Dr. Gagner Helps SurgiBot Clear GLP Studies

In recent Bariatric and surgical news, TransEntrix, Inc., a medical device company that is heavily involved in the development of robotics and flexible instruments for the use of minimally invasive surgery, announced on April 16th the successful completion of one of the key steps prior to 510(k) submission for their new SurgiBot system, a patient-side robotic surgery system.

The completion of the GLP (Good Laboratory Practice) Studies, means that FDA filing could be ready as soon as mid-2015.

Upon further investigation, the SurgiBot system would utilize flexible instruments through articulating channels controlled directly by the surgeon, with robotic assistance, at the patient’s bedside, effectively making the surgeons’ job easier. The flexible nature of the system allows for multiple instruments to be introduced and deployed through a single incision.

Dr. Michel Gagner of Montreal, Canada and President of the 2014 World Congress of the International Federation for the Surgery of Obesity & Metabolic Disorders was one of the lead investigators for the GLP Studies using the SurgiBot system.

The GLP studies also included multiple procedures performed by surgeons from varying specialties to demonstrate the SurgiBot’s abilities to handle critical tasks commonly performed during the rigors of laparascopic surgery.

“The SurgiBot system proved to be capable of effectively performing surgery in this completed study”, said Dr. Gagner. “The system provided articulating vision and multiple instruments through a single incision. The user experience keeps the surgeon in the sterile field with familiar laparascopic movement. I prefer to be at the patient’s side during surgery, and appreciate maintaining the approach and movement of gold standard laparscopic surgery while adding the features of robotic assistance.”

Source: Business Wire 


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Bariatric Surgery Helps Hip Replacement Patients

While obesity is known to contribute to several health complications such as cardiovascular disease and diabetes, carrying an excess of weight also affects mobility and takes its toll on joints. As such, not only is it advisable to lose weight through bariatric surgery in order to lead a healthy lifestyle, but it has also proven to be beneficial for those undergoing hip replacement surgery.

Recently, two studies have shown that bariatric surgery helped to improve the outcomes of patients who had hip replacement surgery. These studies were presented at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons in Las Vegas.

Previously, the benefits of bariatric surgery for morbidly obese hip replacement patients was unclear, but these studies have shown that it brings clear benefits, and should be considered for insurance coverage benefits under these circumstances.

Improve Recovery and Reduce Complications

Being obese puts a lot of strain on your your hips and legs. This can be problematic especially if you will be undergoing hip replacement or knee replacement surgery in the near future. Weight loss helps to improve recovery and eliminate pain and subsequent damage to your hips and legs.

Bariatric surgery has always been a cost-effective solution for weight loss, especially for the morbidly obese. Now, these new studies have shown that it can also lend its efficiency as a weight loss tactic to other procedures, further reducing costs and improving people’s lives.

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Weight Discrimination and its Effect on Quality of Life

Obesity is currently highly stigmatized around the world. Individuals who are overweight or obese tend to be susceptible to negative bias, prejudice and discrimination. This occurs in various settings such as the work place, educational institutions, health care facilities and interpersonal relationships.

According to a recent study funded by Cancer Research UK, adults who feel discriminated against on due to their weight have a 70% increase in depression and a 14% drop in overall quality of life (QoL) compared with those who do not.

Weight discrimination can manifest itself in various forms, such as getting treated with less respect, receiving poor service at various establishments and more serious threats. All these have an impact, reducing one’s quality of life.

Depression as an effect of weight discrimination also reduces one’s quality of life by increasing problems that lead to obesity such as emotional eating. Emotional eating is a disorder where an individual resorts to eating (especially unhealthy food) when dealing with any emotional distress.

Weight discrimination can also lead to social isolation, where an individual reduces social contact with people outside their comfort zone. This leads to an individual spending days or weeks in the house and hampers the creation meaningful relationships.

Weight discrimination Discourages Weight Loss

Individuals who are obese tend to receive negative attention and comments about their situation, even from health experts. This discourages them from seeking the required help they need. Lack of exercising or a proper healthy diet will discourage an obese person from losing weight, trapping them in a cycle of weight gain. That is where different measures come in, such as surgery or other medical treatments, in order to offer solutions.

