Obesity: Obesity: Surgical Surgical Management Management Eric S. Hungness, M.D. Eric S. Hungness, M.D. Assistant Professor of Surgery Assistant Professor of Surgery Department of Surgery Department of Surgery Northwestern University Feinberg School Northwestern University Feinberg School of Medicine of Medicine Chicago, Illinois Chicago, Illinois
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Obesity: Surgical Management Eric S. Hungness, M.D. Assistant Professor of Surgery Department of Surgery Northwestern University Feinberg School of Medicine.
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Obesity:Obesity:Surgical Surgical
ManagementManagement
Eric S. Hungness, M.D.Eric S. Hungness, M.D.
Assistant Professor of SurgeryAssistant Professor of Surgery
Department of SurgeryDepartment of Surgery
Northwestern University Feinberg School Northwestern University Feinberg School of Medicineof Medicine
22ndnd only to smoking as the leading cause only to smoking as the leading cause
of preventable death in the United of preventable death in the United
States.States.††
> 110,000 deaths/year in the US are > 110,000 deaths/year in the US are
associated with obesity*associated with obesity*
Life ExpectancyLife Expectancy
* Flegal KM et al. JAMA. 2005 Apr 20;293(15):1861-7. † † CDCCDC
Life ExpectancyLife Expectancy
Years of Life Lost Years of Life Lost (YLL)(YLL) white male 10 yearswhite male 10 years white female 7 yearswhite female 7 years black male 11 yearsblack male 11 years black female 3 yearsblack female 3 years
Life ExpectancyLife Expectancy
Fontaine et al. Fontaine et al. JAMAJAMA 2003; 289:187-193 2003; 289:187-193
UNSUCCESSFUL AT SIGNIFICANT UNSUCCESSFUL AT SIGNIFICANT OR SUSTAINED WEIGHT LOSS!OR SUSTAINED WEIGHT LOSS!
Trends In Surgery 1992 - 2003Trends In Surgery 1992 - 2003
Rationale for SurgeryRationale for Surgery
Long Term Outcome DataLong Term Outcome Data Sustained Weight LossSustained Weight Loss Improvement or Resolution of Co-Improvement or Resolution of Co-
morbiditiesmorbidities Improved long term survivalImproved long term survival
Minimally Invasive SurgeryMinimally Invasive Surgery Public AwarenessPublic Awareness
Obesity as a diseaseObesity as a disease Celebrities Celebrities
Indications for SurgeryIndications for Surgery
BMI >40 kg/mBMI >40 kg/m22, or >35 kg/m, or >35 kg/m22 with with significant co-morbid illnessessignificant co-morbid illnesses
Multiple failed weight loss attemptsMultiple failed weight loss attempts
Acceptable surgical riskAcceptable surgical risk
Age 18-60Age 18-60
Demonstrates commitment and Demonstrates commitment and understanding of weight loss following understanding of weight loss following bariatric surgerybariatric surgery
Leak Leak 1-2%1-2% BleedingBleeding InfectionInfection DehydrationDehydration Stricture/ Ulcer Stricture/ Ulcer 7%7% Conversion to open Conversion to open 1%1% Death Death 0.2 - 0.2 -
0.5%0.5%
Complications:Complications:BPD with Duodenal SwitchBPD with Duodenal Switch
Leak Leak 1-2%1-2% BleedingBleeding InfectionInfection DehydrationDehydration MalnutritionMalnutrition 5%5% Conversion to open Conversion to open 1%1% Death Death 0.5 – 0.5 –
1.1%1.1%
Weight LossWeight Loss
5 yrs5 yrs
MortaliMortalityty
%EBW%EBWLL
LBLB 0.1%0.1% 47.547.5RYGRYGBB
0.5%0.5% 61.661.6
DSDS 1.1%1.1% 70.170.1Buchwald et al. JAMA 2004; 292(14):1724-37
% Resolution of co-morbidity% Resolution of co-morbidity
↑ ↑ Chol/TGChol/TG
AA
DiabeDiabetestes
OSAOSA HTNHTN
LBLB 78.378.3 47.847.8 87.987.9 65.665.6
RYGRYGBB
93.693.6 83.883.8 94.694.6 75.475.4
DSDS 99.599.5 97.997.9 95.295.2 81.381.3
Buchwald et al. JAMA 2004; 292(14):1724-37
-Adams et al. NEJM 2007; 357:753-61-Adams et al. NEJM 2007; 357:753-61
-Adams et al. NEJM 2007; 357:753-61-Adams et al. NEJM 2007; 357:753-61
-Adams et al. NEJM 2007; 357:753-61-Adams et al. NEJM 2007; 357:753-61
SummarySummary
Obesity – epidemicObesity – epidemic Bariatric surgeryBariatric surgery