This post is part of ongoing coverage of Cleveland Clinic’s 2013 Medical Innovation Summit: Finding Balance through Innovation. Obesity, Diabetes & the Metabolic Crisis.
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Bariatric surgery has been a hot topic, offering a spectrum of benefits, especially for patients with diabetes. In addition to hearing about weight loss surgeries, Medical Innovation Summit attendees watched a live bariatric surgery via a screen miles away from the operating room.
While Philip Schauer, MD, Director of the Cleveland Clinic Bariatric and Metabolic Institute, narrated, Stacy Brethauer, MD, bariatric surgeon, performed a laparoscopic sleeve gastrectomy on a female patient with a BMI of 45, and Tomasz Rogula, MD, bariatric surgeon, performed a robotic gastric bypass on a 40-year-old male patient with metabolic syndrome.
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Gastric bypass surgeries account for about 55 percent of all bariatric surgeries performed today in the United States and worldwide, Dr. Schauer said.
Robotic surgery offers benefits, adds costs
Dr. Rogula, who has performed about 100 robotic procedures, said although the use of robotics makes the surgery more “technically challenging,” there are advantages, too.
Based on data from more than 2,000 surgeries, Dr. Rogula said, robotic surgeries show a lower incidence of post-surgical leakage. However, even with traditional surgery, the chance of leakage after a gastrectomy is still very low (less than 1 percent), he added.
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While the robotic surgical procedure affords the surgeon three-dimensional viewing of the patient’s abdominal cavity, it isn’t faster or cheaper than traditional surgery.
“I’d love to say that using a robot is quicker, but (robotic surgery) actually requires some additional setup, and that adds some cost,” Dr. Schauer said.
Dramatic changes in anatomy, diabetes control
During a laparoscopic sleeve gastrectomy, the surgeon uses a stapler to create a “banana-shaped” stomach, taking care not to make the stomach too small, which could result in an obstruction, Dr. Schauer explained.
The procedure reduces the volume of the stomach “from about the size of an NFL football to about the size of a banana, so it’s a sizable reduction,” Dr. Schauer explained.
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“Typically, patients will tell you they just don’t feel very hungry after these operations. They basically get a ‘hunger holiday’ for about six months,” said Dr. Schauer.
The change is dramatic – and good. Both gastric bypass and sleeve gastrectomy can in some cases reverse diabetes, and seem to control the disease better than medications over the long term, Dr. Schauer said. The STAMPEDE study showed that bariatric surgeries could reverse diabetes — as soon as the day of surgery — and keep it at bay.
Although the gastric balloon (inserted in the stomach to reduce the volume available for food intake for about six months) is currently going through the FDA approval process, it has been used for nearly a decade in Europe.
About a third of patients who undergo the procedure – including counseling to develop healthy eating and exercise habits – gain back the weight they lose after the gastric balloon is removed.
However, Dr. Schauer noted that the gastric balloon and other minimally invasive procedures that are also in development may help a patient who weighs more than 500 pounds to lose enough weight to become a candidate for surgery.