Michel Gagner

Background The partial diversion of intestinal contents facilitates achieving and maintaining weight loss and improving glycemic control in patients with obesity and with or without T2DM. The purpose of this study is to report our experience and 1-year follow-up with novel modification of SADI-S. Methods This study is a part of a multicentric tria...

Introduction Uncomplicated surgical approaches that minimize anastomotic complications while improving revisional metabolic/bariatric surgical (MBS) outcomes are needed. Methods This prospective single‐center study assessed the feasibility, safety, and efficacy of the novel linear magnetic anastomosis system (LMAS [3 cm]) in performing a side‐to‐s...

Purpose With the global epidemic of obesity, the importance of metabolic and bariatric surgery (MBS) is greater than ever before. Performing these surgeries requires academic training and the completion of a dedicated fellowship training program. This study aimed to develop guidelines based on expert consensus using a modified Delphi method to crea...

Background Pain management after bariatric surgery remains challenging given the risk for analgesia-related adverse events (e.g., opioid use disorder, marginal ulcers). Identifying modifiable factors associated with patient-reported pain outcomes may improve quality of care. We evaluated the extent to which patient and procedural factors predict 7-...

Introduction In the current opioid crisis, bariatric surgical patients are at increased risk of harms related to postoperative opioid overprescribing. This study aimed to assess the extent to which opioids prescribed at discharge after bariatric surgery are consumed by patients. Methods This multicenter prospective cohort study included adult pati...

Purposes Classical gastrointestinal anastomoses are formed with sutures and/or metal staples, resulting in significant bleeding and leak rates. This study evaluated the feasibility and safety of the novel magnet anastomosis system (MS) to create a side-to-side duodeno-ileal (DI) diversion for weight loss and type 2 diabetes (T2D) resolution. Mater...

Introduction: Bariatric surgery has demonstrated long-term effectiveness in inducing weight loss and improving metabolic parameters for obesity. Single anastomosis duodeno-ileal (SADI) bypass and single anastomosis sleeve-ileal (SASI) bypass have both emerged as new promising bariatric procedures. In this paper, we review the existing literature a...

Introduction Gastrointestinal anastomoses with classical sutures and/or metal staples have resulted in significant bleeding and leak rates. This multi-site study evaluated the feasibility, safety, and preliminary effectiveness of a novel linear magnetic compression anastomosis device, the Magnet System (MS), to form a side-to-side duodeno-ileostomy...

Background Minimally invasive metabolic/bariatric surgery (MBS) may be further advanced by magnetic compression anastomosis (MCA) technology. The study aimed to develop a magnet sized to create a patent duodeno-ileostomy (DI) and verify its effectiveness in a porcine model. Methods Developmental study phase: magnets with 4 different flange-offset...

A side-to-side duodeno-ileostomy, or “duodenal bipartition,” is a modification of the single anastomosis duodeno-ileostomy (SADI), a much less complicated anastomosis. Compared to the SADI, the duodenal transection is easier to perform and produces fewer nutritional complications. When performed as a second-stage procedure for weight regain, inadeq...

Laparoscopic sleeve gastrectomy (SG) as a bariatric procedure was initially described in 1999 as part of a laparoscopic duodenal switch and then performed as a two-stage procedure for high-risk patients, the initial stage of a duodenal switch in 2000. SG was approved by the ASMBS as a stand-alone bariatric procedure in 2008 and has since gained pop...

Surgical therapy for severe obesity is known as “bariatric surgery”. The origin of these surgical techniques is found in the 1950s, when malabsorptive surgery was first performed to treat hyperlipidemia syndromes. A large number of bariatric procedures were developed, but few were shown to be effective and safe with long-term weight loss. As a seco...

Sleeve gastrectomy is presently the most popular weight loss procedure globally. The only absolute contraindication to this procedure is the presence of Barrett’s esophagus. Comprehensive preoperative workup, optimization of comorbidities, and adequate preoperative preparation are of paramount importance. Preoperative patient counseling should focu...

Background and objectives: Gastro-oesophageal reflux disease (GERD) consists in the passage of gastric acid content from the stomach to the oesophagus, causing burns and deteriorating the quality of life. Laparoscopic Sleeve Gastrectomy (LSG) could induce de novo GERD and worsen pre-existing GERD because of the higher gastric pressurisation, reduc...

Objective: This study aimed to survey international experts in metabolic and bariatric surgery (MBS) to improve and consolidate perioperative interventions to prevent gastroesophageal reflux disease (GERD) and marginal ulcers (MU) after MBS. Background: Very important long-term complications after MBS include GERD, Barrett's esophagus, and MU. P...

