P Sahle Griffith MBBS MRCS DM FCCS Medical Director Surgical Solutions Inc Barbados Minimally Invasive Surgery Consultant QEH Barbados Associate Lecturer UWI CaveHill Disclosures ID: 1039214
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1. History of Obesity SurgeryP. Sahle Griffith MBBS, MRCS, DM, FCCSMedical Director, Surgical Solutions Inc., BarbadosMinimally Invasive Surgery Consultant, QEH, BarbadosAssociate Lecturer, UWI (CaveHill)
2. DisclosuresNone
3. “If I have seen further than others, it is by standing upon the shoulders of Giants”Sir Isaac Newton
4.
5. We can all agree that current surgical practice was molded by the exploits of the past
6. It all began with Malabsorption?
7. Jejuno-Ileal BypassThe first operation designed solely for the purpose of weight lossInitially reported by AJ Kremen and colleagues at the University of Minnesota in 1954
8. How does it Work?Induced a state of malabsorption by bypassing most of the intestines while keeping the stomach intactWeight loss with the JIB was good
9. DisadvantagesDiarrhea Night blindness (from vitamin A deficiency)Osteoporosis (from vitamin D deficiency)Protein-calorie malnutrition
10. Disadvantages (cont’d)kidney stonestoxic overgrowth of bacteria in the bypassed intestine - liver failure, - severe arthritis, - skin problems - flu-like symptoms
11. The LegacyJIB is no longer a recommended bariatric surgical procedureHighlighted the dangers of a permanent, severe and global malabsorption
12. The Gastric BypassDr. Edward Mason and Dr. Chikashi Ito from University of Iowa reported the first first bariatric Roux-en-Y Gastric Bypass in 1967
13. LegacyModified from original many timesFirst laparoscopic series reported in 1994 by Drs. Wittgrove and Clark Now the Gold standard bariatric procedure
14. Bilio-Pancreatic DiversionScopinaro published his first experience with his BPD in 1979Designed to be a safer malabsorptive alternative to the JIB
15. Duodenal switchfirst reported by Dr. Doug Hess in 1986Reduced Marginal ulcerationIncreased RestrictionGagner performed the first laparoscopic DS in the world and published his experience in 2000
16. BPD/DSControlled malabsorption without many of the potential side effects caused by bacterial overgrowth associated with the JIBThese procedures have some of the highest reported weight loss in long-term studiesSignificant steatorrheaHighest rate of nutritional complications
17. LegacyThese operations are EXTREMELY technically challenging to performHence Not widely adoptedLed to the development of the Laparoscopic Sleeve Gastrectomy
18. Mini Gastric BypassRutledge developed MGB in 1997Represents an attempt to make Gastric Bypass saferHas not been widely adopted
19. A little restriction please
20. Jaw Wiring
21. Vertical Banded GastroplastySearch for a restrictive procedure as effective as gastric bypass but with less adverse effects and complications led Mason to develop gastroplastyMason reported his experience in 1982
22. LegacyProblems with bandTedious, technically difficult reversalsNo longer performed
23. Adjustable Gastric BandingKuzmak first reported adjustable gastric banding in 1990Currently the most commonly performed bariatric operation globallyDismal results reported by many in the long term
24. Magenstrasse and Mill ProcedureReported by Johnston et al in 2003attempted to overcome several of the problems associated with VBG and AGBunsatisfactory weight loss
25. LegacyLargely replaced by the Laparoscopic Sleeve Gastrectomy
26. Current Bariatric ProceduresLSGGastric BandingGastric BypassBPD/DS
27. Thank You