AIS CHANNEL

Patient Outcomes

In previous events, four of the best bariatric surgeons in the world performed LIVE four of the most common revisional techniques. NOW it’s time to report, analyze and discuss their results and the rationale for their choices! In an interactive format, featuring Dr. Karl Miller as moderator, Dr. Camilo Boza, Dr. Bruno Dillemans, Dr. Michel Gagner and Dr. Robin Blackstone are discussing the mid-term outcomes of: Gastric Sleeve to Re-Sleeve, Gastric Sleeve to Gastric Bypass, Gastric Sleeve to Duodenal Switch & Revision of Banded Gastric Bypass respectively, regarding not only weight loss and co-morbidities resolution, but also complications and patient satisfaction.

Revision of a Gastro-Gastric Fistula

Gastro-gastric fistula is an uncommon complication of gastric bypass (both Roux-en-Y and single anastomosis). Its symptoms range from none (if the fistula is small) to severe (if the fistula is significant). Severe symptoms include: invalidating gastroesophageal reflux (GERD), and failure to lose weight. The treatment can be postponed when symptoms are mild, but more often than not, revisional surgery needs to be considered. Despite several isolated reports on success with endoscopic treatment, state-of-the-art treatment currently still consists of (laparoscopic) revisional surgery. This case is the laparoscopic revision of such a gastro-gastric fistula after a Roux-en-Y gastric bypass.

Gastro-jejunal sleeve/redo gastro-entero

The preview medical information was about a case of weight recidivism after an Open Biliopancreatic Diversion (BPD) procedure performed 20 years ago on a patient with a BMI of 49.6 kg/m2 who reached a nadir BMI of 23 kg/m2 and presented weight recidivism returning to a BMI of 44.1 kg/m2. Patient presented with a good nutritional status, with a light anemia, no diarrhea, and no malodorous gas or feces. Surgery started with a pneumoperitoneum performed with a Veress needle and placement of the trocars. As the first procedure was open there were many adhesions to remove. Although the information was that the first procedure was a BPD, with the progress of the dissection it could be seen that the real surgery had been a Gastric Bypass with transmesocolic retrogastric reconstruction. For these cases a good strategy is moving the dissection to the retrogastric space by dividing the greater curvature vessels that will allow a direct approach to the alimentary limb. Finally, after adhesion removal, a banded long and wide pouch, a 4 cm gastrojejunostomy, and a large candy cane were found. Once we examined the anatomy, we decided to resize the resizing of the pouch and perform a new gastrojejunostomy. The pouch dissection started by approaching the smaller curve, reaching the retrogastric space, making it possible to staple with the green cartridge, reducing pouch length to 3 cm, and reducing pouch width to 2 cm with the vertical staple. Reinforcement of these staple lines was ensured by using the Seamguard. The alimentary limb was divided in order to resect part of pouch and the candy cane, and a new 15 mm gastrojejunostomy was performed. A methylene blue test was performed with a negative result. The highlights of the video could be linked to the importance of having a good previous surgical report in order to make the procedure easier – exactly the opposite than in this case, in which the information provided was not correct. It is very important to proceed with a wide dissection and a clear anatomy in order to have all the information so as to make the best decision about the procedure strategy.

Weight regain after RYGBP: Sugerman-type distalization

Weight regain or inadequate weight loss after gastric bypass represents one of the most challenging problems in revisional bariatric surgery. Pouch and/or stoma reduction has little to offer, except for short-term and minimal results. Operative revision of the gastric pouch is associated with 3-5 times the incidence of leak and other post-operative complications. Separating behavioral and biologic causes for weight regain is difficult and there are no biochemical measurements available to assist in this important differentiation. A subjective, but consistent tool uses the symptoms of the disease, i.e., hunger and satiation as a surrogate for biological food and calorie acquisition as opposed to psychologic eating. Therefore, taking advantage of the increased metabolic response of the distal type 1 bypass can provide a better response and safer revision than working on the pouch.

Conversion to RNY Gastric Bypass

Progressive dysphagia is a known complication of the VBG due to the presence of the ring that has been placed. A recurrence of the sliding hernia after a Nissen fundoplication is also a well-described entity. Unfortunately, our patient experienced both problems concomitantly. Our theory is that the recurrence of the sliding hernia aggravated the dysphagia caused by the earlier placed ring of the VBG. The symptoms have grown gradually worse over the years. The patient’s weight regain, which augments intra-abdominal pressures will not have helped in this matter. In order to alleviate all of our patients’ problems we needed to tackle this case from every angle. Firstly, to make sure the dysphagia and vomiting is gone the ring will have to be removed. To ensure alleviation of her reflux we needed to reduce the hernia. Lastly, because of her weight regain extra measures needed to be taken. Adding more restriction alone would not have helped this patient who already complains of dysphagia and vomiting, so we opted for a conversion to a Roux-en-Y gastric bypass. This is still the gold standard treatment for GERD in the obese population, will result in a significant weight loss and - when the pouch is constructed above the formerly placed ring - her dysphagia and vomiting will also subside.

