12th Annual Surgery of the Foregut Symposium

Biltmore hotelEsteemed faculty gathered from around the world to lecture at the 12th Annual Surgery of the Foregut Symposium, directed by Dr. Raul Rosenthal and Dr. John Fung from the Cleveland Clinic Florida. It was held at the Biltmore Hotel in Florida. The first two days covered a wide variety of topics ranging from GERD to gastric cancer to pancreatic surgery, and the third day was dedicated to metabolic and bariatric surgery.

Included in the metabolic and bariatric surgery presentations, Dr. Walter Pories gave a talk on the past, present and future of obesity disease. He articulated the magnitude of the problem of obesity and many of the challenges in treating this epidemic. Dr. Jaime Ponce moderated sessions on controversies in bariatric surgery and also on surgery reversals and conversions to other procedures. Additionally, Dr. Ponce gave a presentation on the future of gastric banding. He reviewed several papers that have shown that there is wide variability in the weight loss results that patients achieve after gastric banding. He spoke about factors that are necessary for success with gastric banding including surgical technique, frequent follow-up and appropriate dietary counseling focused on taking small bites of food and lots of chewing. He summarized by stating that although the annual number of band surgeries has decreased more than the number of bariatric procedures overall, he predicts that some centers will continue to offer gastric banding. A large driver of this is patient demand for the safest, least invasive operation. Dr Ponce stated that he personally knows of at least 13 bariatric surgeons who have had the band between 5-15 years ago, which is a strong endorsement for gastric banding.

Speaking about gastric bypass, Dr. Alan Wittgrove gave a presentation on when to reverse a bypass, explaining the reasons for reversal are classified as medical or psychological. Dr. Robert Brolin followed with another presentation on reversal of gastric bypass, and his indications included complications with substance abuse, such as intractable anastomotic ulcer with chronic use of NSAIDs, alcohol, or narcotics.

The gastric sleeve – a newer operation but one that is quickly gaining popularity – was also discussed. Dr. Emma Patterson moderated a session on the complications after reoperative surgery, during which Dr. Himpens showed videos of complications after sleeve gastrectomy. During the panel session he stated that his leak rate for primary sleeve gastrectomies is 3.7% and for revisions (such as a sleeve after gastric banding) his leak rate is 7.2%. Dr. Patterson then gave a presentation on banded plication and concluded that there is very little published data on this procedure so it is still an experimental procedure that is not ready for prime time. Dr. Natan Zundel followed with another presentation about gastric plication, in which he stated that in his experience 47% of patients regained their weight, and so he has stopped doing the procedure.

The symposium was held Feb 17-20, 2013.

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