 2000

Bariatric Surgery Gold standard c. 1994 Laparoscopic Roux-en-Y gastric bypass Selected indications c. 2000 Laparoscopic sleeve gastrectomy Popular c. 1990 Laparoscopic adjustable gastric band Largely abandoned c. 1970 Vertical banded gastroplasty Currently performed c. 1960 Open gastric bypass Abandoned c. 1950 Jejuno-ileal bypass

Bariatric Surgery: What is the Evidence that it Works? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Long-Term Mortality After Gastric Bypass Surgery NEJM 2007;357:753-61

Bariatric Surgery: What is the Evidence that it Works? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Effects of Bariatric Surgery on Mortality in Swedish Obese Patients NEJM 2007;357:741-752

Bariatric Surgery: What is the Evidence that it Works? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bariatric Surgery. A Systematic Review and Meta-Analysis. JAMA 2004;292:1724-1737

Effects of Bariatric Surgery on Type 2 DM A Systematic Review and Meta-analysis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Buchwald et al. Am J Med 2009;122:248-256

“ I have got back my life after a bypass!” ,[object Object],[object Object],[object Object]

How does bariatric surgery work? ,[object Object],[object Object],[object Object],[object Object]

Components of Intestinal Bypass Procedures Goldfine et al Nature Med 2009;15:616

Murphy & Bloom Nature 2006;444:854 Gut Hormones

Anti-Incretins: The Effect of Duodenal Exclusion Rubino & Gagner Ann Surg 2002

Perioperative Safety in Bariatric Surgery ,[object Object],[object Object],[object Object],[object Object]

Obesity Surgery-Mortality Risk Score ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DeMaria et al. SOARD 2007 DeMaria et al. Ann Surg 2007 2.4-7.6% 4-5 C 3-5% 1.2-1.9% 2-3 B 48% 0.2-0.3% 0-1 A 46-49% Reported Mortality No. of factors Category

Incidence of Composite End-Point by OS-MRS Class A: 4% 229 patients Class B: 6% 137 patients Class C: 23% 15 patients One death 7% of OS-MRS C 0.3% of total

How to chose your surgeon? Questions you should ask? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

About your Surgeon Dr Abeezar I. Sarela ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Abeezar I. Sarela MSc MS MD FRCS Consultant in Bariatric & Metabolic Surgery e-mail: [email_address] Phone: 9004426263

Weight loss surgery safe & effective

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Weight loss surgery safe & effective

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