Laparoscopic TME

Laparoscopic TME with low colorectal end-to-end anastomosis (stapled) and temporary ileostomy.

Open Sigmoid Resection for colo-vesical Fistula

Lower midline laparotomy (open) with dissection of the sigmoid colon.

Challenges in Emergency Colorectal Surgery

Dr. John Alverdy, Dr. Manish Chand, Dr. Lucía Oliveira, Dr. Inés Rubio and Dr. Hongwei Yao present the Challenges in Emergency Colorectal Surgery.

Should We Change the Strategy in Patients with Compromised Tissue in Colorectal Surgery?

Dr. Roel Hompes, Dr. Masaaki Ito, Dr. Antonio M. Lacy, Dr. Yves Panis, Dr. Nicolas Rotholtz and Dr. Patricia Sylla present the "Should We Change the Strategy in Patients with Compromised Tissue in Colorectal Surgery?" event.

Multidisciplinary Decision-Making In Rectal Cancer

In this event we want to highlight the decision-making process behind the treatment strategy chosen for each of our patients. Pathologists, radiologists, oncologists., and surgeons from all over the world will be coming together to discuss the best available options, the ideal path to follow, and the need for supplemental treatment.

From Fellowship into Practice

Dr. Venkatesh Munikrishnan, Dr. Gabriela Moeslein, Dr. Eduardo Villegas, Dr. Julio Mayol, Dr. Silvia Valverde, Dr. Mark Soliman, Dr. Julio Jiménez present "Dr. Julio Jiménez".

Improving Results in Colorectal Surgery in the Time of Covid-19

Program: Introduction: 1. Welcome & Introduction. Dr. Manish Chand and Dr. Steve Wexner. COVID-19: 1. New clinical pathways in the COVID19 era. Dr. Silvana Perretta (France). 2. COVIDSurg: A Global Study. Dr. Aneel Bhangu (UK). 3. COVID-19 effects in cancer patients waiting lists. Dr. Debby Keller (USA). 4. The Italian reaction. Dr. Luigi Boni (Italy). 5. Discussion. All faculty moderated by Dr. Steven Wexner (USA) and Dr. Manish Chand (UK). Surgery: 1. PIPAC – roles and limitations. Dr. Olivia Sgarbura (France). 2. Can Stapling Technology reduce leaks? Dr. Sam Atallah (USA). 3. Is TaTME dead? Dr. Antonio Lacy (Spain). 4. Is smoke dangerous? Dr. Jared Torkington (UK). 5. Discussion. All faculty moderated by Dr. Manish Chand (UK) and Dr. Steve Wexner (USA). Faculty: Dr. Debby Keller (USA), Assistant Professor of Surgery in Colorectal Surgery, Columbia University, New York (USA). Dr. Aneel Bhangu (UK), Consultant Colorectal Surgeon, University Hospital Birmingham, Founding member of the COVID Surg Initiative. Dr. Silvana Perretta (France), Chief of Foregut Surgery and Advanced Gastrointestinal Endoscopy Division, Director of the Esophageal Motility Laboratory at the NHC University Hospital, Strasbourg, France. Dr. Luigi Boni (Italy), Chief of Surgery at the Fondazione IRCCS – Ca’ Granda, Policlinico Hospital, Milan, Italy. Dr. Steven Wexner (USA), Director, Digestive Disease Center, Cleveland Clinic Florida, Vice Chair of the American College of Surgeons Board of Regents. Dr. Olivia Sgarbura (USA), Surgical Oncologist, Institut Regional du Cancer Montpellier, France. Dr. Sam Atallah (USA) , Professor of Surgery, University of Central Florida, USA. Dr. Antonio Lacy (Spain), Chief of Gastrointestinal Surgery Department, Hospital Clinic Barcelona. Dr. Jared Torkington (UK), Consultant Colorectal Surgeon, Spire Cardiff Hospital, UK. Dr. Manish Chand (UK), Consultant Colorectal & Endometriosis Surgeon, University College London (UCLH), UK.

