maurizio de luca md department of surgery – regional hospital of vicenza – italy department of...

Maurizio De Luca MD

Department of Surgery – Regional Hospital of Vicenza – ItalyDepartment of Surgery – Regional Hospital of Vicenza – Italy

XXI Congresso Nazionale SICOb

Cagliari, 25-27 Aprile 2013

Mini Gastric Bypass: l’opinione degli esperti

La gestione delle complicanze. Esperienza personale e letteratura a confronto

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 SURGERYM DE LUCA, G Segato, L Busetto, D Asthon, F Favretti.Obesity Surgery, 18, 4, 153, 471-472, 2008

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 41/114 VLS from Jan 20010,7% 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 deficiences39% 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

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 obesityM Garcia Caballero and M CarbajoNutricion 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

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%)

OSAS 5 pts Complete resolution 100%

Sonnolence 7 pts Complete resolution 100%

Hypertension 19 pts Complete resolution 78%Partial resolution 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 (42 Pts)

Comorbidities

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; 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 SURGERYM DE LUCA, G Segato, L Busetto, D Asthon, F Favretti.Obesity Surgery, 18, 4, 153, 471-472, 2008

Nutritional Deficiences

IronCalciumZincVitaminDVitamin A Vitamin KProtein

Maurizio De Luca

Results of Mini Gastric Bypass – Vicenza /Padova Series

Complication of MGB

Short Term Complications Leakage 0 4.7% Omega loop Bleeding 0 2.3% abdominal, intraluminal, thoracic Major atelectasis 0 0 Deep vein thrombosis 0 0 Death 0 0

Long Term Complications (0 redo) Stomal Ulcer 0 0 Bile Reflux 0 2.3% Excessive Weight Loss (malnutrition) 2.3% 0 Bowel obstruction 0 0

Total Redo Surgery (1 Pts 1° day post-op) 2.3%

Primary MGB 4 Pts Revisional 38 Pts

Not published data

Maurizio De Luca

Results of Mini Gastric Bypass – Vicenza /Padova Series

Side Effects of MGB

Asthenia 0 7.7% <0.001 Diarrhea 2.3% 2.3% <0.001 Bloating 0 4.7% <0.01 Epigastralgia 2.3% 4.7% <0.05 Vomiting 0 2.3% <0.01

Major metabolic consequences 0 0


Not published data

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 Bleeding 1.6% 6.4% <0.68 abdominal, intraluminal, thoracic Major atelectasis 0.21% 1.29% <0.09 Deep vein thrombosis 0.1% 0% <0.77 Death 0 0

Long Term Complications (7 redo) 0.69% 5.2% <0.03 Stomal Ulcer 0.65% 0 <0.102 Bile Reflux 0 5.2% <0.001 Excessive Weight Loss (malnutrition) 0,4% 0 <0.001 Bowel obstruction 0 0 <0.562


ONE THOUSANDS CONSECUTIVE MINI-GASTRIC BYPASS. SHORT AND LONG TERM OUTCOMENoun R, Skaff J, Riachi EObesity Surg, 22, 697-703, 2012

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 Bleeding 0.3% abdominal, intraluminal, thoracic Gastric Perforation 0.1% Death 0.1% 1 pulmonary thromboembolism/ 1 gastric wall necrosis

Long Term Complications 0.8% Stomal Ulcer 0.4% Gastrojejunal stenosis 0.4%

Total Redo Surgery 1.3%

Primary/Revisional MGB 1126 Pts

BYPASS GASTRICO LAPAROSCOPICO DE UNA SOLA ANASTOMOSIS (BAGUA) ASISTIDOCON BRAZO ROBOTICO:TECNICA Y RESULTATOS EN 1126 PACIENTESCaballero MAC, De Solorzano JO, Garcia-Lanza CCirurgia Endoscopica, 9,1, 6-13, 2008

Maurizio De Luca

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 experienceObesity Surgery 22: 1827-1834, 2012

Lee GBP vs MGP: 10 year results - Complication

Maurizio De Luca


Lee GBP vs MGP: 10 year results Weight Loss

Maurizio De Luca


Lee GBP vs MGP: 10 year results

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 md department of surgery – regional hospital of vicenza – italy department of...

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