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4th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY DIRECTOR'S MESSAGE Table of Contents Michel Gagner, MD, FRCSC, FACS, FASMBS, FICS, AFC (Hon.) I: The Utilization of Sleeve Gastrectomy Clinical Professor of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; and the Department of Surgery, Hopital du Sacre Coeur, Montreal, Quebec, Canada Changes in the Framework of Bariatric Surgery T he 4th International Consensus Summit on Sleeve Gastrectomy (ICSSG-4) was held in New York City at the Marriott Marquis, December 6 to 8, 2012. This follows three similar meetings held in New York City in 2007, Miami Beach in 2009, and again in New York City in 2010. This meeting included a record 25 live surgeries from multiple operating rooms from four continents and more than 100 oral presentations on various subjects touching this intervention. Here, we present 10 of the most influential presentations from the ICSSG-4. Sleeve gastrectomy (SG) has become the number one bariatric intervention in many countries in South America, Europe, and Asia, and it is in rapid progression in North America, with more federal, state, and provincial healthcare systems and private insurers accepting to cover this medically necessary procedure. The first session of oral presentations has been classically dedicated to understanding of the mechanism of SG, which is integrated in articles by Drs. Vidal and Lacy. Dr. Parikh discusses whether weight loss effectiveness of SG correlates with transit. In subsequent sessions, Dr. Nguyen reviews the changes seen in the frequency of various types of bariatric procedures. The ICSSG-4 focused particular attention to the management of weight regain after SG. One way to handle weight regain after SG is to convert to another procedure. Exploring this topic, Dr. Pomp provides a review of conversion of SG to Roux-en-Y 8 Video Features Gastric Bypass (RYGB), Drs. Torres and Sánchez-Pernaute, condense their experience with SG to duodenal switch with its single anastomosis or SADI-s, and Dr. Prachand discusses on duodenal switch after SG. We have seen more adjustable gastric bands being removed and then inserted again. Drs. Zundel and Hernandez review AGB revisions. Dr. Vemulapalli covers technical considerations in performing SG as a revisional surgery, and shares her own techniques. Dr. Cirangle discusses technical options and alternatives for SG and shares his own recommendations. This year, the live surgeries performed by Dr. Chouillard from Poissy France, brought by satellite transmission, were outstanding, clearly demonstrating that a laparoscopic side-to-side gastrojejunostomy (Roux-en-Y), without gastrectomy keeping the sleeve in continuity, can be constructed to treat a chronic fistula from an earlier leak. Dr. Chouillard's later presentation has shown that this operation is 100-percent successful in treating this dreadful complication, which is fortunately rare these days. I hope you enjoy this supplement. I also welcome you to the attend the 5th International Consensus Summit on Sleeve Gastrectomy, which will be held in the summer of 2014 in Montreal, Canada, in parallel to the annual meeting of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), August 26 to 30, 2014. View exclusive videos, including a live surgery broadcast to the ICSSG-4 from Dr. Elie Chouillard in Poissy, France w w w.me ta b olicsurge r y.tv Matrix Medical Communications 1595 Paoli Pike, Suite 103 West Chester, PA 19380 A4 Ninh T. Nguyen, MD, and Alana Gebhart, BA II: Mechanisms of Action Is GLP-1 the Culprit of the Effects of SleeveGastrectomy on Glucose Tolerance? A7 Josep Vidal, MD, and Antonio Lacy, MD Does Sleeve Transit Correlate with Weight Loss? A9 Manish Parikh, MD III: Long-term Results Laparoscopic Sleeve Gastrectomy As A Primary Weight Loss Operation: Six-Year Results A11 Emanuele Lo Menzo, MD, PhD, FACS, FASMBS; Samuel Szomstein, MD, FACS, FASMBS; and Raul J. Rosenthal, MD, FACS, FASMBS IV: Revisions Laparoscopic Adjustable Gastric Band Failure: Remove, Replace, or Revise? A14 Natan Zundel, MD, FACS, FASMBS, and Juan D. Hernandez, MD Technichal Considerations in Performing Sleeve as a Revisional Surgery A16 Pratibha Vemulapalli, MD, FACS V: Conversions Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass A18 Alfons Pomp, MD, FACS, FRCSC Sleeve to Duodenal Switch/SADI-s A20 Antonio J. Torres, MD, and Andrés Sánchez-Pernaute, MD Sleeve to Duodenal Switch A22 Vivek Prachand, MD VI: Controversies and Debates Technical Options and Alternatives for Sleeve Gastrectomy A24 Paul T. Cirangle, MD, FACS, FASMBS ICSSG-4 Meeting Summary A26 Michel Gagner, MD, FRCSC, FACS, FASMBS, FICS, AFC (Hon.) Supported by funding provided by Covidien. © 2013 Matrix Medical Communications. All rights reserved. Opinions expressed by authors, contributors, and advertisers are their own and not necessarily those of Matrix Medical Communications, the editorial staff, or any member of the editorial advisory board. Matrix Medical Communications is not responsible for accuracy of dosages given in the articles printed herein. The appearance of advertisements in this journal is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety. Matrix Medical Communications disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements. Reprints are available. Contact Matrix Medical Communications for information. Bariatric Times (ISSN 1551-3572) is published by Matrix Medical Communications, 1595 Paoli Pike, Ste. 103, West Chester, PA 19380. Telephone: (866) 325-9907 or (484) 266-0702, Fax: (484) 266-0726. Printed in USA. May 2013 • Supplement A • Bariatric Times A3