SADI Procedure by A. Pernaute and A. Torres

The Single Anastomosis Duodeno-Ileal bypass (SADI procedure) is a bariatric operation aimed at decreasing postoperative complications and achieving sustainable long-term results: The SADI procedure (Single Anastomosis Duodeno Ileal bypass) is a bariatric procedure that is the evolution of a BPD-DS after a sleeve gastrectomy aimed at decreasing technical difficulty and postoperative complications. Follow-up after 5 years is available and reveals good control of T2DM (74 - 80% of patients with HbA1c below 6%). Other benefits are: a low complication rate and “easy revision” if required. Dr. Andrés Sanchez-Pernaute and Dr. Antonio Torres performed a Live SADI procedure at Hospital Clínico San Carlos of Madrid.

Winter Event 2017

During the AIS Winter Event 2017, AIS Channel broadcasted LIVE the following surgeries: ESD colon/rectal by A. Haji / P. Bhandari, Lap Right Hemicolectomy (4K Surgery) by AM Lacy / B. De Lacy and Robotic Right Hemicolectomy by V. Obias / C. Johnson

Gastric Sleeve to Re-Sleeve

Sleeve Gastrectomy has become the most common bariatric procedure worldwide due to its good results, simplicity, and low complication rate. However, a number of patients can experience weight regain after several years. Although most of the time bariatric surgeons would prefer revision to a duodenal switch or a bypass, new evidence has shown that a re-sleeve gastrectomy is a feasible option, specially when the patient had a good initial outcome in the absence of reflux and hiatal hernia and when there is a dilation of the gastric tube. We present the case of a 34-year-old female patient who underwent a Sleeve gastrectomy 6 years ago, losing 43 kilos, from 113 to 70 kilos over 18 months (BMI 41 to 25). She maintained her weight for 3 years, but after having her second daughter she progressively regained weight. She came to the hospital with a BMI of 35, a relapse of joint disease, and sleep apnea. Weight 97, Height 1.66m. Preoperative studies showed a dilated gastric tube but no evidence of hiatal hernia or reflux. After the assessment of the multidisciplinary team, the re-sleeve surgery has been selected as the reasonable option.

Gastric Sleeve to Gastric Bypass

Even though long-term results support the consideration of sleeve gastrectomy as a standard-alone procedure, when weight loss failure (insufficient weight loss or weight regain) occurs, or complications such as de novo GERD appear, a reversal procedure must be considered. There is no consensus on the procedure of choice for LSG reversal. Weight loss after revisional procedures tends to be modest and decision making must consider not only morphological aspects but also other patient-related factors such as resolution of comorbidities, dietary habits, or the presence of sleeve-related sequelae. Therefore, several options such as re-sleeve, RYGBP, banded sleeve, BPD, SADI-S or OAGB can be offered not only to add weight loss but also to improve both metabolic results and procedure-related complications. Current evidence suggests that in the presence of GERD, conversion from SG to RYGBP could regarded as the procedure of choice.

Adjustable Gastric Band to Gastric Bypass

Reoperative bariatric surgery procedures are becoming a significant part of MBS practice. They are performed to deal with complications and weight gain after the primary procedure. One of the most common complications in patients with a history of gastric bypass is marginal ulcer (MU) and stricture. The incidence of marginal ulcer (MU) is 1-16%, although true incidence is unknown. Bleeding and perforation are the presenting factors in some patients. Chronic MU is often accompanied by abdominal pain and stricture as in the case presented.

Gastric Sleeve to Duodenal Switch

Sleeve gastrectomy (SG) is currently regarded as a standalone procedure for most morbidly obese patients due to its results for both weight loss and comorbidity resolution. Nevertheless, up to 64 and 70% of patients can present with insufficient weight loss and weight regain in the long term. Hence revisional techniques are often needed in order to improve both weight loss and metabolic control. Although there is no consensus on which technique should be performed after SG as a second-step procedure, Roux-en-Y Gastric Bypass (RYGBP), re-sleeve and bilio-pancreatic diversions (duodenal switch, SADI-S, SIPS) are commonly considered. Due to its excellent results for both weight loss and comorbidity improvement, specially in super-obese patients, duodenal switch can be an optimal option for those patients with very significant weight regain or por metabolic control.

