The surgical lipo-industry - Forum

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Grandpa Phil

The surgical lipo-industry - Ärzteforum

Post#1 »

I was silently following the recent discourse on Bariatric surgery and wish
to briefly lay down a few modest thoughts about this topic. In my mind,
the principles of the surgical lipo-industry are as following:

1. It's "standard of care" is "lack of any standard"

2. It exchanges a state of "altered physiology" for a state of a "new
pathology".

3. Morbid obese patients stick as honey

4. It stinks of money


It's "standard of care" is "lack of any standard".
This is a fact! Looking at the history of these procedures one sees how
each group seeks to improve on the "existing" operation, adding or
discarding this or that gimmick. A band here, a stapler line there, until
yet a "new type" of complication appears. In fact, if you carefully
examine the genesis of all such procedures it consist of experimental
surgery on humans; no animal models, no randomized clinical trials- the fat
guys and girls being the guinea pigs

It exchanges a state of "altered physiology" for a state of a "new
pathology".
Definitely! Morbid obesity is a disease -caused by altered physiology-what
ever it is. Patients undergoing any of those procedures must understand
however that if successful- they are "trading-in" the state of obesity for
a pathologically dysfunctional foregut. If you want the operation to
succeed - you must "live with" your new pathology. A failed operation,
however, does not always mean the patient returning to his pre-op happy
obese exsistence.

Morbid obese patients stick as honey
They do! At the first interview they are sweat as honey-hiding their
psychopathology which usually is IMMENSE. They "understand everything",
they promise to be cooperative. But see them after the operation-once they
cannot enjoy their huge volumes of food, once they can cheat the operation
by drinking a lot of full cream milk-shake. They complain and bitch- and
stick to you as honey. Until you move away or they find another genius who
is ready to "revise" your operation.

It stinks of money.
It does! Those surgeons performing Bariatric procedures as a significant
portion of their practice have the mentality of hair transplant surgeons-
and you know what I mean.
Avi, you mentioned your "colleagues" who have an experience with thousands
of such proceudres. I had the pleasure to treat a few of the "acute" and
"chronic" complications originating from that specific Bariatric group
(will be happy to share with you very interesting case reports). The
financial "methods" practiced by the ex leader of this group wound sound
horrific even in NY.

Saying all this I do not mean that there is no place for Bariatric surgery.
Selected morbidly obese patients should be treated in dedicated centers
performing a standardized operations and offering an around the clock
follow-up. Groups performing the operations should be able to document and
provide early and late results.

Unfortunately, this not the situation in the surgical lipo-industry around
the world!

I tried to keep this communication brief. Anyone who wants to take issue
with any of the above "principles"? I'll be more than happy to provide
examples.


User avatar
Surgeon

Re: The surgical lipo-industry - Ärzteforum

Post#2 »

And the Lord said to the surgeon on Judgment Day....I made them fat, you should have left them this way...

Grandpa Phil

Re: The surgical lipo-industry - Ärzteforum

Post#3 »

The above was saved into my growing file of Surgical Aphorisms- to be published sooner or later

forceps

Re: The surgical lipo-industry - Ärzteforum

Post#4 »

I have seen patients who have had
bariatric surgery successfully performed and who greatly benefitted from the
operation. I have never performed this type of operation and I do not plan to.
There are surgeons who have published their results in standard peer-reviewed
journals whose reuslt are thus open to scrutiny. I feel there are honest,
ethical surgeons who perform bariatric surgery and help patients. These are the
ones, I would refer my patients to.

forceps

Re: The surgical lipo-industry - Ärzteforum

Post#5 »

Surgeon wrote:And the Lord said to the surgeon on Judgment Day....I made them fat, you should have left them this way...

Nevertheless, as physicians, we attempt to reverse many of the maladies with the L-rd has inflicted on human beings.

