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Luigi Angrisani Director - General and Endoscopic Surgery Unit S.Giovanni Bosco Hospital, Naples, Italy Roux-en-Y-GASTRIC by-pass e ripresa del peso: terapia.

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Presentation on theme: "Luigi Angrisani Director - General and Endoscopic Surgery Unit S.Giovanni Bosco Hospital, Naples, Italy Roux-en-Y-GASTRIC by-pass e ripresa del peso: terapia."— Presentation transcript:

1 Luigi Angrisani Director - General and Endoscopic Surgery Unit S.Giovanni Bosco Hospital, Naples, Italy Roux-en-Y-GASTRIC by-pass e ripresa del peso: terapia chirurgica, endoscopica o counseling

2 ANGRISANI 2013 Naples, Italy

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10 LRYGBP:5 years weight loss results Morbid vs Super-Obese PTs * * p<0.05 * Luigi Angrisani Naples - Italy FU = 96%

11 * * p<0.05 * LRYGBP:7 years weight loss results Morbid vs Super-Obese PTs Luigi Angrisani Naples - Italy

12 BMI FU = 96% * p<0.05 Luigi Angrisani Naples - Italy LRYGBP: long term weight loss results Morbid vs Super-Obese PTs

13 CONCLUSIONS LRYGB with 40-60cm of Bilio-pancreatic Limb and 150cm of Alimentary Limb should not be offered to Super-Obese Pts Long term weight loss results of Laparoscopic Roux-en-Y Gastric Bypass in Italian MO pts are encouraging

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17 Overall complication rate: 20.7 % Reoperation rate: 7.3 % Overall leak rate: 12.1 % Mean follow-up: 4 years

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24 To achieve better weight loss control over time

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28 Capella technique To achieve better weight loss control over time

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34 Our option for weight regain following LRYGB Pouch resizing, stoma reconstruction and pericardial patch ring placement

35 Novel technique for weight loss failure or weight regain in bariatric surgery

36 L’INTERVENTO NUTRIZIONALE PROTEICO INTEGRATO NEL WEIGHT REGAIN POST BY-PASSGASTRICO UN PROGRAMMA TERAPEUTICO CHE PERMETTE DI OTTENERE UN DIMAGRIMENTO RAPIDO (10-12 GIORNI) ED EFFICACE (7- 10 % DEL PESO DI PARTENZA), PRESERVANDO LA MASSA MAGRA. SI POSSONO EFFETTUARE FINO A TRE CICLI CONSECUTIVI INTERVALLATI DA BREVI PERIODI DI RIEQUILIBRIO E STABILIZZAZIONE TRE CICLI CONSECUTIVI (CIRCA 2 MESI) CONSENTONO DI OTTENERE UN CALO PONDERALE IN CIRCA IL 20 % DEL PESO INIZIALE

37 RAZIONALE DELL’INTERVENTO NUTRIZIONALE PROTEICO INTEGRATO Protezione della massa muscolare grazie all’apporto proteico Riduzione dei livelli di insulinemia e stimolo alla chetogenesi che inibirebbe la proteolisi muscolare Le proteine facilitano la produzione di glucagone e la sua conseguente azione lipolitica Sfruttare l’anoressia conseguente alla chetogenesi.

38 LE MODALITA DI INTERVENTO INTERGAZIONE PROTEICA

39 PROGRAMMA NUTRIZIONALE PROTEICO INTEGRATO “LE FASI” PROGRAMMA NUTRIZIONALE PROTEICO INTEGRATO “LE FASI” 2°/3° CICLO

40 LAPAROSCOPIC GASTRIC BYPASS TECHNIQUE

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42 Novel technique for weight loss failure or weight regain in bariatric surgery

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47 CONCLUSIONS (2) Not all patients do well after a bariatric procedure, and the LRYGB is no exception The decision to revise a patient surgically for a bypass that failed in terms of weight loss is critical Revisional procedures are technically challenging and carry out high complication rates If possible, conservative means should be preferred Future studies should be addressed toward limbs length and banded pouch to minimize weight regain Endoscopic procedures are promising, but need further investigation and longer term follow-up Angrisani-Formisano 2013

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