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Possible Link Between Gut Bacteria and Obesity?

If you haven’t heard of fecal transplants before, you may want to put it on your radar soon, as it is fast becoming one of the most promising new treatments for a variety of gastrointestinal diseases. The fecal bacteria strain in question: the Clostridium difficile.

While the image of a fecal transplant may be unpleasant, rest assured that the donor stool is rinsed and strained before it is introduced into another person or recipient, and this is done in multiple ways: through an enema, an endoscopy, or ingested orally, in pill form. The main idea is to introduce and eventually replace gut bacteria after the normal balance is disturbed (by antibiotics or other sources).

In the process of introducing C. difficile in some patients, however, doctors have stumbled upon a strange revelation that could have profound impacts on the way we see obesity. One woman who was treated with C. difficile found herself rapidly gaining weight soon after, even when she had no prior history of weight problems.

So what could have led to this patients sudden and massive weight gain? Doctors speculate that the bacteria donor could have played a role in her weight gain. Examination revealed that the recipient was also infected with other bacteria that may have changed the culture in her gut.

“We’re questioning whether there was something in the fecal transplant, whether some of those ‘good’ bacteria we transferred may have had an impact on her metabolism in a negative way,” said Colleen R. Kelly, MD, of the Warren Alpert Medical School of Brown University, who wrote the case report with Neha Alang, MD, of Newport Hospital in Rhode Island.

If true, this would mean that there could be a possible link between gut bacteria and weight. This would also be the first time such an association was made in the medical world.

A test conducted on mice further supports this assertion: transfer of gut bacteria from obese to normal-weight mice led to a marked increase in fat over time. In light of this data, doctors now recommend selecting donors who are not overweight for fecal transplants.

Source: IDSA, Open Forum Infectious Diseases

Written by Guillaume Lapointe-Gagner

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1st International Consensus Conference on Duodenal Switch this Summer in Montreal

The Canada chapter of American Society for Metabolic and Bariatric Surgery (ASMBS), the largest society for this specialty in the world, is holding it’s first International Consensus Conference on Duodenal Switch in Montreal this summer, June 22-23. Dr. Michel Gagner, President of ASMBS Canada Chapter, will host the conference with other soon to be announced international delegates.

Founded in 1983, the ASMBS strives to advance the art and science of metabolic and bariatric surgery by continually improving the quality and safety of care and treatment of people with obesity and related diseases by “advancing the science of metabolic and bariatric surgery and increase public understanding of obesity” and “fostering collaboration between health professionals on obesity and related diseases”.

The Consensus Conference on Duodenal Switch is a big step in achieving these goals; by bring a host of international health professionals on obesity and related diseases all under one roof, the conference hopes to provide understanding and public awareness on issues pertinent to obesity on a global scale.

The first day of the conference (June 22nd) will be dedicated to live surgery demonstrations supervised by Dr. Gagner, including a Laparoscopic Duodenal Switches, revision of duodenal switch, conversion of sleeve to duodenal switch, SADI-S (Single Anastomosis Duodeno-Ilestomy with Sleeve), conversion of sleeve to SADI-S, SIPS (Stomach Intestine Pylorus Sparing surgery), conversion of bands to DS, and conversion of gastric bypass to DS.

The second day will have a focus on oral presentations, debates, and panel discussions on nutrition, physiology of malabsorption, hormonal aspects, outcomes and results, along with complication management and the when, whys, and how’s of Conversions. While this conference might hold numerous educational opportunities, one of the largest added advantages of coming in person to one of these events is fraternizing with colleagues. By attending you will be able to enjoy the company of like-minded professionals who have a vested interest in the field of Bariatrics and Metabolic Surgery.

So now that you know about the conference, save the date! There isn’t a better time to come visit Montreal. In this town, it’s next to impossible to miss a big festival during the summer. The city pulses with music, fireworks, sports events, along with many other indoor and outdoor happenings that are perfect for family outings. Streets close off to cars to make way for sidewalk sales and terasses, and the entire city is packed with free concerts almost everywhere you go. Speaking of free concerts, the Montreal International Jazz Festival is just around the corner, starting June 26th and lasting until July 5th.  Enjoy world-class music in one of the most culturally vibrant cities in the world.

