More and more people are fat. Even many children are overweight. The number of people suffering from adiposity has increased tenfold over the past decades — not only in the industrialized world. According to the World Health Organization and Statista, the obesity rate has increased by 20% since 1990. In Germany, 67.1% of men and 53.0% of women are overweight.
Sports courses, diet coaching, hormone therapies can help with obesity. Some countries even have an obesity tax to encourage people to stay fit. However, sometimes none of these things help. What can you do when your weight just keeps increasing?
Surgery is the last resort, especially when multiple organs are negatively affected by adiposity. People who have had no success with traditional methods of weight reduction can opt for a sleeve gastrectomy.
Weight reduction by surgery is the specialty of Professor Zehetner. He is an expert on visceral surgery, has his own private practice, and also works at Beau-Site Hirslanden Clinic in Bern, Switzerland. He treats diseases of the stomach and the bowels, malformations of the intestines, tumours, problems with the pelvic base, and soft tissues. However, Professor Zehetner is also a specialist when it comes to obesity.
Professor Zehetner, a few days ago, a 17-year-old boy from Switzerland died from „overeating“. He spent his last days in a retirement home and weighed 240 kg (529.11 lb). How could this happen?
ZEHETNER: Thank you for inviting me to this interview. I’ve only read about this in the media, so I don’t know the details. Unfortunately, we do not have the same standards as, for example, the United States or many Arab countries when it comes to treating obese children. Oftentimes, we are a bit too conservative or have moral scruples due to the patients‘ age and the nature of the procedure.
When it comes to malign diseases, however, we are not as concerned. In this recent case, treatment should have started earlier and should have been more thorough. Right now, we are assembling a team of experts for the pre- and post-treatment of obese children here at the Center for Bariatric Surgery. The story you mentioned shows the need for such a team.
Can you briefly explain the term metabolic surgery?
ZEHETNER: Metabolic disorders such as diabetes, fatty liver disease, high cholesterol levels, and high blood pressure are all part of the metabolic syndrome. Patients with diabetes and obesity can be healed with a gastric bypass or a gastric sleeve. This is made possible by metabolic surgery, which has seen rapid development in recent years. However, not every patient benefits from such a procedure. There is a high chance of healing, if diabetes was diagnosed not more than 7 years ago. Metabolic surgery is basically the performance of these procedures on patients with a BMI over 30. Normally, these are patients who were treated conservatively, because their health insurance company considered them not obese enough to be eligible for surgery.
You held a chair at the University of Southern California for many years. How did this affect you?
ZEHETNER: I was in Los Angeles from July 2008 until summer 2018. I am still an Associate Professor of Surgery at USC, but I attend to my teaching and research duties from here in Switzerland. Originally, I came to the United States following an inivitation for a research project by Tom DeMeester. No surgeon has published more on the topic of reflux and oesophageal cancer. He is well-known among surgeons all over the world.
I was impressed by the willingness of my colleagues to invest their time in our research projects. Sometimes, Tom DeMeester scheduled meetings for 5 o’clock in the morning. Long hours are taken for granted. Patients with severe problems can benefit from this. Colleagues happily help each other and share their knowledge.
After completing my research and my special training, I joined the faculty and stayed in Los Angeles until 2015 before Dr Steffen and Prof Z’graggen called me to Bern.
Let’s switch topics. You also treat acid reflux. What can you do for prevention and how can modern medicine help?
ZEHETNER: Occasional reflux can be remedied to some degree by changing your diet and lifestyle. Even then, most people need to take antacids. Your primary care physician can perform the initial diagnostic tests. Patients who are on medication but still suffer from oesophageal inflammations, altered mucous membranes, or ructus should go and see a surgeon. The best treatment option is a laparoscopic surgery, especially when the chronic reflux is caused by a hiatal hernia. With the LINX Reflux Management System, I provide a well-established therapy. I am one of only three surgeons in Switzerland who can offer this. With almost 10 years of experience in this field of surgery, I can assess very precisely who is suited for this procedure and who is better off with a traditional laparascopic reflux surgery like Nissens’s fundoplicatio or even conservative treatment.
What can you tell us about robot-assisted surgery?
ZEHETNER: With the DaVinci Surgical System, we currently have a modern robot at our disposal. I have worked intensively with this system in the United States. Here in Bern, I use this system for very specific purposes.
We will continue to play a leading role in this region. In next five to ten years, five refined systems will become available with overwhelming advantages for surgeons and patients alike. We are already looking forward to this.
Right now, we experience a transition in the field of surgery. Soon, new sensor technologies will allow us to offer more sophisticated robot-assisted surgeries. Huge amounts of data can be processed thanks to the latest technology. This information can help us make the right decisions during surgery. Patients‘ safety will increase tremendously in the future. The interconnection of computer technologies enables systems to learn and then apply their knowledge in difficult situations during surgery.
That’s impressive, Mr Zehetner! Thank you for this enjoybale and exciting conversation.