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Rudolf A Weiner

The Frankfurt specialist

We talk to Professor Rudolf A Weiner, President of the forthcoming XVI IFSO World Congress in Hamburg, Germany, who discusses his achievements, the challenges facing bariatric and metabolic surgery and the meeting in Hamburg...

Why did you decide to specialise in bariatric surgery?

It was over 30 years ago and we started on so-called open intestinal bypass surgery and I remember I published my first paper on intestinal absorption in 1978. I was very interested at the time in the pathophysiological background of intestinal absorption and nutrition, this was my starting point. I continued to perform this surgery for the next 16 years. Then in 1994, came laparoscopic surgery and this changed everything and I was very interested to start performing gastric banding procedures.

Who have been your greatest influences and why?

My teacher Wolfgang Hartig from the University Hospital of Leipzig, who founded the Department of Experimental Surgery. He allowed us to perform new investigations from intestinal absorption to metabolic research. He was an expert mentor, not only in the field of scientific research, but he also encouraged me to try new techniques and to discover what was best for the patient.

What experience in your training has taught you the most valuable lesson?

For me the most important things was to never try a new surgical procedure or technique without visiting and learning from someone who had experience in this field. All the time I would invite surgeons to take part in my first procedure or visit surgeons to see first-hand how they performed a procedure. I remember going to Belgium to learn laparoscopic fundoplication and Dr Dallemagne came to Frankfurt to in 1991 and we performed our first cases together. 
In 1994, I visited Mitiku Belachew in Huy, Belgium and unfortunately, he was so busy he declined my invite to come to Frankfurt. However, I invited Peter Forsell and Dag Arvidson from Sweden and together we performed my first gastric banding cases. Then I went to Sweden some time later to see a gastric bypass, and I travelled to Spain and the USA. For me, it was important to find a teacher and to learn from the expert from the beginning. 
Tell us about one of your most memorable surgeries?
One of the most memorable cast was the first gastric bypass I performed with Hans Lonroth (Goteborg/Sweden) on a patient who had a gastric band eight years previously and there were major complications. The procedure was very successful and she lost nearly 100kg with a band, but then she regained 100kg. So in 2000, we performed a gastric bypass and after this major complication she is still visiting me today, and she still has a normal weight and a normal BMI. It is nearly 20 years since her first operation and I still see her today. Normally we see a patient for the first few years and then they disappear. She had a major complication, survived and still visits to this day. I have never lost a patient to gastric bypass for a surgical complication. 

What are you current areas of research?

I am currently involved in metabolic research and I am investigating the application of gastric and hormonal stimulation technologies, and I think the future we will see the utilisation of more combined techniques. I think in the future we will not see the same numbers of major surgeries such as bypass. 
How have you seen the speciality change over the last decade?
The greatest change was the introduction of minimally invasive surgery, then we had a little bit of change between different techniques. Now, over the last few years we have seen new approaches emerge like single port and natural orifice (NOTES) access, but these will not change the spectrum of obesity surgery. However, what we will see over the next few years is the introduction of new endoscopic procedures. We have had the new types of intragastric balloons, ROSE, Endosphere, Endobarrier and the endoscopic sleeve gastrectomy. This is the most important change we have seen emerge over the last few years from laparoscopic to endoscopic surgery. 

What are the biggest challenges facing bariatric surgery?

We have more and more super obese patients and at my institution the normal BMI is over 60. Therefore, it is a very long treatment to reduce the patient’s BMI. The biggest challenge is to have more surgeries treating those patients with high BMI classes. 
How should we tackle the growing obesity problem?
Surgery is not the solution. The only solution for the world-wide obesity problem is prevention. We need more action especially at the political level, prevention is the key. Surgery on its own will not solve the problem, as we can only operate on 1% of the obese population. The solution is to change people’s lifestyles, to improve their diet, increase their activity. This should start at home, we should educate parents how to feed their children, in schools children should be taught what to eat instead of drinking fizzy drinks and eating fast food. 

What can we look forward to at this year’s IFSO meeting?

This will be the largest meeting in the history of obesity surgery. We will have over 400 presentations, live surgery (with standard and new procedures) with Spanish & Portuguese translation, as we are expecting several hundred delegates from Latin America. We are also delighted to welcome many delegates from India, Pakistan and China. 

Outside of surgery, how do you relax?

Sailing, I go to the Baltic sea and sail. Unfortunately, it is not too close to Frankfurt, but now there is a flight so I go as often as I can. For me sailing is very relaxing.