Results of Mini Gastric Bypass

XXI Congresso Nazionale SICOb
Mini Gastric Bypass: l’opinione degli esperti
La gestione delle complicanze.
Esperienza personale e letteratura a confronto
Maurizio De Luca MD
Department of Surgery – Regional Hospital of Vicenza – Italy
Cagliari, 25-27 Aprile 2013
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, 471-472, 2008
Maurizio De Luca
Results of Mini Gastric Bypass – Vicenza Padova Background
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 41/114 VLS 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.
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 138.7 ± 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
Maurizio De Luca
Results of Mini Gastric Bypass - Technical Details
Performed by Laparoscopy (4-5 Trocar)
20-30 ml Gastric pouch (vertical gastrectomy)
Gastro-jejunal anastomosis with a stoma diameter of 1.5-2 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) 372-375, 2004
Maurizio De Luca
Results of Mini Gastric Bypass as Remedial Surgery
Weight Loss (38 Pts)
Kg
months
Maurizio De Luca
Results of Mini Gastric Bypass as Remedial Surgery
Weight Loss (38 Pts)
% EWL
months
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
Complete Remission: 9 pts (75%)
Improvement: 12 pts (100%)
Mean Follow-up: 13 .1months (±2.3)
Dyslipidemia
11 obese Pts with hypercolesterolemia
and/or hypertrygliceridemia
Complete remission 10 pts (90.1%)
Mean Follow-up: 12.4months (±1.9)
Maurizio De Luca
Results of Mini Gastric Bypass (42 Pts)
Comorbidities
OSAS
5 pts
Complete resolution
100%
Sonnolence
7 pts
Complete resolution
100%
Hypertension
19 pts
Complete resolution
Partial resolution
78%
10%
Hyperuricemia
3 pts
Complete resolution
100%
Fatty liver
10 pts
Ultrasound at 0 and 12 months
Improvement
90%
Maurizio De Luca
Results of Mini Gastric Bypass – Vicenza Padova Series
Nutritional Deficiences
Iron
Calcium
Zinc
VitaminD
Vitamin A
Vitamin K
Protein
Dolen K et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch.
Ann Surg 2004; 240-51
Slater GH, Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery.
J Gastrointestinal Surg 2004; 8: 48-65
APPROPRIATE BARIATRIC OPERATION – POSSIBLE ROLE OF STAGED SURGERY
M DE LUCA, G Segato, L Busetto, D Asthon, F Favretti.
Obesity Surgery, 18, 4, 153, 471-472, 2008
Maurizio De Luca
Results of Mini Gastric Bypass – Vicenza /Padova Series
Complication of MGB
Primary MGB 4 Pts
Short Term Complications
 Leakage
Revisional 38 Pts
0
4.7%
0
2.3%
 Major atelectasis
 Deep vein thrombosis
 Death
0
0
0
0
0
0
Long Term Complications (0 redo)
 Stomal Ulcer
 Bile Reflux
 Excessive Weight Loss (malnutrition)
 Bowel obstruction
0
0
2.3%
0
0
2.3%
0
0
Omega loop
 Bleeding
abdominal, intraluminal, thoracic
 Total Redo Surgery (1 Pts 1° day post-op)
Not published data
2.3%
Maurizio De Luca
Results of Mini Gastric Bypass – Vicenza /Padova Series
Side Effects of MGB
Primary MGB 4 Pts





Asthenia
Diarrhea
Bloating
Epigastralgia
Vomiting
 Major metabolic consequences
Revisional 38 Pts
0
2.3%
0
2.3%
0
7.7%
2.3%
4.7%
4.7%
2.3%
0
0
<0.001
<0.001
<0.01
<0.05
<0.01
Not published data
Maurizio De Luca
Results of Mini Gastric Bypass - Literature
Complication of MGB
Primary MGB 923 Pts
Short Term Complications (6 redo)
 Leakage
Revisional 77 Pts
2.7%
0.4%
11%
3.8%
<0.001
<0.001
1.6%
6.4%
<0.68
 Major atelectasis
 Deep vein thrombosis
 Death
0.21%
0.1%
0
1.29%
0%
0
<0.09
<0.77
Long Term Complications (7 redo)
 Stomal Ulcer
 Bile Reflux
 Excessive Weight Loss (malnutrition)
 Bowel obstruction
0.69%
0.65%
0
0,4%
0
5.2%
0
5.2%
0
0
<0.03
<0.102
<0.001
<0.001
<0.562
Gastrojejunostomy, gastric tube, gastric remnant
 Bleeding
abdominal, intraluminal, thoracic
ONE THOUSANDS CONSECUTIVE MINI-GASTRIC BYPASS. SHORT AND LONG TERM OUTCOME
Noun R, Skaff J, Riachi E
Obesity Surg, 22, 697-703, 2012
Maurizio De Luca
Results of Mini Gastric Bypass - Literature
Complication of MGB
Primary/Revisional MGB 1126 Pts
Short Term Complications
 Leakage
1.4%
0.9%
Gastrojejunostomy, gastric tube, gastric remnant
 Bleeding
0.3%
abdominal, intraluminal, thoracic
 Gastric Perforation
 Death
0.1%
0.1%
1 pulmonary thromboembolism/ 1 gastric wall necrosis
Long Term Complications
 Stomal Ulcer
 Gastrojejunal stenosis
0.8%
0.4%
0.4%
Total Redo Surgery
1.3%
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
Maurizio De Luca
Maurizio De Luca
Lee
GBP vs MGP: 10 year results - Complication
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: 1827-1834, 2012
Maurizio De Luca
Lee
GBP vs MGP: 10 year results Weight Loss
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: 1827-1834, 2012
Maurizio De Luca
Lee
GBP vs MGP: 10 year results
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: 1827-1834, 2012
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 85-90 % 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)
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
Maurizio De Luca
Results of Mini Gastric Bypass
Thank You for your attention
Maurizio De Luca