Wednesday 8th of April 2015 – Landgoed Zonheuvel, Doorn
This year the 5th edition of the national congress of the Dutch Society for Metabolic and Bariatric
Surgery (DSMBS) was held at landgoed Zonheuvel in Doorn. Participants from the current 18
registered bariatric centers exchanged information and experiences at an informal level. The loor
was mainly given to surgical residents and research candidates who were able to present their results,
backed by the whole range of sta surgeons, endocrinologists, dieticians, psychologists, specialized
nurses and managers of the centers.
The program started with a very interesting lecture titled ‘Neural mechanisms underlying the di iculty
to lose weight’ by Prof Roger Adan from the University of Utrecht. Several yet not fully unraveled
hormonal and neuronal pathways a ect di erent parts in the brain. Hormones like Leptin and Ghrelin
play a central role and Leptin resistance occurs in obesity models. Also subtle changes in core
temperature seem to play a role in energy metabolism. According to Prof. Adan, bariatric surgery is
not going to be replaced by a pill in the next 1020 years.
In the morning session, several relevant topics were discussed. Pain is an upcoming topic, especially in the treatment of acute versus chronic pain. Obese
patients appear to have a higher pain threshold and social economic status and IQ do inluence. The DUCATI (Dutch Common Channel Study) showed
that a very long common channel is safe to perform with equal short term results. Long term results however have to be awaited. On the other hand,
the group from Arnhem showed that a long (150 cm vs 75 cm) biliopancreatic limb resulted in a 10% more excess weight loss (EWL). The underlying
mechanism has yet to be identiied. Body contouring surgery (BCS) after bariatric surgery was performed in only 11% of patients in a study from the
‘Nederlandse Obesitas Kliniek’, however resulting in sustained weight loss. Twenty ive percent (majority male) did not want BCS and over 60 % had a
wish to undergo BCS. Another topic was trocar hernia, which appear to occur in about 0.5%. The conclusion was that trocar ports of any size do not have
to be closed.
After lunch the program was continued with an update on Obstructive Sleep Apnea Syndrome (OSAS), showing a correlation with insu icient weight loss.
The next presentation showed a correlation between insu icient weight loss in the irst three months and weight loss after 12 and 24 months. Centers
could use this di erentiation in follow up programs. Another topic was on Quality of life (QOL). The Impact of Weight on Quality of life (IWQOL) score
was able to di erentiate between EWL above and below 50%, contrary to Rand. Preoperative motivation could not predict weight loss and interestingly,
the same group showed that 65% of patients overestimated and only 20% of patient correctly estimated postoperative weight loss. Next, a new tool for
the prediction of postoperative complications was presented: The Bariatric surgery Index of Complications (BASIC). Predictive factor were gender (male),
hypercholesterolemia, COPD, anticoagulation, a history of psychiatric disease and revisional surgery. The last presentation before tea break showed that
early switch to solid meals did not increase complications.
The inal part of the day started with the award winning presentation (best paper IFSO Montreal) about standard
vitamin supplement compared to an optimal supplement (Fit for me). In the standard group 56% deiciencies occurred
compared to 18% in the optimal group. As a consequence, less (16%) outpatient visits were needed. Next early and
late dumping was discussed. Questionnaires appeared to be most sensitive as diagnostic tool. More basic research
encompassed the e ects of morbid obesity and metabolic syndrome on T-cell aging. Telomere length is a useful
parameter. Next, results of the duodenal-jejunal bypass liner were studied in 200 patients. Finally, the scientiic session
was inished with a presentation on subclinical hypothyroid disease and the inluence of Roux-en-Y gastric bypass.
The organizing committee is very pleased about the very high level of scientiic presentations and interaction with
sponsors that made this day to a success. I am looking forward to next years DSMBS congress.
Bart A. van Wagensveld, MD, PhD
President of the DSMBS