Notes bariatrics 2
1 like323 views
This document discusses notes (natural orifice transluminal endoscopic surgery) bariatrics. It summarizes a study of 21 patients who underwent either transvaginal sleeve gastrectomy or transoral extraction of the remnant stomach. Key results include: - Average stomach volume extracted was 470cc. - Average OR time was shorter for TORE at 91 minutes compared to 135 minutes for transvaginal. - There were no post-operative complications. - Weight loss at 6 months and 1 year was identical to traditional laparoscopic sleeve gastrectomy. - Transvaginal and TORE approaches are concluded to be viable options for sleeve gastrectomy.
Notes bariatrics 2
- 1. Notes BariatricsGarth R Jacobsen, M.D.Surgical Program DirectorUCSD Center for the Future of SurgeryAssociate Residency Program DirectorUC San Diego Department of Surgery
- 2. Bias?Ethicon Honoraria: Speaking, Consulting, Research Grants, Fellowship SupportW.L. Gore: Honoraria: Speaking, Consulting, Writing, Fellowship SupportUSGI: Honoraria: Speaking, Consulting, Research Grants, ProctoringCovidien Honorarium: SpeakingLifeCell: Honorarium: ConsultingDavol: Honoraria, Speaking, ConsultingMTF: Honorarium, WritingNovus: Honorarium; Consulting
- 3. WHY NOTES ?POTENTIAL ADVANTAGES: Decreased risk of abdominal wall hernia
- 5. Decreased risk of infection/seroma
- 6. Better cosmesisMETHODS- 2 arms: 21 patientsTransvaginal sleeve gastrectomy with remnant extraction: 3 patients Transoral remnant extraction (TORE): 18 patients 14 women and 4 men
- 7. Patient Characteristics Mean age of patients: 49 years (range 29-63 yrs)Mean pre-operative BMI: 46.1 (range 33-60)
- 8. CO-MORBIDITIES* PSH significant for laparoscopic hysterectomy in 1 patient in the transvaginal series.
- 9. Standardized technique for trans-oral extraction (TORE)
- 11. RESULTS- Average volume of stomach extracted: 470cc (20 X 5 X 2.5 cm)Average OR time: Transvaginal series- 135 minutes TORE series- 91 minutes (transoral extraction- 12 min)
- 12. POST- OPERATIVE COURSE Average hospitalization: 2 days
- 13. Post-op complications: NONE
- 14. No sexual dysfunction
- 15. Follow-up ranges from 1 month -2.5 yearsWEIGHT LOSS NOTES cohort : 38 % at 6 months 54% at 1 year Identical to our traditional laparoscopic sleeve gastrectomy series
- 16. SUMMARY- Transvaginal sleeve gastrectomy is a safe approach- Transoral extraction of remnant stomach is feasible- Weight loss is not compromised when compared to conventional laparoscopic techniques
- 17. CONCLUSIONTransvaginal and Transoral Remnant Extraction (TORE) are viable options for sleeve gastrectomy This experience represents the first step towards a purely NOTES bariatric procedure
- 18. Primary Endoscopic TherapyGoal to build on utilization of durable anchorsNotes Gastric ClosureROSETarget anatomic and physiologic effectsRestrictive? Suppression of AppetiteTarget Obesity epidemic with a low risk procedure
- 20. PotentialFeasibility Pilot completed with encouraging resultsRevision of TechnologyFirst generation G-prox to small for commercial viabilityFollow up with a prospective trial in patients with BMI between 28 and 35Currently recruiting
- 21. ConclusionsThe first wide spread application of Natural Orifice Technology will be intralumenalThe platform offers a durable intralumenal anchorPrimary procedures may offer a solution to the obesity epidemic with minimal patient risk