La sleeve gastrectomie et le diabète

Vous avez tout essayé pour perdre du poids: tous les régimes, les programmes d’exercice et les médicaments miracles disponibles sur le marché. Parfois, ce n’est tout simplement pas assez. Certaines personnes sont génétiquement défavorisées à perdre du poids. Si cela sonne chez vous, la procédure bariatrique de sleeve gastrectomie peut vous aider. La procédure de sleeve gastrectomie est conçue pour rendre l’estomac plus petit afin de vous aider à perdre du poids naturellement.

Comment fonctionne la sleeve gastrectomie?

L’opération de sleeve gastrectomie vous fait sentir rassasié plus vite en mangeant moins qui mène à la perte du poids. De très petites  incisions sont faites dans l’abdomen, et une grande partie de votre estomac est enlevée. Vous êtes laissés avec un manchon mince vertical ou un tube de la taille d’une banane. Les agrafes chirurgicales sont utilisées pour fermer votre nouvel estomac. Ceci est une procédure non réversible. Un petit estomac signifie que vous ne serez simplement pas capable de manger autant qu’auparavant.

Comment est-ce que la sleeve gastrique affecte le diabète?

La procédure de sleeve gastrectomie réduit le tractus gastro-intestinal, modifie également les hormones digestives et affecte l’efficacitéé de l’insuline. Cela mène à des améliorations significatives dans le diabète de type II et des changements dans le pancréas, ce qui aide à lutter contre le diabète.

Les avantages de la procédure:

• Met le diabète de type II en rémission
• Pourrait diminuer la prise quotidienne de médicaments nécessaires
• Si vous êtes  pre-diabétique , cette procédure pourrait éviter l’apparition de diabète de type II

Un praticien de renom

Un pionnier dans la sleeve gastrectomie laparoscopique, le Dr Gagner performe avec succès la procédure depuis l’année 2000. La sleeve gastrectomie est une option populaire pour les patients qui font face aux défis du diabète de type II. La procédure prend moins d’une heure, et les patients peuvent retourner au travail dans 2 à 4 semaines.

Existent-ils des complications?

Comme pour toute chirurgie, il existe des complications  comme les fuites et les saignements. Les gens qui ont opté pour la procédure doivent aussi prendre un supplément de vitamine B-12 pour la vie, et certains des médicaments contre le reflux d’acide.

Les chirurgies peuvent parfois avoir des effets sur les problèmes de santé préexistants. Vivre sa vie avec le diabète signifie des luttes quotidiennes pour gérer les niveaux de sucre dans le sang, et même chose avec l’hypertension. Comme méthode efficace de perte de poids, beaucoup d’individus ont des questions au sujet des procédures bariatriques populaires, en particulier la gastrectomie. Contactez-nous pour toutes vos questions : (514) 922-5055.

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Traditional Methods of Weight-Loss Near-Impossible For Obese Patients, Study Finds

Ideally, healthy weight loss should be on every obese person’s to-do-list, but a new study published by the American Journal of Public Health reveals that this is near impossible to achieve with traditional dieting and exercising alone. The study shows the odds of a clinically obese person achieving normal weight without surgical interventions are just 1 in 210 for men in a given month. Women fared a little better; 1 in 124 in a given year. For those who are morbidly obese, the odds are even worse.

On the other hand, the study shows an initial positive effort by the participants: people in the study were successful in dropping 5% of their body weight. However they were not able to sustain it, nor were they able to achieve their weight goals. At least half of those who lost 5 percent of their body weight regained it within two years, and more than 78 percent regained it within five years. This is a clear indication that there is something wrong with traditional weight-loss strategies.

The study was based on analysis of more than 278,000 people from the UK’s Clinical Practice Research database, tracked between 2004 and 2014. The purpose of the study was to highlight the difficulty obese people face in trying to achieve sustained weight loss through diet and exercise alone. Dieting and exercise can work; it is just near impossible for obese patients. Oftentimes, weight cycling (frequent fluctuation in gaining and losing weight) was much more common than sustained weight loss. This has been shown to be even more taxing on the body than stable obesity.

While the findings may be bleak, it also emphasizes the importance of preventative measures for obesity. Part of the problem is that few obese Americans who are eligible for weight-loss medications or surgery actually do get those therapies. A more concerted effort needs to be made to educate the public on surgical treatments for obesity.

