analisi comparativa della gastrectomia verticale vs bendaggio gastrico vs bypass gastrico in...
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ANALISI COMPARATIVA DELLA GASTRECTOMIA VERTICALE VS BENDAGGIO
GASTRICO VS BYPASS GASTRICO IN PAZIENTI CON BMI<35
PIER PAOLOCUTOLOPIER PAOLOCUTOLOGeneral and laparoscopic Surgery Unit – S.Giovanni Bosco Hospital, Naples ItalyGeneral and laparoscopic Surgery Unit – S.Giovanni Bosco Hospital, Naples Italy
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• Bariatric surgery has been widely performed for more than 20 years without any clinical evidence of life survival improvement in operated obese vs non-operated, even if it officially started in 1991 (NIH)
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• Since 1998 (Noya – Sassari) 16 clinical studies regarding BMI<35 Pts have been published. These papers show a good weight loss in these pts and a significant improvement of DM2, with a rate of mortality of 0.29% and complications of 4%.
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SICOB National RegistryPts BMI < 35 (1998 – 2012)
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SICOB National RegistryPts BMI < 35 (1998 – 2012)
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Diabete, OSAS, Ipertensione arteriosa, RGE, Artropatia da carico
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Bariatric procedures on N=59 (3.2%)Bariatric procedures on N=59 (3.2%) obese Pts with BMI <35 obese Pts with BMI <35
Angrisani 2013Angrisani 2013
323
50345923
375100
ANTI -OBESITY PROCEDURES n= 1801
Jan 1996 - Dec 2011
Lap Band System® Gastric BypassBioenterics Intragastric Balloon® BPD-Duodenal SwitchSleeve Gastrectomy Revisions
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Bariatric Procedures in BMI<35 S.Giovanni Bosco experience
April 2000- October 2011
36
11
12
LAGB LRGBP SG
Age 36±10 35±8 43±10
BMI preop 32±1.6 33±0.9 34±0.6
BMI/EWL6months 29/31 27/52 24/75
BMI/EWL1yr 28/36 25/64 23/84
BMI/EWL2yrs 27/44 23/82 23/83
BMI/EWL3yrs 26/46 24/76 25/72
BMI/EWL4yrs 27/42 24/76 ---
BMI/EWL5yrs 26/48 25/70 ---
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Sleeve vs Banding vs Bypass in BMI< 35Pts
Sleeve
LapBand20,00
22,00
24,00
26,00
28,00
30,00
32,00
34,00
Pre-op 6 mo 1yr 2 yr 3 yr 4 yr 5 yr
32,80
2423 23
25
33,8
27
25
23 24 24 25
32
2928
2726 27
26 Sleeve
Bypass
LapBand
Mean BMIKg/m2
Angrisani 2013
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Sleeve vs Banding vs Bypass in BMI< 35Pts
0
3136
44 4642
48
0
52
64
8276 76
70
0
75
84 83
72
0
10
20
30
40
50
60
70
80
90
pre-op 6 mo 1yr 2 yr 3 yr 4 yr 5 yr
LAGB
LRGBP
SG
EWL%EWL%
Angrisani 2013
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• SG pts showed a quicker weight loss compared to GBP pts (better %EWL at 6months and 1 year) but comparable at 2 and 3 years
• SG and GBP pts showed a better weight loss compared to LAGB pts (p=.001)
Sleeve vs Banding vs Bypass in BMI< 35Pts
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LapBand in 36 Pts with BMI< 35LapBand in 36 Pts with BMI< 35
2022242628303234
Pre-op 1 yr3 yr
5 yr7 yr
32,6
28,8
26,30 26,50 27,40
FU rate= 87,8%
BMI
Angrisani 2013Angrisani 2013
36/36
13/19
3 pts were debanded at 3 yearsOne pt converted to SG after 4 yrs
16/218/10
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RESULTS
• 36 Pts with BMI< 35 underwent LASGB • 5M/31F; mean age: 36±10 yo; mean
preoperative BMI was 32.7±1 (range 30-34.9)
• 30-days mortality, intraoperative complications and laparoscopic conversion were absent
• 3 Pts were debended for gastric pouch, 1 was converted to sleeve gastrectomy
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Sleeve vs Banding vs Bypass in BMI< 35Pts
• Percentage of pts suffering from one or more comorbidities.
• They all experienced improvement or remission after surgery
• Comorbidities: DM2, Sleep Apnea, hiatal hernia, ipertension, dislipidemia
SG (11/11)SG (11/11) GBP GBP (8/12)(8/12)
LAGB (20/36)LAGB (20/36)
% of % of ptspts
100100 66.666.6 55.555.5
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DM2 in BMI<35 PtsS.Giovanni Bosco Experience
• 2Pts submitted to LRYGBP – (1M/1F) 44+/-2,8y; preop BMI 34,6+/-0.14
• One suffered from DM2 since >10 years and was under insuline therapy (>80 U/day) with good glycemic control (HbA1c 6,8%)
• At 2 years she improved DM2 with HbA1c 6,8% with 3 gr of metformin/day and BMI 28
• One male pts was on metformin since 3 years with good glycemic control (HbA1c 6,1%) and after 4 years he is in good glycaemic control (HbA1c 5,6%) in absence of therapy
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DM2 in BMI<35 PtsS.Giovanni Bosco Experience
• 2Pts submitted to SG – (1M/1F) 45+/-5y; preop BMI 33,8+/-0.3– Both two Pts were under metformin Therapy
(one since 1,5 years and one since 8 years) with good glycaemic control (HbA1c 6.6+/-1%)
– At 18 months after surgery they were 21,5+/-0,5 Kg/m2 with good glycaemic control (HbA1c 5,6+/-0.3%) in absence of therapy.
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CONCLUSIONSCONCLUSIONS• Patients with BMI 30-35 can be submitted to LAGB, SLEEVE
e LRYGB as a tailored, safe and effective approach to lose weight at short term follow-up
• Short-term weight loss of BMI<35 SG patients is comparable to GBP patients and better than LAGB patients
• SG could improve bariatric comorbidities such as DM2 in low BMI pts.
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Laparoscopic AdjustableLaparoscopic AdjustableGastric Band (LAGB)Gastric Band (LAGB)
Roux-en-Y Gastric Roux-en-Y Gastric Bypass (RYGB)Bypass (RYGB)
Vertical Sleeve GastrectomyVertical Sleeve Gastrectomy(VSG)(VSG)
BMI<35
GO FOR IT!
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