Non invasive methods in bariatric surgery - 2 |
II. NON INVASIVE METHODS IN THE BARIATRIC FIELD: EXISTING METHODS
Only two methods are available for the time being: the intragastric balloon, that we shall here once more address, and endostapling techniques.
Intragastric balloon:as our readers know, the balloon is the most ancient non invasive technique, and has provided fair results over the time provided once its limitations are understood ! It is indeed a temporary and low grade procedure, thus unable to deliver persistent results in the long run that would make it accepted by consensus. It is not reimbursed in many countries and most patients have to pay for themselves. Moreover, it is difficult at the moment to evaluate the natural place of the balloon: should it be used for temporary weight-loss, e.g. before an orthopedic surgery or even a bariatric surgery in a fragile patient (it has been proposed for "super-obese patients", with a high post-operative risk)? Or is it better for less severe obese patients, who are not suited for a typical bariatric procedure (lap-banding, gastric bypass)? Several randomized studies have shown a real benefice in non morbid obese patients, but few of them have demonstrated persistent results over the time, after the balloon had been removed*. Various types of balloons have beeen released, the most reliable being the "BIB" balloon (Allergan, US). A new air ballon made in France (Districlass)**, could be interesting: it has a subcutaneous access-port connected to the balloon through a catheter, enabling insufflations over the time. The duration can be extended to 18 months, hence the weight-loss can at that time matches the results of a lap-band... yet again on a temporary basis.
* Imaz I et al. Safety and effectiveness of the intragastric balloon for obesity. Obes Surg 2008; 18: 841-846.
** Gaggiotti G, Tack J, Garrido A, et al. Adjustable totally implantable intragastric prosthesis (ATIIP)- EndogastR for treatment of morbid obesity: one year follow-up of a multicenter prospective clinical survey. Obes Surg 2007; 17: 949-956.
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