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The paper points out tha an overview of the rapidly expanding field of bariatric surgery is littered with a wide variety of differing forms of weight loss operations and that many have had significant failures. The reivew of this esperience is designed to place these various opertions into perspective to try to gain insight into the similarities and differences of the operative approaches and use this analysis to guide future thinking about this area of surgical therapy.
The novel and attractive part of this review is the insight into the past experiences with various forms of baratric surgery and noting the similarities and differences of the various procedures and attempts to draw some conclusions from how differing "classes" of operations have faired and thus how future variations within a class of procedures may be expected to perform.
The paper uses past experience with bariatric procedures and their results to suggest implications for future choices of bariatric procedures.
The disussion paper is an insightful analysis of the fac that bariatric surgery is notable for :
A rapid rise in the number of operation performed
A wise variety of procedures performed
A classification system for all of the the opertions offered
A sobering exposition of the failures of certian operations
This ia a thoughtful review of the past experience with bariatric surgery and is notable for the insights that the author has pointed out and the fact that although these insights and difficult to seen form the published data on bariatric surgery few others have put forth similar analyses.
The paper is a brief thought piece and could easily be expanded.
This insight into the classification and faioures of bariatric surgery is critically needed. If as Dr Gagner has stated that the band is a failure and thousands have been subjected to this operation, then what does this mean to patients, referring physicians and bariatric surgerons.
Laparoscopic mini-gastric bypass: short-term single-institute experience. Piazza L, Ferrara F, Leanza S, Coco D, Sarvà S, Bellia A, Di Stefano C, Basile F, Biondi A. Updates Surg. 2011 Dec;63(4):239-42. Epub 2011 Nov 22. PMID: 22105765 [PubMed - indexed for MEDLINE] Related citations 2. Hospitalization before and after mini-gastric bypass surgery. Rutledge R. Int J Surg. 2007 Feb;5(1):35-40. Epub 2006 Aug 10. PMID: 17386913 [PubMed - indexed for MEDLINE] Related citations 3. Efficacy of estradiol topical patch in the treatment of symptoms of depression following mini-gastric bypass in women. Rutledge R, Dorghazi P, Peralgie C. Obes Surg. 2006 Sep;16(9):1221-6. PMID: 16989708 [PubMed - indexed for MEDLINE] Related citations 4. Revision of failed gastric banding to mini-gastric bypass. Rutledge R. Obes Surg. 2006 Apr;16(4):521-3. PMID: 16608620 [PubMed - indexed for MEDLINE] Related citations 5. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Rutledge R, Walsh TR. Obes Surg. 2005 Oct;15(9):1304-8. PMID: 16259892 [PubMed - indexed for MEDLINE] Related citations 6. One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity. García-Caballero M, Carbajo M. Nutr Hosp. 2004 Nov-Dec;19(6):372-5. PMID: 15672654 [PubMed - indexed for MEDLINE] Related citations 7. Similarity of Magenstrasse-and-Mill and Mini-Gastric bypass. Rutledge R. Obes Surg. 2003 Apr;13(2):318. No abstract available. PMID: 12740148 [PubMed - indexed for MEDLINE] Related citations 8. The mini-gastric bypass: experience with the first 1,274 cases. Rutledge R. Obes Surg. 2001 Jun;11(3):276-80. PMID: 11433900 [PubMed - indexed for MEDLINE] Related citations
The claims of the article are clear and well set out at the beginning of the article.
This article is pertinent to the current progress of Bariatric Surgery. Articles of this kind must be published periodically to keep upto date the current status and advances in such a fast growing speciality on the back of an obesity epidemic. This article is an overview of current status of Bariatric Surgery. Furthermore, it is clear from Kamal's article that Bariatric Surgery is an excellent example, where saftey profile of a risky procedure such as a gastric bypass transformed with the advent and application of laparoscopic approach.
I do not agree with the description of a LAGB as reversible. How many of the gastric bands are actually removed following weight loss? This is a myth and I believe LAGB is for life.
There is an increase in LSGs performed worldwide because it is 'perceived' as a safer operation. However the evidence supporting the success (weight loss, and amelioration of co-morbidities) is minimal. While this operation is ideal in selected patients, the meteoric rise of this operation doesn't come with adequate scientific evidence. The rise of MGB is similarly not justified and backed by evidence.
The section on future of Bariatric surgery is wanting more detail. Apart from gastric balloon, there is no mention of other endoscopic procedures, such as duodenal sleeve, POSE, gastric plication (both endoscopic and laparoscopic). Kamal quite rightly mentions that the search for a safer and effective option and evolving role of gut hormones is leading to innovation.
I thoroughly enjoyed reading the article written by an experienced and a thoughtful surgeon.
I am a practising Bariatric Surgeon
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