The Good Dr K's Blog on "Minimally Invasive WLS" - It's a good one

[DSRIGGS]

https://www.dssurgery.com/minimally-invasive-weight-loss-surgery/

Minimally Invasive Weight Loss Surgery
Posted On : May 17, 2016
Minimally Invasive does not mean better, easier, proven outcomes or good excess weight loss. Weight loss surgical patients should be careful of catch phrases such as “less invasive”, “simpler”, “shorter recovery”, “outpatient” and many others that had been used to described procedures with less than optimal outcome. We should not forget the lessons learned from adjustable gastric banding which was also promoted as ” less invasive, simpler to perform, and be done as an outpatient with a short recovery “. We all know how that story has panned out. The overwhelming majority of patients who had an adjustable gastric banding have undergone revision, had it removed or had additional surgeries following the complications which were associated with this simple procedure.

When evaluating outcome data for weight loss surgical procedures, it is important to bear in mind that the long-term success of these procedures will take years to document. More often than not the early weight loss is significantly better than the long-term stable weight loss. This has been clearly documented in the case of the adjustable gastric banding and the gastric bypass and laparoscopic sleeve gastrectomy operation. Duodenal switch , as described by Dr. Hess using the percentage based technique, has the best long-term documented success of all of the weight loss surgical procedures. The scientific data reports 20+ years of successful excess weight loss with a Hess Duodenal Switch procedure. There has been an alternative proposed to Duodenal Switch recently, the SIPS and SADI procedures. As I have already stated in the past, these are not the same as the duodenal switch operation. Any suggestion or innuendos that SIPS/SADI is the same as the Duodenal Switch is deceptive and misleading. We have also seen attempts to use the same catch phrases as described above to promote these on proven procedures. The published data that’s been reported with SIPS/SADI is mostly short-term in small population studies. There are no long-term studies that have documented the efficacy of the SIPS/SADI procedure and “simpler” or minimally invasive does not mean better.

 

[Larra]

So true! Yet so many patients are frightened of malabsorption, or don't want their intestines "rearranged", or have relatives who don't want them to have surgery at all (for supportive or not so supportive reasons) and convince them to have something quicker, simpler, supposedly lower risk, etc.
I also think there is still some element of denial with some patients, in that they have come to realize that they need help, but still minimize the amount of help they need and convince themselves that a lesser procedure will do the trick. For most people, it doesn't.
The latest thing I saw is a new device (I would say gadget myself) headed towards clinical trial where the patient swallows a pill that, once in the stomach, opens up into a ballon that stays in the stomach for about 4 months before it deflates and the patient poops it out. Yet another purely restrictive approach, and temporary at that. The proported advantages are that no surgery is involved, so lower risk and less cost that surgically placing a gastric balloon. But why anyone would expect the results to be any better is a mystery to me.

 

[DSRIGGS]

I hear you Larra. The DS, the malabsorptive part is the only thing that ever made sense to me but I guess I am different than the average Joe.

That balloon you poop out sounds potentially dangerous.

 

[Larra]

I don't know that it's dangerous. it's amazing what the human intestinal tract can propel downwards and outwards, and I would hope that, once deflated, this thing would be flat and thin enough to move right along. I just don't think it's going to work, and don't understand why anyone would think it would work.

 

[DSRIGGS]

I don't know that it's dangerous. it's amazing what the human intestinal tract can propel downwards and outwards, and I would hope that, once deflated, this thing would be flat and thin enough to move right along. I just don't think it's going to work, and don't understand why anyone would think it would work.

Completely agree with the "why would anyone think it would work" part and yeah I know the intestinal tract can pass some crazy things. I guess as things bulk up and pick up some mass it would easily push a rubbery substance along

 

[Spiky Bugger]

I don't know that it's dangerous. it's amazing what the human intestinal tract can propel downwards and outwards, and I would hope that, once deflated, this thing would be flat and thin enough to move right along. I just don't think it's going to work, and don't understand why anyone would think it would work.

Otoh...my BIL did the "pill cam" thing. They figured it died and found its way out. A year later, endoscopy photos revealed a round thing stuck in his intestines and the very visible words "Pill Cam." It had found a home.

 

[DSRIGGS]

Yikes!

 

[Larra]

@Spiky Bugger you and your kin never cease to amaze me. BIL can't even manage to poop a pill correctly.

It occurred to me later that they better have a system that doesn't allow the balloon to deploy in the esophagus. Hopefully they have considered that potential hazard and have some way to make sure the balloon inflates in the right place.

 

[Munchkin]

@Spiky Bugger you and your kin never cease to amaze me. BIL can't even manage to poop a pill correctly.

It occurred to me later that they better have a system that doesn't allow the balloon to deploy in the esophagus. Hopefully they have considered that potential hazard and have some way to make sure the balloon inflates in the right place.

I am guessing the cannula is visible on the fluoroscope and you could tell visually when you get to the right place? My personal little insurance policy on this would be to NOT connect the cannula to the gas/air/whatever till I knew I was in the stomach. And I bet something like this will be in the OR protocol. Or at least I hope so.