Dr. Gagner’s Recent Interview with Bariatric News About LSG

Bariatric News recently interviewed Dr. Michel Gagner who will be participating in two bariatric surgery events this summer to discuss the current status of the Laparoscopic Sleeve Gastrectomy (LSG): The 6th Annual International Consensus on Sleeve Gastrectomy and the GORE Sleeve Symposium. Dr. Michel Gagner is the preeminent surgeon of gastric sleeve surgery, which has become an increasingly popular procedure for weight-loss.

A Laparoscopic Sleeve Gastrectomy Procedure

In an LSG, 60% to 85% of the stomach pouch is removed through a series of small incisions, and the remaining stomach pouch is left in a sleeve shape. In this bariatric procedure, the patient’s appetite and hunger-related hormone production are reduced, thus improving the patient’s chances of long-term weight management.

6th Annual International Consensus on Sleeve Gastrectomy

Day One: On the first day of the Consensus, approximately 20 live LSGs, revisions, conversions, and single anastomosis duodeno–ileal bypasses will be performed by surgeons from all over the globe.

Day Two: The second day will involve discussions on the mitigation and prevention of LSG complications involving weight regain, revisions, and leak management. The Consensus will end with a questionnaire whose results will appear in a peer-reviewed journal.

GORE Sleeve Symposium

Unlike the Consensus, the Symposium will be hosting an Expert Panel Discussion in which experts give a speech and answer questions from the audience. The panel will discuss various ways to avoid surgical complications from LSGs. During the Symposium, Dr. Michel Gagner will demonstrate how to avoid preventable mistakes, such as:

  • Staple Line Reinforcement, which shows strong evidence of eliminating leakage and bleeding.
  • Dr. Gagner also questions recent study findings published by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), which stated that Staple Line Reinforcement was more commonly associated with increased leakage. Based on the paper’s inability to properly support their claims, Dr. Michel Gagner is unwilling to accept the paper’s findings.

Clinique Michel Gagner performs various bariatric surgeries. If you’re wondering if a laparoscopic sleeve gastrectomy is the right weight loss procedure for you, please fill out this patient questionnaire.

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Long-Term Differences Between Bypass and Sleeve Gastrectomy

In a recent editorial written by Dr. Michel Gagner in the Surgery for Obesity and Related Diseases journal by the American Society for Metabolic and Bariatric Surgery (ASMBS), Dr. Gagner illustrated very crucial differences in the short and long-term effects of Roux-en-Y Gastric Bypass (RYGB) and laparoscopic sleeve gastrectomy (SG).

What is a Laparoscopic Roux-en-Y Gastric Bypass?

In an RYGB procedure, a small gastric pouch is created near the lower end of the esophagus, and the intestine is cut in two. The roux limb is attached to the gastric pouch, and the biliopancreatic limb is attached to the Roux limb. The digestive juices from the excluded stomach and Bilio-Pancreatic limb flow into the Roux limb, which keeps digestion and ingestion further down the intestinal pathway.

What is a Laparoscopic Sleeve Gastrectomy?

An SG procedure reduces the stomach volume by removing 60–85% of the stomach and shaping the remaining part like a sleeve. It is a minimally invasive procedure that involves very precise and small incisions into which narrow surgical instruments are placed to perform the procedure. An SG procedure helps patients lose weight by making them feel fuller faster while reducing hunger-related hormone production.

Readmission Rates of Both Surgeries

After comparing the results of several studies conducted in Sweden and the United States, Dr. Gagner has illustrated that readmission rates are generally higher in RYGB patients. According to one Massachusetts study, common reasons for hospitalization after RYGB surgeries were cholecystectomies (5.2%), adhesions/obstructions (17.6 %) internal hernias (15.7 %) ulcers (3.7%) and intussusceptions (2.8%). Patients who underwent sleeve gastrectomies had a much lower rate of reoperations compared to RYGB patients.

In terms of short-term admission rates, a Swedish study found that 4.9% of RYGB patients were hospitalized within 30 days, compared to 2.8% in SG patients. Some causes for short-term hospitalization in these patients were nausea, vomiting, nutritional depletion, abdominal pain, and bleeding.

As Dr. Gagner noticed in his article, several measures can be taken to reduce this long-term risks in bariatric patients, such as using a longer period of proton-pump inhibitors (PPI), and creating a smaller gastric pouch to decrease the incidence of ulcers.

