mini gastric by-pass in italy multicentre review 2006-2012

MINI GASTRIC BY-PASS IN ITALYMULTICENTRE REVIEW 2006-2012

M. Musella

Università degli Studi di Napoli “Federico II” Dipartimento di Scienze Biomediche Avanzate

Chirurgia Generale

M. Musella - SICOB - Cagliari 04/13

Mini Gastric Bypass in Italy 2006-2012

Che intervento è?E’ lecito eseguirlo?E’ vantaggioso

eseguirlo?Quali risultati?


12-14 cm long gastric pouch





200 – 220 cm from Treitz ligament


Che intervento è?E’ lecito eseguirlo?E’ vantaggioso eseguirlo?Quali risultati?


20012001



20052005



20082008



20112011



20122012




Biliary GastritisAchloridriaMucosal chronic

inflammationNitrosoderivate

activationGastric stump cancer



Biliary Gastritis

Rutledge 2005 (2475 pts.) 0.2%Carbajo 2005 (209 pts.) 0%*Chevallier 2008 (100 pts.) 2.0%Noun 2012(1000 pts) 0%-5.1%**Lee 2012 (1163 pts.) 3.7%***



Biliary Gastritis

Johnson WH, Fernanadez AZ, Farrell TM, Macdonald KG, Grant JP, McMahon RL, Pryor AD, Wolfe LG, DeMaria EJ.(2007) Surgical revision of loop ("mini") gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007 Jan-Feb;3(1):37-41.



Gastric stump cancer

Caygill CP, Hill MJ, Kirkham JS, Northfield TC (1986) Mortality from gastric cancer following gastric surgery for peptic ulcer. Lancet 1(8487):929-31.Viste A, Bjørnestad E, Opheim P, Skarstein A, Thunold J, Hartveit F, Eide GE, Eide TJ, Søreide O (1986) Risk of carcinoma following gastric operations for benign disease. A historical cohort study of 3470 patients. Lancet 2(8505):502-5.Lundegårdh G, Adami HO, Helmick C, Zack M, Meirik O (1988) Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med 319:195-200.




Fischer AB, Graem N, Jensen OM. Risk of gastric cancer after Billroth II resection for duodenal ulcer (1983) Br J Surg 70:552-4.Tokudome S, Kono S, Ikeda M, Kuratsune M, Sano C, Inokuchi K, Kodama Y, Ichimiya H, Nakayama F, Kaibara N, et al. (1984) A prospective study on primary gastric stump cancer following partial gastrectomy for benign gastroduodenal diseases. Cancer Res 44:2208-12.





Bassily R, Smallwood RA, Crotty B. (2000)Risk of gastric cancer is not increased after partial gastrectomy. J Gastroenterol Hepatol. Jul;15(7):762-5.

The records of a total of 569 patients who had a partial gastrectomy for peptic ulcer disease at Repatriation General Hospital, Heidelberg, between 1957 and 1976 were reviewed.Duration of follow up was 17.3 years (range 1-41 years). The expected number of cancers in this population was 6.5. Assuming all survivors were free of gastric cancer, the standardized incidence ratio was 1.39 (95% confidence intervals 0.64-2.65, P=0.313).The risk of gastric cancer was not increased after partial gastrectomy in this Australian population.


Esophago Gastric cancer



Esophago Gastric cancer

33 esophagogastric cancers (ca)4 ca (12.1%) following a loop bypass (not better described)3 ca located in the excluded stomach1 ca located in the gastric pouch following a 1980 surgery15 ca (45.4%) following restrictive procedures (LAGB, SG, VBG)14 ca (42.4%) following RYGBP (5 located in the excluded stomach)


Dal 11/07/2006 al 31/12/2012 abbiamo valutato i risultati ottenuti dall’esecuzione del Mini Gastric Bypass laparoscopico, per la cura dell’obesità e di alcune comorbilità associate ad essa, eseguiti nei seguenti centri :

Centers Patients

Musella 52

Piazza 380

Greco 70

Susa 406

De Luca 45

Manno 21



Sono stati eseguiti un totale di 974 interventi

475 pazienti maschi (28%)499 pazienti femmine (71,69%)

BMI medio = 48 ± 4,579

Età media della popolazione = 39,45 anni



Main Preoperative ParametersMain Preoperative Parameters



Calibre of the bougie :

• 42 fr (380 patients)



Loop lenght :

224.6 ± 23.2 cm


Size of the blue cartdrige linear stapler (gastrojejunal anastomosis):

• 30 mm (70 patients)



Stapler holes closure method:

• Double layer running 2-0 suture (573 patients)

• Single layer running 2-0 suture (21 patients)

• Interrupted 2-0 stitches (380 patients)

Reinforcement of the suture line:

• Fibrin sealant (52 patients)

• Oversewing (45 patients)


In 451 patients an anti-biliary reflux mechanism was provided.

All 974 patients were checked by an intraoperative methylene blue test at the end of the procedure



TOTALE PAZIENTI DECEDUTI

• 2/974 = 0,2%

PAZIENTI DECEDUTI PER COMPLICANZE NON RELATIVE ALLA PROCEDURA • 1/974 = 0,1%

•Trombo-embolia polmonare 3 casi (0,3%) di cui 1 decesso (25%)•Infarto del miocardio 0 casi•Ischemia cerebrale 1 caso (0,1%)•Insufficienza renale acuta 0 casi

PAZIENTI DECEDUTI PER COMPLICANZE RELATIVE ALLA PROCEDURA:

• 1/974 = 0,1%

LEAK ANASTOMOSI = 3 casi (0,3%) di cui 1 decesso (33%)

LEAK TUBULO GASTRICO= 5 casi (0,5%)

LEAK MONCONE GASTRICO= 2 casi (0,2%)

BLEEDING= 25 casi (2,5%)

EMORRAGIE DIGESTIVE= 9 casi (0,9%)


Peri-operative complications



Follow up outcome


Follow up complication rate




Conclusioni1.E’ un intervento eseguibile senza rischi per il

paziente2.E’ un intervento vantaggioso per il paziente…3.E’ un intervento che ha dimostrato una

efficacia sovrapponibile e in alcuni parametri anche superiore al RYGBP



Mail to:

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Il giorno 17/apr/2013, alle ore 09.46, Dr Rutledge ha scritto:Looks Great!

May I advertise it, Please?

Translation:

10:30 to 11:30 SESSION III MINIGASTRIC BYPASS: OPINION OF EXPERTS

Chairman: C. Giardiello (Caserta)

Moderators: L. Square (Catania), A. Susa (Rovigo)

mini gastric by-pass in italy multicentre review 2006-2012

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