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01:23 07/03/14 | Owen Haskins | Editor in chief, Bariatric News

Bariatric News talks to Dr Patrick Grumillier, a bariatric surgeon from Clinique Louis Pasteur, Essey-lès-Nancy, France, about his experience using the BIORING…

How many procedures have you performed using BIORING?

More than 1,000 procedures, I have been using BIORING since its launch.

According to your experience, what do you think about the BIORING safety and efficacy results?

I am convinced about the efficacy of this gastric band. For me it is the most efficient. About safety, I have no problem so far.

In your opinion what are the design advantages of the BIORING compared to other devices on the market?

The BIORING device has a major advantage thanks to its self-adhesive port called “Adhesix”. It is time saving for the port implementation with no fixation. According to my experience I have no problems with port flipping. Also, the bellow system brings a better comfort to the patient and decrease band slippage.

Dr Patrick Grumillier

Do you have any advice (tips or tricks) for surgeons who may use the device?

I do not have any advice in particular. However, for me the average effective setting of the ring is 6cc but it is variable depending on the patient. I also perform the filling of the ring with saline and not contrast fluid. In my practice the ring size has covered the needs of all my patients.

What makes you propose to a patient a sleeve versus a LAGB or a GBP (age, BMI, co-morbidities, nutritional education sensibility, etc)?

Gastric band is presented to all my patients in first intention. I am not doing anymore bypass. For me, the sleeves are dangerous with a high risk of fistulas. The outcome/risk ratio is excellent for gastric banding. LAGB represents 85% of my practice. Out of these 85%, I have 84% of good to excellent results.

What do you think about gastric band and more specifically the BIORING in the treatment of obesity for teenagers?

No treatment before 18 years old, however, the gastric band is for me my preferred technique for young people as it is a reversible, adjustable and non-mutilating technique. Also in the future the technique and treatment of morbid obesity will evolve. A ring can always be removed after years following the arrival of a new treatment, unlike a Sleeve or Bypass. Also, Bypass technique brings great vitamin deficiencies, which is intolerable for teenager.

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06:48 04/03/14 | Owen Haskins | Editor in chief, Bariatric News

The March issue of Obesity Surgery (Volume 24, Issue 3,), the official journal of the International Federation for the Surgery of Obesity and Metabolic Disorders, is now available online. Here are some of the highlights from this issue:

Vitamin D Status 10 Years After Primary Gastric Bypass: Gravely High Prevalence of Hypovitaminosis D and Raised PTH Levels.

The aim of this study was to evaluate the prevalence of vitamin D deficiency and secondary hyperparathyroidism after RYGB in 293 patients. The researchers found that Vitamin D was inversely correlated with PTH levels and positively correlated with calcium. They concluded that the data was “alarming” and highlighted the need for improved long-term follow-up...(Abstract)

Hiatal Hernia Repair in Laparoscopic Adjustable Gastric Banding and Laparoscopic Roux-En-Y Gastric Bypass: A National Database Analysis.

The investigators wanted to assess the surgical risk of hiatal hernia repairs performed concomitantly with laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) to decrease gastro-oesophageal reflux disease (GERD). They used the US Nationwide Inpatient Sample 2004–2009 to compare mortality risk, prolonged length of stay (PLOS), and perioperative adverse events using propensity score-matched analysis. They found no evidence of increased risk of perioperative adverse events among patients undergoing concomitant HH repair with LRYGB or LAGB...(Abstract)

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06:07 04/03/14 | Owen Haskins | Editor in chief, Bariatric News

Just in case you missed any news last month, these were the 10 most read articles on bariatricnews.net in February 2014 including the latest research, product & industry news, policy news and more...

Diabetes - prevention is better than cure

In a recent paper, Australian researchers reported that bariatric surgery may be an effective diabetes prevention strategy for paitents with impaired fasting glucose. Here, co-author of the study, Professor Paul O'Brien, discusses the possible implications of the findings...(more)

LSG does not relieve or resolve GERD

Laparoscopic sleeve gastrectomy does not resolve or relieve gastroesophageal reflux disease (GERD) and in some instances may actually contribute to reflux, according to the study by researchers from the Madigan Army Medical Center, Ft Lewis, WA…(more)

Low cost, low risk procedure aids weight loss

A recent paper, ‘Banded Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity’, published in Surgery for Obesity and Related Diseases (SOARD), concluded that the banded bypass procedure is safe and may provide better weight loss in super-obese patients. Bariatric News talked to one of the study’s authors, Dr Philip Schauer (Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH), about the study and benefits of the procedure...(more)

Banded bypass more effective in super obese

Banded bypass procedure is safe and may provide better weight loss in super-obese patients, according to a paper, published in Surgery for Obesity and Related Diseases (SOARD). The researchers urged further prospective and long-term comparative studies of the banded bypass procedure to confirm its safety and whether it is superior to standard non-banded bypass...(more)

Mesenteric defects: To close or not to close

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09:07 13/02/14 | Anonymous (not verified) |

On 11 February 2014, Bariatricnews.net published an article featuring a paper by Maureen Boyle and co-workers at Sunderland Royal Hospital who reported an analysis of a small prospective database on the mini-gastric bypass (MGB); this first MGB series from the UK found excellent safety and weight loss compared to other bariatric operations, as found recently in large series (1-3).

However, an additional presentation by Bennett et al from Cambridge stated that the reduced peri-operative complications in the MGB may be outweighed by the long-term risk of developing oesophago-gastric cancer.  This is a theoretical study. A SurveyMonkey questionnaire filled out before and reported at the Paris Consensus Conference on MGB in October 2013, involving 16,651 MGBs performed by the expert attendees over the past 16 years found no development of carcinoma in the gastric channel or oesophagus (4).  As an aside, the MGB has been effective in resolving GE reflux disease, likely related to traction which the gastro-jejunal anastomosis provides on the gastric pouch, which reduces the cardia within the abdomen, plus resolution of the patient’s obesity.

Increased concentration of bile could be problematic in operations which result in bile at the cardia – high Billroth II gastrectomy and the old Mason loop horizontal gastric bypass. In the 1960s and 70s, we performed 1,000s of vagotomies and pyloroplasties when duodenal ulcer was common, and all had bile in the lower end of their stomach, but none developed carcinoma. The Billroth II gastrectomy and old Mason loop gastric bypass are definitely not the MGB, which has a long vertical pouch to at least the crow’s foot. Furthermore, long-term studies following Billroth II did not find increase in cancer in the remaining stomach, although the likely presence of H. pylori was then unknown and untreated (5-8).

Studies with concentrated bile have been performed in the rodent stomach, in which the proximal two-thirds is squamous cell and the distal one-third is glandular.  It was shown in 1991 that concentrated bile or irritants in the rat’s stomach led to hyperplasia and malignancy in the proximal two-thirds on the unique rat stomach (which is squamous cell) and not in the glandular distal one-third (which corresponds to the human stomach) (9). This should cause some concern in another bariatric operation, the sleeve gastrectomy, where GE reflux is not infrequent.

About 40 carcinomas have been reported after Roux-Y gastric bypass, gastric banding and lately sleeve gastrectomy. No doubt someday a carcinoma may also be reported in the gastro-oesophageal tube after MGB, but the evidence for increased concern is very weak.

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