Discuss Your Concerns With Your Doctor

Whether you’re on the waitlist for your RYGB or SG surgery or you’d like more information about the benefits and side effects of weight-loss surgery, Clinique Michel Gagner is here to answer your questions. Contact us today or get started on your patient questionnaire.

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Report on Bariatric Surgery from Canadian Obesity Network

The recent publication called the Report Card on Access to Obesity Treatments for Adults in Canada 2017 was recently published by the Canadian Obesity Network and gave a detailed and comprehensive analysis of the state of bariatric surgeries performed in this country and the access to such a procedure among adults with severe obesity or BMIs over 40 kg/m².

Top Findings: a Highlight

The most striking fact is just how little bariatric surgery is performed compared to the number of eligible patients that need them. While the number of Class II and Class III obese people in Canada continues to climb, the amount of centres that offer bariatric surgery has stayed the same. Of the over 1.5 million people in the country who may be in need of the surgery where diet and exercise alone cannot help them, there are only 113 surgeons like Dr. Michel Gagner who can help them. The 113 surgeons who are able to perform these surgeries are not evenly spread out through the country.

Neither the territories nor Prince Edward Island offers bariatric surgery, despite the 15,000+ eligible patients living there who would have to first find a centre that would accept an out-of-province patient, and second, travel a great distance for a consultation and then months later again for the actual procedure. No matter where you are in the country, the total wait time from beginning to end, or referral to procedure can take over 2 years. Unfortunately, there is a risk that patients in need of this surgery may die while waiting for their procedure.

How Does Quebec Measure Up?

While certainly not the worst offender, in terms of wait times and accessibility, Quebec, like all provinces with centres that offer bariatric surgery, has some work to do. It received a B grade for its wait time between consultation and surgery, which is six to 12 months, and an F grade (like every other province) for its wait time between referral and consultation, which is up to 24 months.

While the number of weight loss surgeries continues to climb in Canada, it’s clear from this report that something needs to be done to improve the wait times and the number of centres who perform these life-saving operations.

If you are considering bariatric surgery, contact Clinique Michel Gagner as soon as possible or fill out our questionnaire to get started on your path to a healthier life.

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Dr. Gagner’s Letter to the Editor Questions Recent Article

Dr. Michel Gagner recently published a Letter to the Editor in Obesity Surgery (April 2017) called “What Is a Favourable Risk-Benefit Profile Concerning Metabolic Surgery for Patients with Type 2 Diabetes?” The letter addressed many recommendations listed in an article called “Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations,” in which the choice of procedure was discussed.

In his letter, Dr. Gagner disagreed with a number of the article’s recommendations, especially because the authors showed considerable bias towards Roux-en-Y Gastric Bypass (RYGB) surgery as the most favourable risk-benefit profile for patients with Type-2 diabetes. The article, according to Dr. Gagner, provides misleading information, which has the potential to cause harm to future patients. Dr. Gagner proposed to eliminate the “choice of procedure” recommendation part of the article as it does not accurately represent a Type-2 diabetes patient’s best options. In many instances, sleeve gastrectomy or duodenal switch is the best operation for type-2 diabetes.

While Dr. Gagner does not entirely rule out the benefits of a Roux-en-Y Gastric Bypass procedure, he does insist that the risk-benefit profile is not measured appropriately and that the risks involved in a RYGB should not be understated. The risks for Type-2 diabetes patients undergoing RYGB surgery include:

?      Long-term nutritional deficiencies, such as bone demineralisation
?      40% weight loss failure rate in patients with an initial BMI > 50 kg/m2
?      33% recurrence rate of diabetes
?      Nutritional micronutrient deficiencies
?      Intestinal complications
?      Hypoglycaemia and dumping syndromes

There are a number of article recommendations that Dr. Gagner does not agree with, such as bundling a biliopancreatic diversion and duodenal switch, which, in his opinion, is a “grave scientific mistake.” The classic biliopancreatic diversion called “Scopinaro procedure” is now abandoned due to frequent nutritional complications and duodenal switch has replaced entirely this old procedure. Most of the recommendations that Dr. Gagner takes issue with are seemingly caused by lack of understanding and experience.

