Journal Club

Bariatric Surgery, like any other field in Medicine, is constantly evolving. I always tell my residents that the procedures I do today - and the way I do them - is drastically different from what I learned in my surgical training. As experimental procedures become validated and new studies on existing procedures are published, we adapt and evolve in our practice and recommendations. A good example is the way the adjustable gastric band went from being the most popular procedure in the years 2000 to almost completely falling out of favor today.

As educators, we are always teaching our surgical residents and medical students the latest in bariatric surgery. We also learn with them as we humbly understand that we too are students for life. Among our various educational venues, we hold a Journal Club every other month where we get together - surgeons and residents - and review a few high-quality peer-reviewed journal articles that were recently published. This week, one of our articles discussed a variation to the gastric bypass.

Although the gastric sleeve is currently the most popular bariatric procedure worldwide, the gastric bypass is often the preferred bariatric treatment, especially when type 2 diabetes is present. The Roux-en-Y gastric bypass however has not had any essential alterations to its original design since it was first developed in the 1970s. In the article we reviewed, Dr. Berends’ group From The Netherlands examined the possibility of constructing a longer stomach pouch in gastric bypass patients, and its effect on surgery complications, long-term weight loss and reduction of obesity-related medical illnesses. He randomized patients to having either a standard pouch or an “extended pouch”. Interestingly, he found no significant differences in terms of weight loss between the 2 groups during the first 2 years of follow-up. In the third year of follow-up however, the standard pouch group regained 3 kg, while in the extended pouch group, no weight regain was observed. No other significant differences between the groups were found.

I have been a fan of Dr. Berends’ work. He is often thinking outside the box and has been designing some high quality studies. Some of his earlier publications, specially a recent one looking at the rerouting of the small bowel in gastric bypass surgery, have already lead me to make some changes in my current practice. Although I found the extended stomach pouch concept interesting, I did not feel that the difference in weight loss was clinically significant enough to push me to change the way I do my surgery. I would be interested however to see more data on these patients as he continues on following them over time.

The study did reinforced for me a couple of things that I already do currently. First: there is no need to create a super tiny stomach pouch. Second: there should be no concern in creating a longer stomach pouch if the anatomy of the patient dictates it.

We will continue on learning as the field of bariatric surgery continues on evolving. As it has been said many times, if you are staying in place, you’re actually falling behind.

- JRS