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Bariatric Surgery Moves into the Mainstream for Obesity Control

Posted Jan 18 2010 12:00am

Weight loss surgery, also known as bariatric surgery, is rapidly transforming itself from a procedure scorned by mainstream medicine to a common procedure deemed to be effective for weight control. For some operated patients, it may also provide a cure for diseases like adult-onset diabetes (see: "Curing" Diabetes with Bariatric Surgery). This more positive view should probably not come as a surprise given our current epidemic of obesity that provides a stream of candidates for the operation and our growing familiarity with this type of intervention. A recent article in the LA Times provided a comprehensive description of bariatric surgery with a glimpse at how a new device may provide a new option for patients (see: Weight-loss surgery may soon be widely used). Below is an excerpt from it:

Advancements in procedures that are usually a last resort for the obese are making them potentially suitable for moderately overweight and diabetic people....Usually reserved for the most obese people, weight-loss surgery is unlikely to be a last-ditch option much longer. Technological advancements are turning it into a one-hour, incisionless procedure -- making it more attractive to moderately overweight adults...; overweight and obese teenagers; and normal-weight people with difficult-to-control diabetes. Several new procedures are already in human clinical trials....Many studies already attest to the effectiveness and increasing safety of the most popular weight-loss surgeries among morbidly obese people. Depending on the type of surgery used, patients lose 50% or more of their excess body weight and maintain that loss for as long as 10 years after surgery. In comparison, the most recent studies on long-term use of weight-loss medications show a typical weight loss of 5 to 22 pounds over one year with some side effects. Other research has found that bariatric surgery cures Type 2 diabetes in a majority of patients studied, as well as improving symptoms related to sleep apnea and heart disease, such as high cholesterol and blood pressure....The improvements in traditional bariatric surgery, combined with patient interest, have led to a surge in investigational new procedures, as well as discussions on whether more people could benefit from surgery....Furthest along in clinical trials is a noninvasive technique called TOGA, or transoral gastroplasty. In the procedure, a surgeon inserts a flexible tube through the mouth into the stomach and then uses staples to create a pouch that limits the amount of food that can be consumed....A previous small study showed that patients lost an average of almost 25 pounds after three months with no major complications reported. Long-term data aren't yet available.

I have posted a previous note about the LAP-BAND bariatric procedure (see: "Curing" Diabetes with Bariatric Surgery). It seems logical that new procedures such as TOGA are now being developed for weight loss (see: First U.S. incision-free procedure for obesity performed at Washington University). However, I do need to take issue with the author of the article quoted above who calls TOGA  "non-invasive" and describes it in the following way: a flexible tube [is inserted] through the mouth into the stomach and staples [are then  used] to create a pouch that limits the amount of food that can be consumed. Any procedure that limits the capacity of the stomach will have major metabolic consequences for a patient so that the post-operative management of such patients becomes critical. Obviously, the TOGA procedure is still in its early stages of development and it may eventually have distinct advantages over the LAP-BAND. However, only a small key-hole incision is required to install the the latter device and it has proved to be generally safe in the hands of experienced practitioners

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