If you have Type-2 diabetes and are considering undergoing weight loss surgery, the most important thing to remember is that there is no one-size-fits-all procedure. Your situation is unique, so it is very important to consult with a physician that won’t recommend a procedure strictly based on bias. The American Diabetes Association has not recommended one particular type of surgery, therefore, the choice of procedure is ultimately yours to make.

Clinique Michel Gagner specializes in many forms of metabolic surgery. Fill out our patient questionnaire or contact us today to arrange a consultation.

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Study Says Parents’ BMI a Major Contributor to Child Obesity

According to a recent study conducted by the University of Sussex, 40% of a child’s body mass index (BMI) can be attributed to their parents. However, if the child is obese, the percentage climbs up to more than 50%, which means that parents’ genes are a major factor in their children’s obesity.

The study was conducted over 6 six countries of varying GDPs, standards of living and average BMIs and discovered that the intergenerational transmission of BMIs was the same across the board and that children of obese parents were likely to become obese. Environmental factors such as the country’s stage of industrialization and economics did not seem to matter. Even race was not an underlying factor for the transmission of BMI. Of the 100,000 children and their parents that were studied, the average transmission of BMI was consistently 20% per parent, no matter how overweight or thin the subjects were. However, that transmission percentage climbed with obese parents and children.

These findings, which were published in Economics and Human Biology, demonstrate most crucially that healthy diet and exercise aren’t solely responsible for how we look. In other words, our weights are largely pre-determined before we’re born. The stigma and judgement obese people face from “fat shaming” and societal pressures does nothing except blame people who were at a disadvantage before they even started making their own lifestyle decisions. For people who have fought to lose excessive weight their whole life, these findings may shed some light on their difficulties. It can, however, be quite disappointing knowing that there are factors beyond our control that contribute to our weight.

How we treat childhood obesity as a nation-wide health concern should not start and stop at diet and exercise. The fact that we pass down our BMIs onto our children should steer us in a new direction toward ending childhood obesity.

Clinique Michel Gagner has helped people for decades overcome their obesity and achieve their weight-loss goals. Get started on your journey toward better health today by filling out our Patient Questionnaire.

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Ethicon Discontinues Adjustable Gastric Band Due to Declining Popularity

In 2016, Ethicon, a Johnson & Johnson company, announced that it would no longer be manufacturing and distributing its Endo-Surgery Curved Adjustable Gastric Band. The reason for this cessation in sales is the declining popularity in gastric banding surgery itself. While some patients have lost weight and have seen a significant improvement to their health, our clinic does not offer gastric bands, nor do we recommend them.

The Realities of Gastric Bands

First of all, what is a gastric band? Essentially, a gastric band procedure does not entail removing any parts of the stomach. Your surgeon simply ties the adjustable gastric band around the top part of your stomach to reduce the amount of solid food you need to eat before feeling full. It does not restrict liquid intake. While the fact that it’s not as invasive as other bariatric operations can be considered a plus, long term effectiveness is not a guarantee, and you might find your limited weight loss to be nothing short of heartbreaking.

Why Gastric Bands Are Not Recommended

Gastric Band procedures are in decline due to the continuously high rate of necessary removal, which explains Ethicon’s decision to discontinue the sale of their product. According to some statistics, only 11% of Gastric Band patients still have their original bands intact. Complications make arise, such as leaks, gastric erosions, slippage, stomach dying, obstructions, perforations, etc. At Clinique Michel Gagner, we know that bariatric surgery is an expensive choice toward a healthier lifestyle. Patients who spend thousands of dollars on a procedure, which has proven many times not to be as effective as other procedures, may never see the weight loss results they paid for. That’s why our clinic only specializes in weight loss surgeries with higher result rates.

Alternatives to Gastric Bands

If you are considering undergoing weight loss surgery, our clinic provides many alternatives that will ensure a better success rate than a gastric band and minimal recovery time. Click here to learn more about what bariatric surgeries we perform at Clinique Michel Gagner in Montreal. Here are a couple preferred bariatric procedures.

Laparoscopic Sleeve Gastrectomy: In 2000, in New York City, Dr. Michel Gagner pioneered this ground-breaking procedure, which involves removing up to 85% of your stomach volume. This procedure has shown to reduce body weight by up to 75% in a single year.

