Maurizio De Luca MD

Department of Surgery Regional Hospital of Vicenza Italy

XXI Congresso Nazionale SICObCagliari, 25-27 Aprile 2013Mini Gastric Bypass: lopinione degli esperti

La gestione delle complicanze. Esperienza personale e letteratura a confronto

Maurizio De LucaResults 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 41/114VLS 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 LucaResults 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 LucaResults 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 LucaResults of Mini Gastric Bypass as Remedial Surgery Weight Loss (38 Pts)

Kgmonths

Maurizio De LucaResults of Mini Gastric Bypass as Remedial Surgery Weight Loss (38 Pts)

% EWLmonths

Maurizio De LucaResults 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%)

Maurizio De LucaResults of Mini Gastric Bypass (42 Pts)

Comorbidities

OSAS 5 ptsComplete resolution 100%Sonnolence 7 ptsComplete resolution 100%Hypertension 19 ptsComplete resolution 78%Partial resolution 10%Hyperuricemia 3 ptsComplete resolution 100%Fatty liver 10 pts Ultrasound at 0 and 12 monthsImprovement 90%

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 LucaResults of Mini Gastric Bypass Vicenza /Padova Series

Complication of MGBShort 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

Maurizio De LucaResults of Mini Gastric Bypass Vicenza /Padova Series

Side Effects of MGB Asthenia07.7%

Maurizio De LucaResults of Mini Gastric Bypass - Literature

Complication of MGBShort Term Complications (6 redo)2.7%11%

Maurizio De LucaResults of Mini Gastric Bypass - Literature

Complication of MGBShort 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 PACIENTESCaballero MAC, De Solorzano JO, Garcia-Lanza CCirurgia Endoscopica, 9,1, 6-13, 2008

Maurizio De Luca

Maurizio De LucaLee 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, 2012Lee GBP vs MGP: 10 year results - Complication

Maurizio De LucaLee 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, 2012Lee GBP vs MGP: 10 year results Weight Loss

Maurizio De LucaLee 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, 2012Lee 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

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