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?
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
12-14 cm long gastric pouch
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
200 – 220 cm from Treitz ligament
200 – 220 cm from Treitz ligament
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Mini Gastric Bypass in Italy 2006-2012
Che intervento è?E’ lecito eseguirlo?E’ vantaggioso eseguirlo?Quali risultati?
M. Musella - SICOB - Cagliari 04/13
20012001
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
20052005
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
20052005
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
20052005
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
20082008
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
20112011
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
20112011
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
20122012
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Mini Gastric Bypass in Italy 2006-2012
20122012
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Mini Gastric Bypass in Italy 2006-2012
Biliary GastritisAchloridriaMucosal chronic
inflammationNitrosoderivate
activationGastric stump cancer
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
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%***
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
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.
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
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.
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Gastric stump cancer
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.
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Gastric stump cancer
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Gastric stump cancer
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Gastric stump cancer
M. Musella - SICOB - Cagliari 04/13
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.
Mini Gastric Bypass in Italy 2006-2012
Esophago Gastric cancer
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
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)
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
M. Musella - SICOB - Cagliari 04/13
Che intervento è?E’ lecito eseguirlo?E’ vantaggioso
eseguirlo?Quali risultati?
Mini Gastric Bypass in Italy 2006-2012
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
M. Musella - SICOB - Cagliari 04/13
Che intervento è?E’ lecito eseguirlo?E’ vantaggioso
eseguirlo?Quali risultati?
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
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
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
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Main Preoperative ParametersMain Preoperative Parameters
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Calibre of the bougie :
• 42 fr (380 patients)
• 40 fr (70 patients)
• 36 fr (524 patients)
Loop lenght :
224.6 ± 23.2 cm
M. Musella - SICOB - Cagliari 04/13
Size of the blue cartdrige linear stapler (gastrojejunal anastomosis):
• 30 mm (70 patients)
• 45 mm (451 patients)
• 60 mm (453 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)
M. Musella - SICOB - Cagliari 04/13
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
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
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%)
M. Musella - SICOB - Cagliari 04/13
Peri-operative complications
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Follow up outcome
M. Musella - SICOB - Cagliari 04/13
Follow up complication rate
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
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
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
Mail to:
M. Musella - SICOB - Cagliari 04/13
Mini Gastric Bypass in Italy 2006-2012
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)