Source: HealthDay

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Startling Statistics Reveal 95% of Parents Believe Their Obese Children To Be “Just Right”

Naturally, parents want to believe that they are raising their children right; that they are providing them with a healthy diet, and that an inclination for food amongst younger children is a sign of good health and vitality. This was confirmed by a team of researchers from NYU Langone Medical Center who looked at data on how parents perceive their overweight young children, revealing that 94.9 percent of parents believe their kids’ size to be “just right” Researchers studied two groups of young children: a group of 3,839 kids from 1988-1994, and another group of 3,151 kids from 2007-2012, and published the findings in the journal Childhood Obesity. Similar findings were reported last year in the journal Pediatrics.

Perhaps even more disturbing, researchers found that results worsened from the same survey taken 20 years earlier. Obese children today are roughly 30% less likely to be appropriately perceived by their parents than they were in the 1990s. Amongst those with the highest chances of inaccurate perceptions were low-income parents and African Americans.

In the study, parents were asked the pivotal question: “Do you consider [child’s name] to be overweight, underweight, just about the right weight, or don’t know?” Data showed that parental responses were pretty much the same within the two time periods studied, however there was one very noticeable difference: childhood obesity is much more widespread today than it was the first time the study was conducted, meaning more parents are viewing their obese children as “just right”.

Signs point to changing societal ideals and a redefinition of healthy body weight. As obesity keeps rising in North America, larger body types are becoming more and more commonplace. Even among kids aged 2 to 5, who were the subjects of this study, perceptions of weight ideals have drastically changed. If every other child is obese, parents are more likely to see their own child as “normal” because of its prevalence.

Lessons can be learned from this study, yet none of them may be pleasant. Firstly, childhood obesity isn’t going away anytime soon. Secondly, more work needs to be done by pediatricians on educating parents about healthy diets for their children in the face of rising obesity rates. Thirdly, most parents have obviously lost a clear idea of what a healthy child looks like.

The important thing is that we start taking action now, before these trends become irreversible.

Source: Washington Post

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Dr. Gagner Appears In Wall Street Journal – “Obesity Surgery Is Better At Treating Type 2 Diabetes In Obese Patients Than Diet And Exercise”

The Wallstreet Journal recently published an article on July 1st that reflected on the growing body of evidence that suggests that weight-loss may be an effective way to treat type-2 diabetes, in conjunction with Dr. Gagner’s editorial companion piece published in the JAMA Surgery Journal.

According to a small but rigorous randomized trial published by JAMA Surgery, evidence shows baratric surgery is superior to lifestyle changes in resolving type-2 diabetes. In the trial, obese patients were randomly assigned either a Roux-en-Y gastric bypass, a laproscopic adjustable gastric banding, or a lifestyle weight loss intervention plan. Results showed that patients who had had the Roux-en-Y gastric bypass procedure had the highest type-2 diabetes partial or complete remission rate with 40%; 29% with the laparoscopic banding; 0% with weight loss intervention patients. In other words, no one in the group who received intensive lifestyle intervention resolved their diabetes, which stands in stark contrast to those who received weight-loss surgery.

If the JAMA Surgery study didn’t convince you, Dr. Gagner points to another study –  the TODAY clinical trial on adolescents with recent-onset type-2 diabetes similarly indicates no benefits of intensive lifestyle intervention. For Obese patients with type-2 diabetes, surgery resulted in better glucose control than did medical therapy.

Dr. Gagner states – “We should consider the use of bariatric (metabolic) surgery in all severely obese patients with T2DM and start a mass treatment, similar to what was done with coronary artery bypass graft more than 50 years ago.”

Source: Wall Street Journal, JAMA Surgery

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IFSO EFC – Interview With The Expert – “Which Is The Most Important Trick To Avoid In Sleeve Gastrectomy Staple Line Leaks?”

Dr. Gagner gives his expert advice on how to avoid staple leaks in Sleeve Gastrectomy surgeries.


