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Maurizio De Luca MD Department of Surgery – Regional Hospital of Vicenza – Italy Department of Surgery – Regional Hospital of Vicenza – Italy XXI Congresso.

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Presentation on theme: "Maurizio De Luca MD Department of Surgery – Regional Hospital of Vicenza – Italy Department of Surgery – Regional Hospital of Vicenza – Italy XXI Congresso."— Presentation transcript:

1 Maurizio De Luca MD Department of Surgery – Regional Hospital of Vicenza – Italy Department of Surgery – Regional Hospital of Vicenza – Italy XXI Congresso Nazionale SICOb Cagliari, Aprile 2013 Mini Gastric Bypass: l’opinione degli esperti La gestione delle complicanze. Esperienza personale e letteratura a confronto

2 Maurizio De Luca Results of Mini Gastric Bypass – Vicenza Padova Background Our Series before Mini Gastric Bypass Our Primary Surgery Sept 1993 Dec 2012 : Gastric Banding → 2400 Patients  0 moratility  5.4% complication requiring reoperation  Mean %EWL 49% at 12 years  25% of GB with %EWL < 30 (failure) APPROPRIATE BARIATRIC OPERATION – POSSIBLE ROLE OF STAGED SURGERY M DE LUCA, G Segato, L Busetto, D Asthon, F Favretti. Obesity Surgery, 18, 4, 153, , 2008

3 Maurizio De Luca Our Series before Mini Gastric Bypass Our Remedial Surgery from Dec 1995 to January 2011 Duodenal Switch (DS) → 155 Patients (F/M 98/57)  open/VLS 41/114VLS from Jan 2001  0,7% mortality (1 case for malignant hypertermia)  16.7% post-op surgical complication (fistula, bleeding, internal hernia)  5.5% post-op medical complication (non fatal PE, pneumoniae, ARDS, MI)  3% surgical revisions (diarrhea, low protein,excess WL, poor WL)  12.5% metabolic complication requiring rehospitalization arthralgia, peripheral edema, vomiting, diarrhea, nutrients deficiences  39% of patients proctitis, alitosis, acid sweating  75% EWL 13 years follow up  Comorbidities resolution 94% hyperlipemia, 91% Type II Diabetes ADJUSTABLE GASTRIC BANDING WITH DUODENAL SWITCH (BANDINARO): SEQUENTIAL TREATMENT IN A FAILED RESTRICTIVE PROCEDURE (LAPAROSCOPIC PRELIMINARY EXPERIENCE) DE LUCA M, Segato G, Busetto L, Ceoloni A, Banzato O, Enzi G, Favretti F Obesity Surgery, 16,4,2006, 400. Results of Mini Gastric Bypass – Vicenza Padova Background

4 Maurizio De Luca Results of Mini Gastric Bypass Mini Gastric Bypass : Vicenza Hospital /Padova University Series Antrophometric Data April 2011 – December 2012 (20 months experience) 42 Patients (F/M 26/16) Primary Surgery /Remedial Surgery for Band Failure 4/38 Age 39.7 ± 10 (19-62) Weight kg ± 26.8 (93-182) BMI 45.6 ± 8.1 (35-61) Lap/Open 42/0 Skin-to Skin Time 110 ± 4.65 (85-190) No published data

5 Maurizio De Luca Results of Mini Gastric Bypass - Technical Details  Performed by Laparoscopy (4-5 Trocar)  ml Gastric pouch (vertical gastrectomy)  Gastro-jejunal anastomosis with a stoma diameter of cm  L-L anastomosis  Antireflux Stitches  Omega Loop 220 cm  Antecolic anastomosis One Anastomosis Gastric Bypass: a simple, safe and efficient surgical procedure for treating morbid obesity M Garcia Caballero and M Carbajo Nutricion Hospitalaria, XIX, (6) , 2004

6 Maurizio De Luca Results of Mini Gastric Bypass as Remedial Surgery Weight Loss (38 Pts) Kg months

7 Maurizio De Luca Results of Mini Gastric Bypass as Remedial Surgery Weight Loss (38 Pts) % EWL months

8 Maurizio De Luca Results of Mini Gastric Bypass (42 Pts) Comorbidities Diabetes 12 obese Pts DM2  3 years,  HgA1c > 7.5%  Failure previous medical treatment Mean Follow-up: 13.1months (±2.3) Dyslipidemia 11 obese Pts with hypercolesterolemia and/or hypertrygliceridemia Mean Follow-up: 12.4months (±1.9) Complete Remission: 9 pts (75%) Improvement: 12 pts (100%) Complete remission 10 pts (90.1%)

9  OSAS 5 ptsComplete resolution 100%  Sonnolence 7 ptsComplete resolution 100%  Hypertension 19 pts Complete resolution 78% Partial resolution 10%  Hyperuricemia 3 ptsComplete resolution 100%  Fatty liver 10 pts Ultrasound at 0 and 12 months Improvement 90% Maurizio De Luca Results of Mini Gastric Bypass (42 Pts) Comorbidities

