腹腔鏡迷你胃繞道手術 成果分析 林修賢, 吳柏鋼 一般外科, 花蓮慈濟醫院

Introduction Surgical treatment is the most important method for morbid obesity. Mini gastric bypass (MGB)  6.6 % bariatric surgery in 2017 in Taiwan TSMBS, 2019  Gastric tube + ante-colic tension-free gastrojejunostomy  Equivalent or better weight loss than RYGB and SG International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) LAGB= Laparoscopic adjustable gastric banding Because of longer biliopancreatic limb, LMGB might have better weight loss than RYGB because of malabsorptive effect. Duodenal bypass (Decreased hormone like Glucogan) and rapid food transit to distal bowel (Increased hormone like GLP-1) , gastric tube restrition Surgical Endoscopy (2018) 32:3024–3031

Study Design and Patients Hualien Tzu Chi hospital Laparoscopic MGB (LMGB) from June 2014 to September 2018  Total 21 patients Retrospective chart review

Procedure Patient in supine position Mini-laparotomy performed at supraumbilical region  12 mm trocar Three trocars (12mm at RUQ, 5mm at left subcostal region, 5mm at subxyphoid region) Left lobe of liver elevated by liver retractor hold by iron intern Angle of His was dissected.  EG junction exposed Lesser omentum opened below crow’s foot Gastric partition was performed by Endopath-GIA 60-3.5 along 36 Fr boigie Greater omentum was splitted. 180cm jejunum  End-to-side gastrojejunostomy Serosal reinforcement by Lumber suture by 3-0 V-loc 15mm J-vac drain placed at left subhepatic region Wounds closed by 1-0 Vicryl and 4-0 Nylon

GJ by GIA in anterior wall of gastric tube

GJ by GIA in posterior wall of gastric tube

GJ by hand-sewn in posterior wall of gastric tube

Results

 50-year-old female, post-OP Y-1 41-year-old male, post-OP D-20 

Effect of LMGB on Weight and BMI

Effect of LMGB on Glycemic Effects

Discussion Data compare  Mortality Marginal ulcer EWL data compare Effect of glucose metastasis

Morbidity and Mortality 0.1 % mortality rate in a systemic review of 12807 patients  0% mortality rate in our experience 1.96 - 10 % minor morbidity rate  14.4 % in our experience  One with IAI  Two with marginal ulcer OBES SURG (2018) 28:2956–2967

Marginal Ulcer 2.7% in in a systemic review of 12807 patients Risk factors: - HP infection - NSAID consumption - Alcohol and tobacco consumption PPI for six months postoperatively for prophylaxis OBES SURG (2018) 28:2956–2967

Obes Surg. 2014 May;24(5):741-6. 

OBES SURG (2018) 28:2956–2967

Reflection for Lower %EWL Behavioral management - Patient education - Self-monitoring - Dietary considerations Physical activity Psychological considerations  Incomplete follow-up Diabetes Metab Syndr Obes. 2015;8:263-74.

Results Summary Total 21 patients underwent LMGB from June 2014 to September 2018 in our hospital No mortality was encountered. 14.4% morbidity rate in our experience. Two patients with marginal ulcer and underwent medical treatment. EWL in 6 and 12 months were 48.0 and 57.4 %. Significantly decreased mean AC and HbA1c post- OP months 6 were noted. 92.8% patients with HbA1c <6.5 post-OP months 6