Laparoscopic Roux-en-Y Gastric Bypass: A surgery that Dr. Gagner has pioneered and perfected over decades (He first performed it in 1995 at the Cleveland Clinic), this procedure has been proven to cause a significant amount of weight loss—up to 85% in the first year.

Laparoscopic Duodenal Switch: A surgery that Dr. Gagner pioneered laparoscopically since his work at Manhattan’s Mount Sinai Hospital in 1999, it gives the best weight loss results of any procedures and resolves type-2 diabetes.

Contact Clinique Michel Gagner to discuss if weight loss surgery is right for you.

 

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Dr. Michel Gagner Mentioned in NY Times Article

Dr. Michel Gagner was recently quoted in a New York Times article entitled “What is Bariatric Surgery and How does it Work?”, an in-depth look into the function and uses of bariatric surgery. The article spans common questions associated with the procedure like its cost, statistics on the procedure, what the surgery entails, the history of this procedure and its after effects.

 

As many of our readers know, bariatric surgery is an option that almost always has positive health implications on obesity. It can help to reduce or even completely remove harmful conditions associated with obesity such as:

 

  • Diabetes (a long-term remission for type 2 diabetes)
  • Acid reflux problems
  • Obstructive sleep apnea
  • Depression
  • Risk of coronary heart disease, stroke and peripheral heart disease — as blood pressure and cholesterol levels can return to normal or near-normal levels
  • Joint pain
  • Fertility issues and pregnancy complications
  • Metabolic syndromes
  • Gallbladder disease

 

Dr. Gagner’s Role

 

Under the historical question on bariatric surgery, Dr. Gagner was featured because he discovered the laparoscopic sleeve gastrectomy (LSG), one of the two most important procedures in bariatric surgery. Back in 2000 when he was a surgeon at the Mount Sinai Hospital in New York, he was operating on an extremely obese woman. He was quickly made aware that she was not getting enough oxygen and that he would have to stop the surgery. Dr. Gagner had already removed most of the patient’s stomach and had to patch up the patient, thinking that he had left the surgery incomplete. However, time told that the procedure was a success and the woman managed to lose a lot of weight and have a fresh start.

 

More on LSG

 

The LSG procedure was refined not long after into a standard procedure. It involves reducing the stomach volume by permanently removing 60-85% of the stomach pouch leaving the remaining section in what looks like a sleeve. This helps to restrict the amount of food (by restricting the hunger-related hormone) helping a person to feel full after a sufficient amount of food. This allows a person to naturally eat less, lose weight and later maintain a healthy weight.

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Dr. Gagner Wins the 2017 SAGES Pioneer in Surgical Endoscopy Award

Recently, Dr. Gagner was informed that he was unanimously chosen by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and their Board of Governors as the recipient of the SAGES Pioneer in Surgical Endoscopy Award for 2017.

The award is designed for an industry colleague or physician who has made a significant long-term scientific or technological contribution to the field of surgical endoscopy. Dr. Gagner was chosen because of countless work and innovation he has brought to this field, including the work he does in at Clinique Michel Gagner in Montreal.

This award is not given out annually. Instead, it is only given when an individual has substantively changed and improved aspects of the field of endoscopy. Dr. Gagner is one of handful of physicians and medical professionals in the industry to receive an award of this kind. The SAGES foundation awards will be taking place in Houston, Texas at the end of March.

More on SAGES

SAGES strives to improve quality patient care through their efforts in education, research, innovation and leadership — principally in the area of gastrointestinal and endoscopic surgery. They primarily focus on innovations in minimal access and non-invasive technology and techniques like therapeutic flexible endoscopy, laparoscopic surgery and endoscopic image-guided and energy-assisted modalities and thoracoscopy that relate to gastrointestinal or abdominal disease. Their Board of Governors are made up of medical professionals from all over the US and Canada who have also contributed greatly to this field of medicine.

SAGES also has its own University, courses for medical students and scholarships. It acts as a great resource for jobs in the medical industry and also provides resources such as keynote lectures, a number of publications. SAGES is also known for its participation in global affairs and humanitarian efforts around the world.

For more information on Clinique Michel Gagner read our FAQ and get started by filling out our online application today.

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All About Stretta Therapy

Dr. Gagner is the first physician in Canada to be certified to use the Stretta, a new non-invasive therapeutic technique that helps patients with chronic GERD symptoms.

How does it work?

