Re-Do Bariatric SurgeryThursday, March 26, 2015
This week I am Co-Chairing and speaking at the 8. Annual Obesity Symposium hosted by the European Surgical Institute in Norderstedt, just outside of Hamburg, Germany.
As was pointed out, even in the best hands, 10 to 20% of patients undergoing bariatric surgery will “fail”, often prompting surgeons to reoperate.
As I write this post, I am watching live “re-do” surgery on a patient who had an open Mason vertical-banded gastroplasty in 1987 (remining us that bariatric surgery has been around far longer than many people think).
Listening to the surgeon (Dr. Bruno Dillemans, Bruges, Belgium) commenting on the operation, it is apparent (even to a non-surgeon like myself), that this kind of surgery can be most challenging.
With the vast increase in the number of patients undergoing bariatric surgery worldwide, it is easy to see that bariatric “re-do” surgery will pose a significant challenge down the road.
Thursday, March 26, 2015
Unfortunately I see so many patients who have had revisions making their RYGB more distal due to weight regain and desperation but these procedures not only are not successful in solving the patient’s problem but they leave patients in poor health due to such limited nutrient absorption. As physicians it’s past time that we stop trying to limit absorption and calories in and start understanding the science of metabolism and offer patients a science based approach. Hyperghrelinemia is a significant factor driving AGRP levels up and deactivating the MC4R. Further caloric limitations will only make the situation worse in the long run. We can and must do better for our patients.