10 Maurizio De Luca Results of Mini Gastric Bypass – Vicenza Padova Series Dolen K et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004; Slater GH, Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointestinal Surg 2004; 8: APPROPRIATE BARIATRIC OPERATION – POSSIBLE ROLE OF STAGED SURGERY M DE LUCA, G Segato, L Busetto, D Asthon, F Favretti. Obesity Surgery, 18, 4, 153, , 2008 Nutritional Deficiences Iron Calcium Zinc VitaminD Vitamin A Vitamin K Protein

11 Maurizio De Luca Results of Mini Gastric Bypass – Vicenza /Padova Series Complication of MGB Short Term Complications  Leakage 04.7% Omega loop  Bleeding02.3% abdominal, intraluminal, thoracic  Major atelectasis00  Deep vein thrombosis00  Death 00 Long Term Complications (0 redo)  Stomal Ulcer00  Bile Reflux02.3%  Excessive Weight Loss (malnutrition)2.3%0  Bowel obstruction00  Total Redo Surgery (1 Pts 1° day post-op)2.3% Primary MGB 4 Pts Revisional 38 Pts Not published data

12 Maurizio De Luca Results of Mini Gastric Bypass – Vicenza /Padova Series Side Effects of MGB  Asthenia07.7%<0.001  Diarrhea2.3%2.3%<0.001  Bloating04.7%<0.01  Epigastralgia 2.3%4.7%<0.05  Vomiting02.3%<0.01  Major metabolic consequences00 Primary MGB 4 Pts Revisional 38 Pts Not published data

13 Maurizio De Luca Results of Mini Gastric Bypass - Literature Complication of MGB Short Term Complications (6 redo)2.7%11%<0.001  Leakage 0.4%3.8%<0.001 Gastrojejunostomy, gastric tube, gastric remnant  Bleeding1.6%6.4%<0.68 abdominal, intraluminal, thoracic  Major atelectasis0.21%1.29%<0.09  Deep vein thrombosis0.1%0%<0.77  Death 00 Long Term Complications (7 redo)0.69%5.2%<0.03  Stomal Ulcer0.65%0<0.102  Bile Reflux05.2%<0.001  Excessive Weight Loss (malnutrition)0,4%0<0.001  Bowel obstruction00<0.562 Primary MGB 923 Pts Revisional 77 Pts ONE THOUSANDS CONSECUTIVE MINI-GASTRIC BYPASS. SHORT AND LONG TERM OUTCOME Noun R, Skaff J, Riachi E Obesity Surg, 22, , 2012

14 Maurizio De Luca Results of Mini Gastric Bypass - Literature Complication of MGB Short Term Complications 1.4%  Leakage 0.9% Gastrojejunostomy, gastric tube, gastric remnant  Bleeding0.3% abdominal, intraluminal, thoracic  Gastric Perforation0.1%  Death 0.1% 1 pulmonary thromboembolism/ 1 gastric wall necrosis Long Term Complications 0.8%  Stomal Ulcer0.4%  Gastrojejunal stenosis0.4% Total Redo Surgery1.3% Primary/Revisional MGB 1126 Pts BYPASS GASTRICO LAPAROSCOPICO DE UNA SOLA ANASTOMOSIS (BAGUA) ASISTIDOCON BRAZO ROBOTICO: TECNICA Y RESULTATOS EN 1126 PACIENTES Caballero MAC, De Solorzano JO, Garcia-Lanza C Cirurgia Endoscopica, 9,1, 6-13, 2008

15 Maurizio De Luca

16 Lee WJ et al. Laparoscopic Roux en Y Gastric Bypass vs Mini Gastric Bypass for the treatment of Morbid Obesity: a 10 Years experience Obesity Surgery 22: , 2012 Lee GBP vs MGP: 10 year results - Complication

17 Maurizio De Luca Lee WJ et al. Laparoscopic Roux en Y Gastric Bypass vs Mini Gastric Bypass for the treatment of Morbid Obesity: a 10 Years experience Obesity Surgery 22: , 2012 Lee GBP vs MGP: 10 year results Weight Loss

18 Maurizio De Luca Lee WJ et al. Laparoscopic Roux en Y Gastric Bypass vs Mini Gastric Bypass for the treatment of Morbid Obesity: a 10 Years experience Obesity Surgery 22: , 2012 Lee GBP vs MGP: 10 year results

19 Maurizio De Luca Results of Mini Gastric Bypass – Conclusion 1  Less Surgery compared to GBP and BPD  Quicker Surgery compared to GBP and BPD  Low peri-operative complications compared to GBP and BPD  Long Term Weight Loss as BPD (75% EWL at 10 yrs)  Remission /improvement of Diabetes in % of cases  Remission of hyperlipidemia in 85-95% of cases  Absence of some BPD side effects (like diarrhea, hemorrhoids, proctitis etc.)  Reduction of metabolic consequences of BPD (protein malnutrition)

20 Maurizio De Luca Results of Mini Gastric Bypass – Conclusion 2  In our series first choice operation is Gastric Banding (72% of Pts)  First option for Bile Reflux Obese Pts is GBP  First option for Diabetic or Hyperlipemic Obese Pts is MGB  First option as remedial surgery is MGB  Current studiies show that MGB is an effective, low-risk and low-failure bariatric procedure  MGB can be revised in GBP or reversed if necessary

21 Maurizio De Luca Results of Mini Gastric Bypass Thank You for your attention


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