Nuove Frontiere nella Chirurgia dell`Obesità

SIO Triveneto
LA GESTIONE INTEGRATA DEL PAZIENTE BARIATRICO
Nuove Frontiere nella Chirurgia dell’Obesità
Franco Favretti MD
Department of General Surgery
“San Bortolo” Regional Hospital of Vicenza (I)
Director: Franco Favretti
Medical Department University of Padua (I)
Director: Giuliano Enzi
Trieste, 21 Maggio 2010
US BARIATRIC SURGERY TRENDS 2002-2010E
177 K Surgeries in 2009 / 2010
Source: - Total Procedures – ASMBS 2002-2007, AGN Estimates 2008-2010; Banding 2002-2008 – LAP-BAND® Sales; Total Banding / Bypass / Sleeve
Procedures – AGN Estimates
Anno 2006 – 4. 870 interventi
3.000 2.887 Anno 2007 – 4.989 interventi
2.720 2.500 2.000 1.500 1.204 1.036 1.000 520 500 500 216 248 56 40 86 207 69 70 -­‐ Bendaggio gastrico Gastroplas8ca ver8cale Procedure 2006 Duodenal switch Procedure 2007 By pass bilio -­‐ intes8nale Anno 2006 – 4. 870 interventi
Anno 2007 – 4.989 interventi
58
%
59
%
24
%
2%
24
%
16
%
3%
14
%
Chirurgia dell’Obesità
mininvasività
FUTURO
tecnologia
THE DEVICE
EASY BAND
THE DEVICE
•  Similar to other gastric banding implants, except that adjustment is performed
from outside the body, telemetrically, in a non-invasive manner
Simulated images of technology – NOT final device
  Precise diameter adjustment from 19 to 29 mm
  Real time “on screen” diameter display
  Microchip card records last band adjustment
ADVANCED TECHNOLOGY
•  Telemetric adjustment
•  A small band antenna is placed underneath the skin
•  telemetrically activated electric motor embedded in the implant
•  Adjustment requires the use of an external control unit
•  The control unit is placed on the surface of the patient’s skin
•  Locates the band antenna and then adjustments are performed by pressing
the ‘open’ or ‘close’ button
•  The control unit displays a measurement of the band diameter, allowing
for precise and fine-tuned banding information
9
POTENTIAL ADVANTAGES
•  No puncturing of the patient’s skin
•  Reduction in access port related complications
•  Port irritation and discomfort
•  No system leaks or port and tube disconnections
The Tantalus System
Dispositivi Intragastrici
Gastroesophagoplasty Project
Nerves of Esophagus
Right Thoracic
Splanchnic Nerve
(Sympathetic)
Left Thoracic
Splanchnic Nerve
(Sympathetic)
Anterior vagal trunk
(parasympathetic)
Target
(subfascial area)
  Approach
Below Diaphragm
Above Diaphragm
Devices
Paddle type electrode
Generator
Devices
Balloon
Inflate
Balloon attached paddle electrode
  Inflate balloon
Inflate balloon to constrict esophagus
  Measure inter-lumenal pressure
Pressure sensor
Device monitored by pressure sensor
• The TransPyloric Shuttle™ (TPS™)
proposed novel mechanism of action
–  Intermittent sealing of pylorus in concert
with peristalsis
•  Delayed gastric emptying
•  Increased residence time for meals
•  Induced early satiation
•  Multi-year device dwell time
The contents of this document are proprietary and confidential
Intermittent Sealing of the Pylorus
Slows Gastric Emptying
The contents of this document are proprietary and confidential
Entirely endoscopic … Self-placing…
Non-anchored…Multi-year dwell
• TPS™ within delivery sleeve • TPS™ prior to locking
• TPS™ after unlocking
• Locked TPS™
TPS™ A New Approach
•  Proposed novel mechanism of action
–  Intermittent sealing of pylorus in concert with peristalsis
–  Self-positions
–  Non-anchored and free floating within the gastric cavity
•  Solid silicone device
–  Multi-year dwell time for behavior modification treatment
–  Avoids short-term placement limitations and device rupture/tearing
The contents of this document are proprietary and confidential
ReShape Dual-Balloon and Delivery
System
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The ReShape Procedure
Non-surgical 15 minute procedure
Step 1
Evaluation
Step 2
Placement
Step 3
Inflation
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The EndoBarrier System
The Valentx
Bariatric Surgery
Future characterized by:
•  Major impact of Quality of Life and Risk
/Benefits Analyses Concepts
•  Step by Step approach/Sequential Therapy
of Obesity