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

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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