The EndoBarrier is fundamentally a gastrointestinal impermeable barrier or a gastric sleeve that prevents food from coming in contact with the intestinal wall.

The EndoBarrier Gastric Sleeve is implanted endoscopically through the mouth and is placed in such a way that it lines the first two feet of the small intestine. This helps to prevent easy absorption of food as long as it remains in the sleeve and has huge impact on the person’s intake of nutrients and calories. The digestive enzymes are on the outside of the liner and the food and the digestive juices do not mix until 2 feet downstream in the small intestines.

The EndoBarrier received European CE mark approval for the treatment of type 2 diabetes and obesity in December 2009.

Currently the EndoBarrier is being considered as a prelude to gastric bypass surgery and hence is treated as a temporary fix. But, its future, as a non-surgical alternative to weight loss and diabetes type 2 treatment, is extremely promising.

Clinical trials to date demonstrated a significant weight loss and diabetes improvement achieved with the Endo-Barrier Gastrointestinal Liner.

Undoubtedly we will hear a lot more about this New Obesity Surgery/

Robotics Obesity Surgery is a particularly good option for bariatric patients who choose the gastric bypass procedure. Robotic surgery isn’t commonly available yet, but certainly considered a new technology on the rise.

Robotics is a cutting-edge method of performing surgery using only a few small incisions, or keyholes similar to that used in laparoscopic cases, as ports for instruments that allow access to the heart, lungs and abdomen, while at the same time fine-tuning the technical skills of the surgeon. This surgery is performed in a three dimensional image compared to the two dimensions of laparoscopic surgery. Robotic instrumentation works by mimicking the motions and movements of the surgeons’ hands and fingers. This provides an added element of dexterity for the surgeon. Furthermore, the da Vinci’s wrist action capabilities allow the surgeon to get around corners and in tight spaces for improved precision.

When performing a gastric bypass procedure, the most complicated and important part of the obesity surgery is creating the connection between the stomach and small bowel after creating the gastric pouch. The most common approaches in connecting them are to either staple or to hand sew them together, but the best results to date and the least complications have been demonstrated with the sewing approach. The robot makes hand sewing much easier by increasing the dexterity, precision and vision of the surgeon in the tight space. More and more studies are now showing that not only in bariatrics but also in other surgical specialties complication rates are less in the robotic assisted approach when compared to the standard laparoscopic approaches.

The Gastric Balloon is a non-surgical procedure available for weight loss in many countries. While gastric balloon procedures generally cost less than other weight loss procedures, the FDA has not approved of the procedure in the United States. The balloon is effective in temporarily reducing hunger, controlling food intake, initiating behavioral (lifestyle) change, and achieving target weight loss of 10 to 25kg. This procdure is also called Toga (for transoral gastroplasty)

What is the gastric balloon?
The gastric balloon is a soft, silicone balloon that is inserted into the stomach and filled with sterile saline (salt water). When the balloon is filled (inflated) it stretches the stomach wall producing a feeling of satiety – or flack of hunger.. Additionally, because the gastric balloon fills a significant portion of the stomach, patients use smaller portion sizes, which means fewer calories!

How is the balloon implanted?
Placement of the balloon takes approximately 20-to-30 minutes to perform by a team of qualified gastroenterologists. Because the balloon is inserted and removed in a day clinic and does not involve surgery, it is considered to be a minimally invasive procedure.

The doctor passes a special endoscope (camera) through the mouth, down the gullet and directly into the stomach. This is done to ensure no abnormalities are present and it is safe to insert the gastric balloon. Once the physician has determined everything is okay, he or she will pass the deflated gastric balloon into the stomach. To ease discomfort, the doctor might offer a local anesthetic to numb the throat to make it easier to swallow. In some cases, muscle relaxants are also used to sooth throat muscles.

Once the gastric balloon is inside the stomach, it is immediately filled with sterile saline through a small filling tube (catheter) attached to the balloon. Once filled, the doctor removes the catheter by gently pulling on the external end. The balloon has a self-sealing valve and at this point it is floating freely in the stomach. Physicians also add a specially made green dye so that in the event of the balloon leaks or ruptures, the patient’s urine will change color, thereby alerting them to visit the doctor.

Because there is no general anesthesia involved in this weight loss procedure, the patient is observed for a short time, he or she is free to leave the hospital in one or two hours.

Obese patients with diabetes type 2 whom had obesity surgery reversed their diabetes very soon after their obesity surgery.

More surgeons are testing whether obesity surgery helps diabetics who are merely overweight or a tad obese to control their blood sugar.

It has been reported that The Cleveland Clinic is recruiting 150 overweight and obese diabetics. Some will have surgery and their progress will be compared to those who manage their diabetes with medicine. The goal is to see which group can beat their diabetes.

Also seen reported on the wire that the New York-Presbyterian/Weill Cornell Medical Center is looking for 50 diabetics to undergo surgery. Doctors will track if patients’ blood sugar levels normalize after the procedure.

Longterm success of keeping weight off after obesity surgery depends on maintaining the lifestyle you needed to made to lose the weight.

That means continuing improving your body and mind.

Even if you now look and feel great after the weight loss you achieved with obesity surgery, there are always steps you can take, every day, to improve your body and mind to ensure the weight stays off. It takes constant work to improve your life, even when you have achieved already so much.

The stress of modern life can sometimes make it difficult to continue leading a healthy lifestyle. You can continue living healthy by adopting a healthy mindset.