Written by: Guillaume Lapointe-Gagner

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The Maestro Rechargeable System – New Weight-Loss Surgical Product Approved By FDA

On January 14th, 2015, the FDA approved a new surgical product for the American market that could revolutionize weight-loss surgery. The Maestro Rechargeable System, developed by EnteroMedics, Inc., is a treatment intended for those who suffer from morbid obesity or who are obese with one or more obesity-related conditions.

So how does it work, one might ask? Surgeons would place an internal component inside the stomach that would emit electrical impulses to nerve electrodes lining the vagus nerve in the abdomen. Two electrical leads would then connect the electrodes directly to the pulse generator. These internal components would attach to a transmit coil, a mobile charger, and a clinician programmer that could be manually operated externally. These electrical impulses transmitted by the Maestro Rechargeable System in the stomach sends signals to the brain that the stomach feels empty or full.

Although the weight loss mechanisms remain unclear, one could see the advantages for creating a feeling of “fullness” amongst those who crave food. It has been shown by numerous studies that cutting appetite can directly lead to weight-loss amongst obese patients. The Maestro Rechargeable System is intended for use by morbidly obese patients: those with a Body Mass Index that fall between 40 and 45 or those with obesity-related health complications such as high cholesterol or high blood pressure and whose BMI falls between 35 and 39.9. Since this procedure is relatively new, only those who are 18 years and above are eligible.

According to a study conducted by the manufacturer, a sample group of people who used the Maestro Rechargeable System lost 8.5% more excess weight than those belonging to a control group, who used other means of weight-loss. On average, those that used the product lost 24.4 pounds in comparison to 15.9 pounds for those who didn’t. These results are promising, but the surgery may not be for everyone. Patients who may have a higher risk to surgical procedures do not make ideal candidates for the procedure and may need to look elsewhere to resolve their weight-related woes.

Written by: Guillaume Lapointe-Gagner

Source: FDA

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Fact or Fiction: Healthy Obesity

Scientists from the Washington University School of Medicine in St Louis have recently completed a study following 20 obese patients over the course of several months and have discovered that around a quarter of them were healthy despite having gained several kilos during the course of the study. This study was published in the January 2nd edition of the Journal of Clinical Investigation. Subjects were asked to consume 1000 additional calories per day, mostly from fast food restaurants, to increase their weight by at least 6%.

The results of the study show that some obese patients do not suffer from traditional symptoms and complications that come with obesity. In fact, scientists have already observed such findings in the general populace: around a quarter of obese people do not suffer from complications that put them at risk of heart attacks, aneurisms, and diabetes, such as high cholesterol, high blood pressure, and an excess of fat in the liver. Those who have already observed metabolic problems, however, only made the problem worse after they gained more weight. It is important to underline that for the vast majority of people, gaining weight will still have an adverse effect on their health. In other words, just because there are a few people out there who have won the genetic lottery doesn’t mean that we ought to expect the same treatment. The key is to stay healthy.

One way this study has helped researchers is by giving them vital insight into what differentiates obese individuals that are less susceptible to developing further complications and those that are more susceptible. “…Genetics might play a role”, Samuel Klein, the author of the study and director of Washington University’s Center for Human Nutrition, suggests. Results show that people of excess weight with a normal metabolism had advantageous genes that helped them regulate their fat intake. Gene activity is still present when people with normal metabolism gain weight, but not the same can be said for those with abnormal metabolisms.

Written by Guillaume Lapointe-Gagner

Source: lapresse

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Is Obesity a Disability? – EU Courts Rule

In some circumstances obesity could be considered grounds for disability, EU courts ruled in December. The court ruling followed one Danish man’s (Karston Kaltoft) claim to false termination of employment for being too fat: Kaltoft claims that he was terminated because he was overweight.

This discrimination case was brought to trial after he was fired four years ago by his employers, of which he had worked for 15 years. Kaltoft worked as a childminder, a job that required him to, in some cases, perform strenuous activities he was unable to perform.

If obesity could hinder “full and effective participation” at work, then it could be considered as a disability, the courts said. This ruling is of great interest to employers across Europe; it sends a powerful message that an obese worker whose weight hinders their performance at work is entitled to disability protection.