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A Score Of New Peer-Reviewed Articles From Dr. Gagner

Be up to date in the field of Bariatrics by reading the latest peer-reviewed articles from Dr. Gagner:

1. Gagner, M: Bariatric surgery saves lives. CMAJ. 2015 Jun 16;187(9):681. doi: 10.1503/cmaj.1150042. Link

2. Gagner M: Effect of sleeve gastrectomy on type 2 diabetes as an alternative to Roux-en-Y gastric bypass: a better long-term strategy. Surg Obes Relat Dis. 2015 Mar 24. pii: S1550-7289(15)00064-7. Link

3. Nedelcu M, Noel P, Iannelli A, Gagner M: Revised sleeve gastrectomy (re-sleeve). Surg Obes Relat Dis. 2015 Feb 14. pii: S1550-7289(15)00040-4. Link

4. Huang R, Gagner M: A Thickness Calibration Device Is Needed to Determine Staple Height and Avoid Leaks in Laparoscopic Sleeve
Gastrectomy. Obes Surg. 2015 May 30. Link

5. Manos T, Nedelcu M, Noel P, Gagner M: Pigtails Internal Drainage for 2-cm Gastric Leak After Sleeve Gastrectomy Prolongs Healing. Obes Surg. 2015 Jul;25(7):1261-2. Link

6. Gagner M: Bariatric surgery: To bypass or switch? That is the question in obesity surgery. Nat Rev Gastroenterol Hepatol. 2015 May;12(5):255-6. Link

7. Roslin MS, Gagner M, Goriparthi R, Mitzman B: The rationale for a duodenal switch as the primary surgical treatment of advanced type 2
diabetes mellitus and metabolic disease. Surg Obes Relat Dis. 2014 Nov 25. pii: S1550-7289(14)00463-8. doi: 10.1016/j.soard.2014.11.017. Link

8. Sato T, Yamaguchi S, Harada M, Koyama I, Gagner M.Impact of laparoscopic surgery on survival of patients with small bowel adenocarcinoma and peritoneal metastasis. Hepatogastroenterology. 2014 Nov-Dec;61(136):2253-5. Link

9. Sato T, Yamaguchi S, Harada M, Gagner M: Long-term outcome of laparoscopic resection for stage IV colorectal cancer. Hepatogastroenterology. 2014 Nov-Dec;61(136):2232-5. Link

10. Nedelcu M, Manos T, Cotirlet A, Noel P, Gagner M: Outcome of leaks after sleeve gastrectomy based on a new algorithm adressing leak size and gastric stenosis. Obes Surg. 2015 Mar;25(3):559-63. doi: 10.1007/s11695-014-1561-y. Link

11. Gagner M: Decreased incidence of leaks after sleeve gastrectomy and improved treatments. Surg Obes Relat Dis. 2014 Jul-Aug;10(4):611-2. Link


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Bariatric Surgery and the Regression of Subclinical Atherosclerosis

Atherosclerosis is a chronic disease that essentially involves the hardening of arteries due to inflammation. It’s a disease that can progress for a long while before any outward symptoms are displayed.  Atherosclerosis that has not progressed enough to present symptoms is known as subclinical atherosclerosis, and can be difficult to screen for.

If left unchecked, the progression of atherosclerosis can lead to serious health problems such as heart disease, angina, and heart attacks.

There is good news, however: a new study has shown that bariatric surgery can cause a relatively fast regression in subclinical atherosclerosis. This means not only will you lose weight due to the surgery, but your risk of developing cardiovascular disease will go down as well.

According to this study lead by Dr Jose Roberto Matos­Souza from the State University of Campinas/UNICAMP Clinics in Brazil, individuals undergoing bariatric surgery saw a regression in atherosclerosis 1 month after their procedure, and results showed that this reduction was sustained after 1 year.

The regression of atherosclerosis demonstrated was most significant within 3 to 6 months of the bariatric surgery procedure, and was correlated with a reduction in LDL cholesterol and an increase in HDL cholesterol. The atherosclerosis reduction occurred before significant loss in body weight.

This finding makes bariatric surgery more than just a procedure that is good for weight loss. It will also improve your overall health and reduce the complications associated with inflammation in your cardiovascular system.



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“To Bypass or Switch?” Dr. Gagner Writes Article For Prestigious Journal, Nature Reviews.