So with that said, we all can use some healthy living tips to ensure that we are the best we can be every day. So here are some healthy living tips to improve your body, mind and long term weight control.

The most essential mental and physical health tip is to enjoy quality sleep. Likely your sleep apnea is gone after the weight loss. Getting enough sleep will boost your health and productivity, and it will rejuvenate your body and mind.

Some people may believe that sleep is overrated, but study after study has shown that those who get at least eight hours of sleep look and feel better than those who don’t.

Don’t be be tempted to skip exercise. Not only does exercise help you look good, but it also helps you feel good. Exercise releases endorphins that make you feel good from top to bottom and stress literally drips off you!

Positive thinking begins when you affirm the positives in your life. You can use the power of positive affirmations to reprogram your mind so you can think in a healthier and more positive way

Use positive affirmations to help remind you of your healthy living goals. Affirmations are short statements that encourage you to sharpen your mind and body while conquering your goals and improving on your weaknesses. Affirmations can help you focus on creating and maintaining the healthy body and mind you desire because it gives you the motivation you need to focus on your most important asset – you!

For example, each morning you could say, “I make positive choices for the best of my body, mind, and soul.” You can use positive affirmations in moments of weakness when you are tempted to fill up on junk food, respond negatively to something, or trade sleep for something less important.

Some other examples of affirmations include, “It is okay for me to take care of myself first,” or, “I am healthy and deserve the benefits of a healthy lifestyle.” You can use these simple positive statements throughout the day to stay motivated and focused. After all, we all need some motivation from time to time.

When you create a healthy mindset by making good choices about food, rest, and positive thinking, you’ll enjoy the new ways you think, feel, and live. You’ll discover that your happier, healthier lifestyle has arrived after your obesity surgery!

Incision Free Obesity Surgery Update

A clinical trial for Transoral Gastroplasty for the Treatment of Morbid Obesity (TOGA®) started April 15,2008. This study is ongoing, but not recruiting anymore participants.

The TOGA procedure is an incision-free treatment using a set of flexible staplers introduced into the mouth and esophagus to create a sleeve in the stomach (transoral formation of a gastric sleeve). The TOGA sleeve limits the amount of food that can be eaten and gives the patient a feeling of fullness after a small meal.

Primary Outcome Measures:
Participants had over 25% excess weight loss after 12 months.

Secondary Outcome Measures:
Improvement in Co-morbidities; Improvements in other Obesity Measures and in Quality of Life Measures after 12 months.

Final data collection date for primary outcome measure is expected by October 2010.

Researchers in Mexico and Belgium also successfully tested TOGA weight loss over the past year. TOGA patients stayed overnight in a hospital after the procedure, but doctors believe it will eventually be performed on an outpatient basis. Repoprts indicates up to 45% of excess weight loss.

The Toga System for transoral gastroplasty is being developed by Satiety, Inc., a medical device company based in Palo Alto, Calif. The system comprises a set of flexible devices designed to be inserted through the mouth into the stomach to staple the stomach. The company is now conducting clinical trials with the hope of filing for FDA approval in the future.

Overweight people who have tried diets and exercise but have not achieved lasting weight loss may be candidates for obesity surgery. Obesity surgery has helped thousands of people in America or abroad lose weight, improve their appearance and improve their health. Weight loss surgery may not be for you. Also this option is currently only available for obese persons. But there are New Trends in Obesity Surgery! We describe them all here at “New Obesity Surgery” Blog!

Patients considering obesity surgery need to have realistic weight loss expectations. Patients also need to make changes to the diet after undergoing obesity surgery.

Bariatric surgical procedures can be divided into three kinds:
1. Restrictive procedures decrease food intake and promote a feeling of fullness after meals. Examples are Adjustable Gastric Banding (Lapband) or Gastroplasty (reduction of the stomach).
2. Malabsorptive procedures reduce the absorption of calories, proteins and other nutrients. Examples are the Biliopancreatic Diversion or the Duodenal Switch. Both are rarely used.
3. A combination of both restrictive and malabsorptive procedures. Examples are the Mini Gastric Bypass, Proximal Roux-en-Y Gastric Bypass and the Distal Roux-enY Gastric Bypass.

Almost all above described obesity surgery procedures have resulted in consistent short-term weight loss. Unfortunately there is no perfect operation. The remarkable drive for the obese patient to regain weight cannot be eliminated in all patients. Furthermore, the history of weight loss surgery repeats itself with procedures that seemed initially to be very promising and safe in theory, but which were later found to be failures. As such, newer procedures should always be viewed with caution.

The Proximal Roux-en-Y Gastric Bypass (RYGBP) has been the most commonly used procedure in USA. The Roux-en-Y Gastric Bypass outnumbers all other procedures and results and count almost for 80% of all bariatric surgeries performed worldwide.

A new restrictive procedure is being clinical tested. The Intragastric Balloon is a silicone prosthesis of spherical format and has a smooth surface. It is introduced into the patient’s stomach by an endoscopic procedure. In general there is no need for hospitalization.

It is important to gather further information about weight loss surgery by consulting an experienced and knowledgeable bariatric surgeon or even just an expert family physician who knows the ins and outs of weight loss surgery. In addition, the patient should also consult the other health experts such as the psychiatrist and dietician with regards to some psychological advices on long-term goals after the operation. Bariatric surgeons do normally have those experts within their staff.