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General Surgery

Perspective on Morbid Obesity and Its Surgical Treatment

Built from Maingot's Abdominal Operations

What’s inside

5 sections · 50 slides

  1. 01

    Overview

    • Scope of this commentary
    • Key terms in bariatric surgery
    • Anatomy of the stomach

    3 slides

  2. 02

    Obesity and type 2 diabetes

    Why the surgical treatment of diabetes stopped being a fringe idea

    • Global variation in adult obesity prevalence
    • 285 m
    • Growth of the diabetes burden
    • Metabolic surgery and its changing reception
    • Mechanisms of glucose improvement after surgery
    • Sequence linking bypass surgery to early diabetes remission
    • The incretin effect and gut hormones
    • Bypass procedures compared with purely restrictive operations
    • Roux-en-Y gastric bypass anatomy
    • Speed of diabetes remission after bypass surgery
    • Milestones in the acceptance of diabetes surgery
    • International Diabetes Federation position statement
    • “
    • Evidence still needed in metabolic surgery

    14 slides

  3. 03

    Sleeve gastrectomy

    A newer operation, its critics, and the evidence that answered them

    • Position of sleeve gastrectomy among bariatric operations
    • Laparoscopic sleeve gastrectomy
    • Laparoscopic adjustable gastric banding
    • Risk and benefit across three bariatric operations
    • Drawbacks and attractions of sleeve gastrectomy
    • Sleeve gastrectomy compared with vertical banded gastroplasty
    • Reasons vertical banded gastroplasty failed
    • Complications rarely seen after sleeve gastrectomy
    • Revisional surgery after sleeve gastrectomy
    • Sleeve gastrectomy converted to a duodenal switch
    • Sleeve gastrectomy as a metabolic procedure
    • Gut hormone response after sleeve gastrectomy
    • Ghrelin suppression after sleeve gastrectomy
    • Long-term evidence for sleeve gastrectomy
    • 53-69%
    • Endorsement of sleeve gastrectomy as a primary operation

    16 slides

  4. 04

    Innovation

    Filling the gap between tablets and the operating theatre

    • Gap between medical therapy and surgery
    • Endoscopic therapy for obesity
    • Obstacles facing endoluminal procedures
    • Laparoscopic greater curvature plication
    • Suture placement along the greater curvature
    • Completed plication and the narrowed channel
    • Investigational less invasive procedures
    • Where new obesity therapies sit
    • Responsible innovation in bariatric surgery

    9 slides

  5. 05

    Summary

    What to carry away from this commentary

    • Summary: obesity and diabetes surgery
    • Summary: sleeve gastrectomy and innovation
    • References
    • References (continued)
    • References (continued)
    • References (continued)
    • References (continued)
    • Maingot's Abdominal Operations, 12th Edition

    8 slides