Challenges and Solutions during COVID-19 Phase 2

Maintaining and enhancing surgeon wellness. Dr. Tan Arulampalam (UK), Advancing science. Dr. Kenneth W. Sharp (USA), Challenges in the assessment of resident education. Dr. Jo Buyske (USA), Maintaining effective communication, Dr. Paula Ferrada (USA), Addressing and mitigating health care disparities, Dr. Wayne Meredith (USA), Impact on education. Dr. Ajit Sachdeva (USA), J&J meeting surgeons / future leaders (residents, fellows) evolving education needs. Mr. Vladimir Makatsaria (USA), Discussion. All faculty moderated by Dr Steven Wexner (USA) and Dr Patricia Turner (USA).  Faculty: Dr. Tan Arulampalam (UK). Professor of Surgery, Colchester General Hospital. Dr. Jo Buyske (USA). Executive Director of the American Board of Surgery, Past President of SAGES. Dr. Kenneth W. Sharp. MD, Professor of Surgery, Vice-Chair for Faculty Affairs, Department of Surgery, VUMC. Dr. Paula Ferrada (USA). Professor of Surgery, Director Trauma and Surgical ICU, Virginia Commonwealth University. Dr. Wayne Meredith (USA). President of the American College of Surgeons, Chair of General Surgery and Director of Surgical Sciences at Wake Forest Baptist Health, Founding Executive Director of the Childress Institute for Pediatric Trauma. Dr. Ajit Sachdeva (USA). Director of the American College of Surgeons Division of Education. Dr. Patricia Turner (USA). Director, Division of Member Services, American College of Surgeons; past Chair, AMA Council on Medical Education; past Chair, Surgical Section, National Medical Association; past President, Society of Black Academic Surgeons; and Member, Board of Directors, Council on Medical Specialty Societies. Dr. Steven Wexner (USA). Director, Digestive Disease Institute, Chair, Department of Colorectal Surgery, Cleveland Clinic Florida, Vice-Chair, Board of Regents, American College of Surgeons. Mr. Vladimir Makatsaria (USA). Company Group Chairman, Ethicon (J&J).

Successful Leadership during COVID-19 Phase 2

Dr. Alberto Ferreres, Mr. Aldo Denti, Dr. David Hoyt, Dr. Joseph Bosco, Dr. Julie Freischlag, Ms. Linda Groah, Dr. Patricia Turner, Dr. Scott Levin and Dr. Steven Wexner present the "Successful Leadership during COVID-19 Phase 2" event.

Challenges and Solutions to Diversity - Part 1

Challenges and Solutions to Diversity Part 1, divided into: Challenges to women surgeons in Asia – Dr April Roslani (Malaysia), Black surgeons as leaders – Dr. Francis Chinegwundoh (UK), The importance of mentoring – Dr L.D. Britt (USA), Women surgeons as mentors – Dr Tracy Hull (USA), Women surgeons as leaders – Dr Valerie Rusch (USA), Diversity in innovation at J&J – Dr Charles Bridges (USA), Discussion – All faculty moderated by Dr Steven Wexner (USA), Dr Patricia Turner (USA) and Dr Mariana Berho (USA)

Myths and Realities on the use of Energy Systems during COVID-19

Welcome & Introduction, Dr. Antonio M. Lacy (Spain). Different types of energy and how they work. Dr. Thomas Robinson (USA). Surgical smoke and viruses: evidence on detection and transmission (monopolar, bipolar, ultrasonic and CO2 laser). Dr. Desmond C. Winter (Ireland). Aerosolization of SARS-CoV-2 with all energy devices. Dr. Jose Balibrea (Spain) Aerosolization of SARS-Cov-2 with ultrasonic energy. Dr. John Alverdy (USA) Surgical smoke evacuation. Dr. Peter J. DiPasco (USA) Energy usage by procedure type: open, lap & robotic. Dr. Simon Ng (China) Alternatives to energy in surgery: Do we need them? Dr. Kjetil Soreide (Norway) Discussion / Q&A. All debates moderated by Dr. Antonio M. Lacy (Spain) Closing Remarks. Dr. Antonio M. Lacy (Spain) FACULTY Dr. John Alverdy, MD, Executive Vice Chair, Department of Surgery, The University of Chicago Medicine, (USA) Dr. Jose Balibrea, Hospital Clinic of Barcelona, Gastrointestinal Dept. of Surgery, (Spain) Dr. Peter J. DiPasco, MD, Surgical Oncologist at the The University of Kansas Health System, (USA) Dr. Antonio M. Lacy, Hospital Clinic of Barcelona, Chief of Gastrointestinal Dept. of Surgery, (Spain) Dr. Simon Ng, Professor, Division of Colorectal Surgery, Department of Surgery, The Chinese University of Hong Kong, (China) Dr. Thomas Robinson, MD, Chief of Surgery at the Denver Veterans Administration Medical Center, Founder and medical director of the Center for Surgical Innovation (CSI), (USA) Dr. Kjetil Soreide, MD, PhD, Consultant Surgeon and Associate Professor at the Stavanger University Hospital and University of Bergen, (Norway) Dr. Desmond C. Winter, Consultant Surgeon at the St. Vincent’s Healthcare Group, Clinical Associate Professor in Surgery at the University College Dublin, (Ireland) Myths and Realities on the use of Energy Systems during COVID-19