John Dissector

Re: The surgical lipo-industry - Ärzteforum

Post#6 »

The problem with this statement is it is poor basis for performing this
considerable surgery in and of itself--and this kind of anecdotal platitude is
all I've seen to justify it.
I have seen morbidly obese patients lose considerable weight without surgery,
greatly benefitting, therfore, even more from medical management--so where
does that leave us--interesting how you overlooked mentioning this other side
of the issue!
Also, in response to aqnother similar post the other day--the benefits you
ascribe to bariatric surgery should actually be ascribed to LOSING WEIGHT, not
the surgery! The question which continues to be slickly avoided here is the
one I originally asked--can't those benefits be equally well achieved without
the surgery--well, clearly yes! The problem is, in the absence of a
randomized trial, such benefit can't be proven, and that is what should be
done for such a major and morbid intervention--if just a fraction of the
effort expended on publishing the meaningless retrospective uncontrolled
studies alluded to above were focussed on a prospective trial, we could have
the answer--Now why do we all suppose such a trial has never been done? It
couldn't be, could it, that we are afraid the results would destroy this cash
cow? Can anyone provide a more likely reason? It is such an obvious step to
take, isn't it?

Grandpa Phil

Re: The surgical lipo-industry - Ärzteforum

Post#7 »

Go and try duplicate Mason's VBG series... or go duplicate Porier's
gastric bypass series. Yes, they are obviously honest (or were) but why-
if you try to do as well as they -you suddenly get all these complications
that they did not describe?

It may be that retrospective or allegedly prospective non-randomized
reports are susceptible to honest manipulations.

this is not Bariatric surgery but anti-gobbling
surgery- it may help a motivated patient lose weight.

Kardashian surgeon

Re: The surgical lipo-industry - Ärzteforum

Post#8 »

I am in the state where bariatric surgery was pioneered by Ed Mason. I know him
personally, and he has not been motivated by monetary reasons. Rather, he
identified a need to help the morbidly obese to lose weight. While I have been
around these unfortunate patients in abundance during my career here, I don't do
the operations. I do review records for preop approval for the operations, and I
have asked for comparison studies of weight loss modalities, and for analysis of
operative results. None have been done by the Iowa Foundation for Medical Care, a
pro. While there have been successes in weight loss by diet, there are few long
term, consistent plans that are successful. There are clearly long term successes
with bariatric operations, and this has been attested to by a consensus conference
of the NIH. Before approval can be given for a VBG, 2 years of diet failure must
be documented. A multidiscplinary medical term evaluates the patients
preoperatively. These patients have demonstrated comorbidities that are related to
their obesity. I attempt to direct all patients to the U of Iowa, because, in
opinion, if these operations are going to be done, and because the patients need
and deserve the best care in a controlled setting where proper analyses can be
performed, a university medical center is only place for them. I have already
gotten into this discussion further than I had planned without having references.

John Dissector

Re: The surgical lipo-industry - Ärzteforum

Post#9 »

there are no studies proving what you say--again, we all agree
there may be a role for this surgery in the proper hands and after the proper
attempt at nonsurgical methods--but how much are you willing to bet that few
if any of those who do this surgery out there put their patients thru this
strict preop trial? None would be my guess--and this is the crux of my
problem with this surgery. Also, as surgeon said, there has been no science
behind its development, much like the early days of another big moneymaking
technology--laparoscopy and lasers.
Let's take a poll of those who do or defended this surgery out there--how many
put their patients first thru a strictly controlled 2 year dietary regimen and
psych counseling before considiering the surgery--just yes or no, not
defensive reasons WHY not, and how hard it would be, etc!

User avatar
Resident

Re: The surgical lipo-industry - Ärzteforum

Post#10 »

I've only assisted on one of these operations as a third yr resident. It
was performed by a surgeon who was by anyone's standards a technically
inferior, money grubbing alcoholic. I feel very strongly it is the wrong
approach to this problem, and angus's thought of "god made em fat...leave
em fat" is fine by me.

My thoughts are that if we really believe surgery is indicated, we ought to
turn the whole mess over to the neurosurgeons. Let them put a needle into
the "eating center" of the hypothalamus and touch the bovie to it a few
times instead of all this mangling of the foregut. Much cleaner and
addresses the problem more directly.

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