This means that employers are required (on a case by case basis) to provide reasonable adjustments for obese employees in the workplace. This can include minor things such as providing larger chairs, special car parking, etc. Furthermore, providers of goods and services are held to the same standards: Places like shops, restaurants, and cinemas will now have to cater to disabled people who are obese.

This ruling has potential to raise awareness among employers of their responsibility towards obese employees in the workplace. “It is implying that people have no control over the condition, rather than something that can be greatly improved by changing behaviour.”

While obesity itself is not a disability, the effects of it can be. This is perhaps the most important takeaway of the entire ruling: people who suffer from illnesses such as joint problems, depression, or diabetes do not have the right to be terminated because of their weight. The ruling is binding throughout the entire EU.

Written by Guillaume Lapointe-Gagner

source: theguardian

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Bariatrics in Canada Today: Bigger and Better

According to a study released by the Canadian Institute for Health Information (CIHI), bariatric surgery in Canada is a better and more viable option for obese patients now more than ever before. Using mainly administrative data, the study examines and describes several aspects of patients’ hospital experiences and outcomes.

Among the study’s main findings, it was found that in 2012-2013, there were 6,000 bariatric surgeries performed in Canada alone! This constitues a growth of 400% from just 2006-2007. This can be attributed to the in part to the growing concern over rising obesity rates in Canada, and the continuing interest and attention in bariatric surgery by the public in recent years. Moreover, it was found that the typical bariatric surgery patient is a 40-year-old woman who has obesity and other obesity related illnesses.

Overall, the study shows that complication and readmission rates have vastly declined over time and that these rates are comparable to those reported in other countries. In other words, Bariatric surgeons are getting better at what they do as the field is maturing. They are finding new and improved ways to save lives every single day.

For people with moderate to severe obesity, bariatric surgery really is an effective tool for long-term weight loss, yet it is important to stress that this is a lifelong commitment. Surgery alone cannot complete the job entirely; diet change and healthier lifestyle choices are also a must.

The report states that the rise of bariatric surgeries in Canada is due largely to increased funding, surgical capacity and treatment programs in some provinces, most notable Ontario and Quebec. It is also estimated that as much as 1,000 of those 6,000 procedures performed in Canada were done so in private clinics.

Written by Guillaume Lapointe-Gagner

Source: Bariatric News

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National Institutes of Health (NIH) Study Reveals Obesity May Lead to Reduced Life Expectancy

In a study released earlier this year, the National Institutes of Health (NIH) and its subsidiary, the National Cancer Institute (NCI), found that adults who belong in the class III category of obesity (those with a BMI of 40.0 or higher) have an increased risk of dying at a younger age than those with lower BMIs.While this may not come as a surprise to some of you, little had been known about the risks of premature death in association with extreme obesity before this study.

Findings revealed that the leading causes of premature death among those with extreme obesity were cancer, heart disease, stroke, diabetes, and kidney and liver diseases. These results were pooled from 20 studies of people from three countries (United States, Sweden, and Australia).

This study is important and relevant in all of our lives because the prevalence of class III obesity is on the rise all over the world, especially in the United States where this study was conducted (almost 6% of American adults are now classified as extremely obese). Researchers found a strong correlation with increased chances of early mortality with higher BMIs; the higher the BMI, the higher the risks.

Years of life lost ranged from “6.5 years for participants with a BMI of 40-44.9 to 13.7 years for a BMI of 55-59.9”. This has profound implications for people that find themselves within those BMIs: they need to get help now or risk dying, at a minimum, six and a half years earlier! To give a better understanding, being morbidly obese is worse for your health than having smoked a pack a day for your entire life with a normal weight.

While there may be some clinical errors to be found within the study: height and weight were mostly self-reported (and if natural tendencies are to be believed, many respondents are hesitant to reveal their true measurements if the study is not done anonymously), as well as with the Body Mass Index format being the sole measurement of obesity (there might be other scales of obesity that do not go by BMI).  Nevertheless, the results show that rising levels of obesity is definitely something to be concerned about. It seems as if our society has reached a point where obesity related diseases may become one of the leading causes of death.

Written by Guillaume Lapointe-Gagner

Source: NIH

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