Ideas from Bariatric Surgery that impact Plastic Surgeons
Lessons from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) World Congress 2024, held from September 3-6, 2024, in Melbourne. As the largest global event of its kind, the congress attracted over 1,700 attendees from 96 countries, including top surgeons, researchers, and health professionals.
For plastic surgeons, the extensive of prescription weight loss drugs like Ozempic, Wegovy and Mounjaro and MANY newer drug innovations will mean a boom in loose skin needing skin tightening or surgical excision. Johnny Franco from Austin Plastic Surgeon in USA has already shifted his practice to take advantage of this need.
Robotics, ERAS and AI will also play a part in the future of Plastic Surgery. The need for Bariatric Surgery may be diminished and some obesity surgeons may offer more Plastic Surgeries like liposuction, panniculectomies and fat transfer,
Key Themes from the Bariatric World Congress:
1. Integration of Bariatric Surgery with Weightloss Science innovations
The merging of traditional surgery with new weight loss technologies, advancements in weight loss drugs and interdisciplinary care. The event focused on integrating the latest in robotics, AI, and pharmacotherapy to improve patient outcomes.
2. Emerging Weight Loss Drug Therapies – Stage 2 & 3 Drugs coming!
A significant highlight was the discussion on new Stage 2 and 3 weight-loss medications, including Semaglutide and Tirzepatide, which offer patients effective alternatives to weightloss surgery with weight loss percentages currently reaching up to 18%. Several new drugs were introduced that target not just fat reduction but also preservation of muscle mass—a critical concern for sustainable long-term weight loss.
3. AI, Robotics and Advanced Technologies for Obesity and Weightloss
AI in Surgery: AI took center stage with demonstrations on how it can predict post-surgical complications and forecast weight loss. AI-based tools, such as Baribuddy, are enhancing patient communication and post-op monitoring.
Robotics: Robotic surgery, including the Da Vinci system, was lauded for its precision, improved recovery rates, and ability to handle complex bariatric procedures.
4. Surgical Innovations – evolution of Bariatric Surgery and post-surgery weightloss drugs
Metabolic and Bariatric Surgery: As obesity management becomes more complex, surgery remains a key treatment. With over 70% of procedures being sleeve gastrectomy and 27% being gastric bypass rather than Lap banding, discussions focused on long-term patient management and the integration of weight loss drugs to enhance surgical outcomes.
5. Perioperative Care & Patient Safety with ERAS
The ERAS (Enhanced Recovery After Surgery) protocols were emphasized as transformative – cutting down hospital stays and patient complication rates. Sessions focused on improving perioperative strategies to ensure patient safety, particularly in high-risk populations.
6. Legal and Medico-Legal Challenges
The rise in patient complaints & litigation concerning bariatric surgery was also discussed, particularly related to revision surgeries. Legal experts advised on how surgeons can better protect themselves through detailed consent processes, improved processes and follow-up protocols. Solo bariatric surgeons in regional areas had higher risks of litigation.
SUMMARY
The IFSO 2024 World Congress provided a comprehensive overview of the evolving landscape in bariatric and metabolic surgery. The integration of new technologies, combined with the development of novel drug therapies, signifies a paradigm shift in how obesity is managed worldwide. Attendees left with valuable insights into cutting-edge surgical practices, the role of AI and robotics, and the critical importance of multi-disciplinary care in treating obesity as a chronic disease.
Top Ideas from the IFSO 2024 World Bariatric Conference, Melbourne
Although there were MANY presentations – here are some of the ones that I attended and a brief summary of the highlights,
SEP 4 :
Medications and Metabolic Surgery
Overview of Lee Kaplan’s Presentation (Dartmouth Geisel School of Medicine)
- Rise of Stage 2 & 3 weight-loss medications with over three dozen new drugs in development.
- 225 known complications of obesity, ranging from metabolic disorders to organ-specific issues.
- Highlighted drugs include Semaglutide (17% average weight loss) and Tirzepatide (12-18% weight loss), focusing on the regulation of fat mass and body weight.
- Retatrutide and Servotatide showed effectiveness in liver fat reduction and overall metabolic improvements.
