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Bariatric Surgery: The Past, the Present, and the Future
By Mr. Kamal Mahawar
Submited on: 30 Jul 2012 05:29:18 AM GMT
Published on: 30 Jul 2012 05:57:58 PM GMT
 
Review of Bariatric Surgery: The Past, the Present, and the Future
Posted by Dr. Robert Rutledge on 07 Aug 2012 01:30:15 AM GMT

  • What are the main claims of the paper and how important are they?

    The paper points out tha an overview of the rapidly expanding field of bariatric surgery is littered with a wide variety of differing forms of weight loss operations and that many have had significant failures.  The reivew of this esperience is designed to place these various opertions into perspective to try to gain insight into the similarities and differences of the operative approaches and use this analysis to guide future thinking about this area of surgical therapy.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The novel and attractive part of this review is the insight into the past experiences with various forms of baratric surgery and noting the similarities and differences of the various procedures and attempts to draw some conclusions from how differing "classes" of operations have faired and thus how future variations within a class of procedures may be expected to perform.


  • Are the claims properly placed in the context of the previous literature?

    The paper uses past experience with bariatric procedures and their results to suggest implications for future choices of bariatric procedures.


  • Do the results support the claims? If not, what other evidence is required?

    The disussion paper is an insightful analysis of the fac that bariatric surgery is notable for :

    A rapid rise in the number of operation performed

    A wise variety of procedures performed

    A classification system for all of the the opertions offered

    A sobering exposition of the failures of certian operations


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    N/A


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    This ia a thoughtful review of the past experience with bariatric surgery and is notable for the insights that the author has pointed out and the fact that although these insights and difficult to seen form the published data on bariatric surgery few others have put forth similar analyses.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    The paper is a brief thought piece and could easily be expanded.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    This insight into the classification and faioures of bariatric surgery is critically needed.  If as Dr Gagner has stated that the band is a failure and thousands have been subjected to this operation, then what does this mean to patients, referring physicians and bariatric surgerons.


  • Other Comments:

    None

  • Competing interests:
    I offer the LMGB and have been a critic of the RNY and the band for over a decade
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Laparoscopic mini-gastric bypass: short-term single-institute experience. Piazza L, Ferrara F, Leanza S, Coco D, Sarvà S, Bellia A, Di Stefano C, Basile F, Biondi A. Updates Surg. 2011 Dec;63(4):239-42. Epub 2011 Nov 22. PMID: 22105765 [PubMed - indexed for MEDLINE] Related citations 2. Hospitalization before and after mini-gastric bypass surgery. Rutledge R. Int J Surg. 2007 Feb;5(1):35-40. Epub 2006 Aug 10. PMID: 17386913 [PubMed - indexed for MEDLINE] Related citations 3. Efficacy of estradiol topical patch in the treatment of symptoms of depression following mini-gastric bypass in women. Rutledge R, Dorghazi P, Peralgie C. Obes Surg. 2006 Sep;16(9):1221-6. PMID: 16989708 [PubMed - indexed for MEDLINE] Related citations 4. Revision of failed gastric banding to mini-gastric bypass. Rutledge R. Obes Surg. 2006 Apr;16(4):521-3. PMID: 16608620 [PubMed - indexed for MEDLINE] Related citations 5. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Rutledge R, Walsh TR. Obes Surg. 2005 Oct;15(9):1304-8. PMID: 16259892 [PubMed - indexed for MEDLINE] Related citations 6. One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity. García-Caballero M, Carbajo M. Nutr Hosp. 2004 Nov-Dec;19(6):372-5. PMID: 15672654 [PubMed - indexed for MEDLINE] Related citations 7. Similarity of Magenstrasse-and-Mill and Mini-Gastric bypass. Rutledge R. Obes Surg. 2003 Apr;13(2):318. No abstract available. PMID: 12740148 [PubMed - indexed for MEDLINE] Related citations 8. The mini-gastric bypass: experience with the first 1,274 cases. Rutledge R. Obes Surg. 2001 Jun;11(3):276-80. PMID: 11433900 [PubMed - indexed for MEDLINE] Related citations

  • Experience and credentials in the specific area of science:
    None
  • How to cite:  Rutledge R .Review of Bariatric Surgery: The Past, the Present, and the Future[Review of the article 'Bariatric Surgery: The Past, the Present, and the Future' by Mahawar K].WebmedCentral 2012;3(8):WMCRW002170
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Good overview of the current status of Bariatric surgery
Posted by Mr. Naga Venkatesh Jayanthi on 06 Aug 2012 07:51:51 AM GMT

  • What are the main claims of the paper and how important are they?

    The claims of the article are clear and well set out at the beginning of the article.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    not applicable


  • Are the claims properly placed in the context of the previous literature?

    yes


  • Do the results support the claims? If not, what other evidence is required?

    not applicable


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    not applicable


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    not applicable


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    not applicable


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    no


  • Other Comments:

    This article is pertinent to the current progress of Bariatric Surgery. Articles of this kind must be published periodically to keep upto date the current status and advances in such a fast growing speciality on the back of an obesity epidemic. This article is an overview of current status of Bariatric Surgery. Furthermore, it is clear from Kamal's article that Bariatric Surgery is an excellent example, where saftey profile of a risky procedure such as a gastric bypass transformed with the advent and application of laparoscopic approach.

     

    I do not agree with the description of a LAGB as reversible. How many of the gastric bands are actually removed following weight loss? This is a myth and I believe LAGB is for life.

     

    There is an increase in LSGs performed worldwide because it is 'perceived' as a safer operation. However the evidence supporting the success (weight loss, and amelioration of co-morbidities) is minimal. While this operation is ideal in selected patients, the meteoric rise of this operation doesn't come with adequate scientific evidence. The rise of MGB is similarly not justified and backed by evidence.

     

    The section on future of Bariatric surgery is wanting more detail. Apart from gastric balloon, there is no mention of other endoscopic procedures, such as duodenal sleeve, POSE, gastric plication (both endoscopic and laparoscopic). Kamal quite rightly mentions that the search for a safer and effective option and evolving role of gut hormones is leading to innovation.

     

    I thoroughly enjoyed reading the article written by an experienced and a thoughtful surgeon.

  • Competing interests:
    none
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I am a practising Bariatric Surgeon

  • How to cite:  Jayanthi N .Good overview of the current status of Bariatric surgery[Review of the article 'Bariatric Surgery: The Past, the Present, and the Future' by Mahawar K].WebmedCentral 2012;3(8):WMCRW002165
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