In a recent article written by Dr. Gagner and published by Nature Review: Gastroenterology & Hepatology, Dr. Gagner comments on the debate on which surgery is best to achieve weight loss and improve health. In light of a new study, duodenal switch is considered superior to gastric bypass for weight loss in patients with a BMI >50, but patients suffered more adverse affects.

In this study conducted by Risstad and colleagues, 60 patients with a BMI between 50 and 60 were randomly assigned to receive either a gastric bypass or a duodenal switch, and then observed over a 5-year period. It was found that, on average, those who had received a gastric bypass had an average BMI reduction of 13.6, while those who had duodenal switches saw reductions of 22.1. Moreover,  only 14% of duodenal switch surgeries were considered unsuccessful versus 55% for gastric bypasses.

Duodenal switch was also associated with more gastrointestinal adverse events, however. In the opinion of Dr. Gagner, “the quality of life in those who received duodenal switch might have been underestimated by a higher frequency of adverse effects as a result of learning curve issues than in those who received gastric bypass”. This means that patients who received a duodenal switch had substantially more hospital admissions than patients with gastric bypass.

Take a look at Nature Reviews’ April issue to learn more:

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La chirurgie de bypass gastrique peut détecter d’autres problèmes et sauver votre vie

Le bypass gastrique est une procédure qui nécessite des tests préopératoires extensifs avant son exécution. Un des avantages de ce genre de tests est que les médecins peuvent parfois finir par découvrir d’autres conditions préexistantes qu’ils ont manquées auparavant.

Dans un cas récent, un patient est allé pour une chirurgie de bypass gastrique et les médecins ont réussi à trouver des preuves de cancer de l’estomac au cours de leurs diverses procédures préopératoires. Le patient en question avait une histoire familiale de cancer, mais en raison de sa jeunesse et de sa bonne santé générale, les médecins n’auront jamais pu découvert la tumeur naissante si le patient n’avais pas été l’objet d’un bypass gastrique. Les médecins ont réussi à détruire complètement la tumeur, ajoutant potentiellement des décennies à la vie du patient.

Cette situation est loin d’être rare. Beaucoup de gens ne cherchent pas les soins médicaux jusqu’à ce qu’ils commencent à développer des symptômes très visibles. Dans ce cas, leurs maladies peuvent avoir sensiblement progressé pendant ce temps. Le fait de découvrir une maladie qui est dans les premiers stades de développement peut faire la différence entre la vie et la mort, en particulier dans le cas du cancer. Les tumeurs qui sont détectées au début de leur développement peuvent être enlevées avant qu’ils ne se propagent.

La détection précoce de la maladie cardiaque peut aussi aider les gens à recevoir un traitement au bon moment. Certains médecins peuvent même arriver à trouver les caillots sanguins chez les patients avant qu’ils ne provoquent des situations d’urgence menaçant la vie du patient. La chirurgie de bypass gastrique est un excellent exemple de la façon dont une procédure peut sauver directement et indirectement la vie des patients.

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MICHEL GAGNER, MD, FACS and CINE-MED, INC. Announce Release of New Book

Woodbury, CT, US – Cine-Med, Inc is pleased to announce the release of its latest surgery book, Atlas of Hepato-Pancreato-Biliary (HPB) Surgery, edited by Michel Gagner, MD, FACS and Daniel B. Jones, MD, MS, FACS.

This oversized atlas includes 42 chapters written by 72 internationally recognized names in HPB surgery. The chapters include: 19 Biliary, 13 Pancreatic, and 10 Hepatic procedures.

The editors have provided written commentary for each chapter offering their perspectives on the procedures as well as alternative methods for performing the surgical techniques.

Presented in step-by-step format, each chapter is accompanied by full color illustrations and intraoperative photos. Surgical videos will be added to the text in the coming months.

“It took 5 years to write, and there is more than 20 years worth of experience written in this book” says Dr. Gagner. “It’s an accumulation of  my life’s work. It’s my baby! It shows how to perform the different surgeries I have helped develop throughout my career. On top of that, there are photos and diagrams that can help students and professionals who are interested in the field of pancreatic surgery. It’s no ordinary book, that’s for sure.”

To order a copy of this book, please contact Mary Panagrosso, Cine-Med, Inc. 800-253-7657 or visit; Product ID: HPB-01, Price: $285 US

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