Overview Michael Cowley’s Research (Monash University)
- Explored older weight-loss drugs like Phentermine and Orlistat and newer agents such as Semaglutide and Tirzepatide.
- Emerging focus on muscle preservation during weight loss, with new drugs targeting myostatin and other factors to prevent muscle loss during fat reduction. This will aim to lose more fat and less muscle during weightloss.
Overview of Phil Schauer’s Presentation (Cleveland Clinic)
- Discussed the future of bariatric surgery and the growing importance of integrating drug therapies with surgery for enhanced weight-loss outcomes.
- No five-year data is yet available for newer drugs like Semaglutide and Tirzepatide (2 year data shows successful weightloss but some weight regain if treatment is discontinued.
Technology & AI in Medicine
Overview of Simon Kos Presentation (Microsoft, NSW)
- Simon explained AI’s role in healthcare, specifically in generating summaries and interpreting diagnostic reports (ECG, radiology).
- Emerging technologies like ambient clinical scribes and Generative AI (e.g., GPT-4) are revolutionising documentation and administrative processes in medical practices.
- Demonstrated the difference between “Amateur” AI tools like Chatgpt, Claude and Copilot and “professional-level” Enterprise AI tools available from Microsoft Azure. You can see where the answers came from and fine-tune your results.
Bariatric Surgery Innovations
ERAS and Perioperative Care Presentation by Mehran Anvari
- Enhanced Recovery After Surgery (ERAS) protocols reducing length of stay from 60 to 38 hours, lowering complications, and reducing costs.
Surgical Safety & Risks Presentation by Dr Lillian Kow
- Bariatric surgery is relatively safe, with a 0.08% risk of death and a 4% risk of complications in USA – Less in Australia.
- Emphasis on the prevention of errors through ERAS, improved patient behaviours, and advanced technologies.
SEP 5:
Medical-Legal Aspects of Bariatric Surgery
Medico-legal Insights Presentation by Adam Skidmore, Bariatric Surgeon in Albury
- 21% of bariatric surgeons are involved in legal cases, and litigation trends are pushing for revisions in practice, particularly in revision surgeries.
- Some Australian Cases have reached settlements of up to $3.5 million, with claims for revision surgeries being most common.
Weight Regain & Surgical Revisions
Weight Regain Presentation by Mohit Bhandari & Lee Kaplan
- Explored causes of weight regain after bariatric surgery, including pouch dilation and behavioural factors.
- Discussed surgical options like endoscopic revisions and changes from OAGB (One-Anastomosis Gastric Bypass) to more aggressive surgeries like RYGB (Roux-en-Y Gastric Bypass).
Revisions in Duodenal Switch Presentation by Michel Gagner
- Focused on techniques to address weight regain by revising duodenal switch procedures, reducing stomach size, or making additional adjustments.
SEP 6:
Future of Bariatric Treatment
AI in Bariatrics Presentation by Natan Zundel
- Use of AI for predicting surgical complications and forecasting weight loss with high accuracy. AI tools like Baribuddy offer support for patient communication and post-op monitoring.
Next-Generation Robotics Presentation by Ann Rogers
- Robotics in bariatric surgery are improving precision and outcomes. Surgeons are increasingly using robotic systems for bariatric procedures, with Da Vinci systems leading the way.
Pharmacotherapy Presentation by Priya Sumithran, Monash University
- Focused on newer drugs like Tirzepatide and Semaglutide, which offer weight loss results similar to surgery, with long-term benefits for glycaemic control, cardiac health, and reducing fatty liver disease.
Lifestyle and Nutritional Considerations
Nutrition and Exercise Presentation by Gary Wittert, University of Adelaide
- Emphasised the importance of resistance training to prevent muscle loss during weight loss, alongside focusing on plant-based diets and intermittent fasting.
Further Useful References
- International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): https://www.ifso.com
- Cleveland Clinic Bariatric Surgery: https://my.clevelandclinic.org/services/bariatric-surgery
- Monash University – Bariatric Surgery Research: https://www.monash.edu/medicine
- Microsoft AI in Healthcare: https://www.microsoft.com/en-us/industry/health/ai-healthcare
- Da Vinci Surgical Systems (Robotic Surgery): https://www.intuitive.com/en-us/about-us/company/da-vinci-surgical-system