Stretta therapy uses radio-frequency (RF) energy delivering it to the area of the muscle between the stomach and the esophagus by gastroscopy, an outpatient examination of the stomach with a flexible tube. This helps to remodel and improve the muscle tissue, which creates a better barrier function resulting in fewer reflux activities. This therapy goes straight to the source of the problem to treat underlying issues that cause GERD.

Who is it for?

Stretta therapy particularly works for patients whose symptoms are not responding well to medication or where long-term medication is not a viable option. Roughly 30% of people with chronic GERD symptoms do not respond well to medication or in many cases, people find surgery an aggressive option. Stretta is for people who would like an alternative choice to these options. It is also used to treat reflux and heartburn, which are common especially after weight loss surgeries such as the Sleeve Gastrectomy and Gastric Bypass.

What are its key benefits?

It’s unique both because it’s an alternative to surgeries and implants (its non-surgical), it can be administered within 20 minutes as an outpatient and it also has a remarkably quick recovery time. Patients can normally return to normal activities within a day after having the procedure.

Studies also show that Stretta resolves reflux symptoms and therefore improves the patient’s quality of life on a long-term basis. There is no need for medication, it reduces acid exposure, and it’s effective from 4-10 years. It may also decrease the incidence of esophageal cancer.

Is it safe?

Yes, many health practitioners use RF energy commonly. For instance, cardiologists use RF to address dangerous heart rhythms. Urologists use RF for treating prostate enlargement and ear, nose and throat specialists use RF to treat excessive snoring and symptoms of sleep apnea. Finally, RF is regularly used in cosmetic surgeries from body contouring to skin rejuvenation.

Studies have also shown in more than 40 clinical studies that Stretta therapy is both a safe and effective method of combatting the symptoms of chronic GERD.

If you or somebody you know suffers from chronic GERD symptoms and would like to try a safe, easy-to-administer, non-surgical therapy option, get in contact with us to set up a consultation today!

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Dr. Gagner Featured in General Surgery News Article on Stomach Intestinal Pylorus-Sparing Surgery

 Recently, Dr. Gagner was featured in a General Surgery News article entitled “Stomach Intestinal Pylorus-Sparing Surgery” also known as SIPS. The article is a round-table style interview with physicians, surgeons and experts on the topic, a surgery that has been at the forefront of discussion in the field. This new technique is based on a modification of the duodenal switch procedure, and in some practices it accounts for more than 40% of bariatric surgeries performed based on information presented at the 2016 Minimally Invasive Surgery Symposium.

 What is the duodenal switch?

 The duodenal switch (DS) is composed of a restrictive part, a gastric sleeve reduction procedure, and a malabsorptive part also known as a biliopancreatic diversion, which decreases absorption of fat mainly.  Both components help those with obesity and remove excess weight, especially the body fat compartment.

 Dr. Gagner’s Key Points

Dr. Gagner states that in the U.S there are many variations of the duodenal switches and that SIPS is just another variant being performed, which is very similar to what has been done for the last 25 years. In SIPS, there is only one anastomosis (connection), and therefore technically simpler and shorter in anesthesia duration.

SIPS, preserves a normal emptying of the stomach, because the pyloric valve, a muscle sphincter between the stomach and intestine is intact. This avoids dumping syndromes and severe swings in blood sugar.  It is a procedure that is either done in super-obese, diabetics (Type-2) or in those who have weight regain after the popular sleeve vertical gastrectomy. The procedure was initiated by surgeons in Madrid more than 5 years ago, and now is becoming more and more popular in the USA and Canada.

 He also explains informed consent in the interview – the concept of explaining what you intend to do with the patient. It is important to have written informed consent whether a classic intestinal reconstruction approach is being taken or a SIPS procedure, as the two procedures could present different side effects. However, Dr. Gagner states that the slight modifications between the two procedures will not make a big difference to the overall outcome.

 For instance, the classic duodenal procedure might affect the frequency and quality of bowel movements (being more frequent and looser) but in terms of micronutrient deficiencies, it will provide the same results as SIPS .This makes the difference between the two procedures such a small change that it should not need approval from the institutional review board.

Dr. Gagner offers SIPS as part of his services at Clinique Michel Gagner. If you or anyone you know could benefit from this procedure, get in contact with us to make an appointment today.

 

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