Successfully Achieving Diversity in Healthcare | Part 2

Program Association of women surgeons – Dr Sharon Stein (USA) Society of Black Academic Surgeons – Dr Andrea Hayes-Jordan (USA) Society of Asian Academic Surgeons – Dr Quan-Yang Duh (USA) Ensuring educational opportunities – Dr Carla Pugh (USA) The role of journals in achieving diversity – Dr Melina Kibbe (USA) Health Equity and the Role of the Private Sector – Dr Pierre Theodore (USA) Discussion – All faculty moderated by Dr Steven Wexner (USA), Dr Patricia Turner (USA) and Dr Mariana Berho (USA)

The New Normal in Elective Surgery

PROGRAM: Welcome & Introduction by Dr. Manish Chand. What drove the CMS/ACS/AORN/AHA/Am Society of Anesthesiologists Guidelines being established? Open Discussion. Dr. Steven Wexner and Dr. Linda Groah. European team perspective on guidelines/protocols/process to reinstate elective surgeries.Round Table. Dr. Jean-Blaise Wasserfallen & Team. Core Team:Dr. Dieter Hahnloser, Department of SurgeryDr. Patrick Schoettker, Department of AnesthesiologyMs. Patricia Neves-De-Oliveira-Dias, Deparment of Nursing American team perspective on guidelines/protocols/process to reinstate elective surgeries.Round Table. Dr. Marc Boom,CEO of the Houston Methodist Hospital Core Team:Dr. Osama Gaber, M.D., Interim Chair, Department of SurgeryDr. Robert A. Phillips, M.D., Ph.D., Executive Vice President and Chief MedicalMs. Roberta A. Schwartz, Executive Vice President and Chief Innovation Officer The role will industry play to ensure the resuming elective surgeries.Ms. Ashley McEvoy. Panel Discussion.All faculty. Moderator: Dr. Manish Chand. Closing Remarks.Dr. Manish Chand. FACULTY(by alphabetical order) Dr. Marc Boom,CEO of the Houston Methodist HospitalDr. Manish Chand,Consultant Colorectal & Endometriosis Surgeon, University College LondonDr. Linda Groah,CEO of AORNMs. Ashley McEvoy,Executive Vice President - Worldwide Chairman and Medical Devices at Johnson & Johnson.Mr. Rod Menchaca,CEO of Advances in SurgeryDr. Jean-Blaise Wasserfallen, Vice-medical director of University Hospital Lausanne, SwitzerlandDr. Steven Wexner,Cleveland Clinic Florida, Director of the Digestive Disease Center.

Patient Selection Considerations for OAGB and SADI-S

Dr. Matthew D. Kroh and Dr. Mitchell S. Roslin present Patient Selection Considerations for OAGB and SADI-S.

Laparoscopic Total Proctocolectomy + TaTME with J- pouch Reconstruction

Dr. Antonio Caycedo performs a Laparoscopic Total Proctocolectomy + TaTME with J- pouch Reconstruction to a 22-year-old male.

Technical Steps to Perform the OAGB

Prof. Mario Musella (ITALY) and his team from AOU "Federico II", Naples, Italy, perform a One Anastomosis Gastric Bypass (OAGB)

OAGB to RNYGB

On April 22 at 4pm (Abu Dhabi Time), AIS Channel will be broadcasting this procedure performed by Dr. Ricard Corcelles (UAE) and his team at Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.

RNY to GJ-S with modified Nissen

RNY to GJ-S performed by Dr. Dillemans.

RNY to GJ-S with modified Nissen

RNY to GJ-S performed by Dr. Dillemans.

Medical Management as an Option

Dr. Lilian Kow, Dr. Scott Shikora, Dr. Michael Talbot and Dr. Plamen Staikov present Medical Management as an Option

Technical Steps to Perform a Gastric Bypass

Dr. Kelvin Higa MD, FACS, FASMBS Clinical Professor of Surgery, UCSF - Fresno Medical Education Program

Sleeve to RNYGB

Program coming soon...

Technical Steps to perform a SADI-S Procedure

Prof. Mario Musella (ITALY) and his team from AOU "Federico II", Naples, Italy, perform a One Anastomosis Gastric Bypass (OAGB)