This white paper documents the consensus opinion of the expert members of the Editorial Board of Artificial Intelligence Surgery regarding the definitions of artificial intelligence and autonomy in regards to surgery and how the digital evolution of surgery is interrelated with the various forms of robotic-assisted surgery. It was derived from a se...

Purpose Staple line reinforcement (SLR) during laparoscopic sleeve gastrectomy (LSG) is controversial. The purpose of this study was to perform a comprehensive evaluation of the most commonly utilized techniques for SLR. Materials and Methods Network meta-analysis of randomized controlled trials (RCTs) to compare no reinforcement (NR), suture over...

IntroductionLaparoscopic sleeve gastrectomy (LSG) is currently the most common procedure performed worldwide, and still the leak is considered the main limitation. After an initial enthusiasm for stents, the endoscopic treatment evolved including in the current management the septotomy with balloon dilatation and pigtails insertions. The aim of thi...

Die chirurgische Therapie der Adipositas permagna ist als „bariatrische Chirurgie“ bekannt. Der Ursprung dieser chirurgischen Techniken findet sich in den 1950er-Jahren, als malabsorptive Operationen erstmals zur Behandlung von Hyperlipidämiesyndromen durchgeführt wurden. Eine große Anzahl von bariatrische Prozeduren wurden entwickelt, aber nur wen...

Background The performance of laparoscopic sleeve gastrectomy has increased markedly to become the single-most performed bariatric surgical procedure globally. To date, a means of standardized trainee teaching has not been developed. The aim of this study was to design a laparoscopic curriculum for trainees of bariatric surgery utilizing modified D...

Background Although early series focused on benign disease, minimally invasive pancreatoduodenectomy (MIPD) might be particularly suited for malignancy. Unlike their predecessors, fellowship-trained (FT) Hepatic-Pancreatic and Biliary (HPB) surgeons usually have equal skills in approaching peri-ampullary tumors (PT) either openly or via minimally i...

Background Using the Ideal Development Exploration Assessment and Long-term study (IDEAL) paradigm, Halls et al. created risk-adjusted cumulative sum (RA-CUSUM) curves concluding that Pioneers (P) and Early Adopters (EA) of minimally invasive (MI) liver resection obtained similar results after fewer cases. In this study, we applied this framework t...

Scoliosis needs surgical correction when the spinal curve surpasses 45 or 50 degrees, especially after skeletal maturity, particularly if it causes loss of lung function. Typically, a posterior fusion has been a standard treatment for scoliosis, and orthopaedic surgeons will use segmental pedicle screw constructs with hooks and wires. Anterior appr...

Concerning future research in magnetic surgery, the efforts will concentrate on shapes, forces, designs, and delivery systems. Each specialized magnet for specific purposes is being developed, and as seen from the previous literature, the magnets for vascular anastomosis are totally different from those of biliary applications or gastrointestinal a...

The utilization of magnets for vascular anastomosis is thought provoking and vividly different from that for gastrointestinal anastomosis because the subsequent necrosis between the two walls in between magnets that occurs in the gastrointestinal tract causes the device to be expelled and passed distal away from the site, most often per anus. In th...

Compression anastomosis has come and gone in the last century. Apart from sutures and staples, there has been nothing innovative and fresh, yet we are capable of much progress. The author is exploring the ideas of the twentieth century and the early decade of the twenty-first century that have led to the development of the surgical stapler, its tra...

The history of magnetic surgery for the last 50 years is explored in various areas, mainly for abdominal and thoracic surgery. Indeed, colorectal applications, from colostomies to anastomosis, vascular applications, mainly of anastomosis, although an entire chapter will be dedicated, with only the surface being explored. Similarly, for urological a...

This chapter is about a surgically implanted magnetic sphincter that can prevent the incontinence of urine in patients and is not to be confused from the recent studies on magnetic stimulation. A clinical review of randomized controlled studies evaluated responses to pulsed magnetic stimulation administered twice weekly for 16 weeks. Investigators...

Gastrointestinal, colic, and vascular anastomoses have been fashioned by the use of sutures, followed by stapling introduced in the early 1900s, and become popular in the last half of the twentieth century. However, compression anastomosis has had a parallel development, which is important to review in this chapter. From the Murphy button, used by...

The problem of fecal incontinence is growing due to an array of causes; it can follow trauma (childbirth), surgery, or be from neurological origin, or other. Over the last century, multiple surgical therapies have been suggested and tried including injection of biomaterials into the anal canal, radiofrequency treatment of the anal canal, repair of...

LSG is one of the most performed bariatric procedures worldwide. It is a safe and effective operation with a low complication rate. Unsatisfactory weight loss/regain may occur, suggesting that the operation design could be improved. A bioengineering approach might significantly help in avoiding the most common complications. Computational models of...

TheSleeve gastrectomysleeve gastrectomyGastrectomy is a restrictive procedure, in which stomachStomach is reduced to a vertical tube with a volume less than 200 mL. A metabolic action has been described in relation to this technique, due to the resectionResection of the greater gastricGastric curvature and the fundus also alters the hormonal milieu...

Is sleeve gastrectomy the result of an omphaloskepsis? Omphaloskepsis or navel contemplation of one's self is known to be an aid to meditation. The word originates from the Greek omphalos, signifying “navel” and skepsis, meaning “viewing”. In Hinduism, the navel is the site of a powerful chakra, focal point of mediation, the site of the universe, b...

At first, sleeve gastrectomy which evolved as a two stage procedure from laparoscopic duodenal switch, then to a stand-alone procedure for non super-obese patients, was recognized to be mostly, purely restrictive, in the early 2000’s. It also involved at that time a decrease in acid output from the stomach, as shown by the dramatic reduction in ulc...

The book encompasses the different concepts and designs using magnets for surgical purposes. It provides a concise yet comprehensive summary of the current status of the field that will help guide patient management and stimulate investigative efforts. The text reviews new data about interventions in all medical and surgical fields. Written by expe...

Introduction: Consecutive to an increase in the number of bariatric surgeries worldwide, the number of articles reporting complications have also increased. The most dreadful bariatric complication is represented by the leak, and the endoscopic stent is still the standard treatment for some bariatric teams despite the poor quality of life and assoc...

Background Gastroesophageal reflux disease (GERD) is probably the main drawback of laparoscopic sleeve gastrectomy (LSG). Herein, we critically discuss the issue and report the results of the first international consensus conference held in Montpellier, France, during June 2019.Methods Fifty international bariatric experts from 25 countries convene...

Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health. People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index. This guideline update reflects su...

KEY POINTS • Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health. • People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index. • This guideline upd...

Background: Laparoscopic sleeve gastrectomy (LSG) can present some complications such as bleeding and leakage. While leaks originate at the level of the staple line, some hemorrhages too, but not exclusively. This motivated the development of techniques to reduce them. Those techniques would be staple-line reinforcement (SLR) and omentopexy.

Background: Laparoscopic sleeve gastrectomy (LSG) is a recent bariatric procedure emerging from duodenal switch, which itself emerged from the standard biliopancreatic diversion.

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world, accounting for more than 50% of all bariatric procedures (Ponce J, DeMaria EJ, Nguyen NT, Surg Obes Relat Dis 12:1637–1639, 2016). LSG is a safe and effective primary bariatric procedure with durable weight loss. We believe LSG should not be calle...

Background: Laparoscopic sleeve gastrectomy (LSG) is a recent bariatric procedure emerging from duodenal switch that itself emerged from the standard biliopancreatic diversion. In this chapter, I chronologically address each step and development leading to laparoscopic sleeve gastrectomy. Conclusion: It has been 20 years since the use of laparoscop...

Background: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world, with 75% of the primary procedures performed in the United States. It is a safe and effective primary bariatric procedure with good weight loss. When comparing with other procedures, LSG is limited to the stomach, avoiding the presence...

Introduction Laparoscopic sleeve gastrectomy (LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe acid reflux after primary LSG can necessitate further interventions. Objectives The aim of our study was to evaluate long term results (5 years) following r...

Background. The Single-Port Instrument Delivery Extended Reach (SPIDER) surgical system is a safe revolutionary technology that defeated difficulties of single-incision surgery. We assessed the long-term outcomes of SPIDER sleeve gastrectomy (SPIDER SG) versus conventional laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients. Methods. R...

Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Staple-line buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (...

Laparoscopic sleeve gastrectomy (LSG) is not only an accepted stand-alone procedure for morbid obesity, but it has become the most frequently practiced bariatric operation in the world. Its technique is becoming more standardized and adjusted to evidence. The surgical technique practiced by the authors is described and explained.

Duodenal switch offers one of the best long-term controls of obesity-related diseases such as type-2 diabetes and is associated with one of the lowest risks of weight regain long-term. It should be part of surgeons’ armamentarium, particularly for the management of weight regain following sleeve gastrectomy. Like any advanced surgical procedure, th...

Sleeve gastrectomy (SG) is the most common bariatric procedure, accounting for more than 55% of all such surgeries performed worldwide. Obesity has become a major global problem that continues to spread in both developed and developing countries. While prevention of obesity is the best approach for the future, the current challenge is managing tho...