ANALISI COMPARATIVA DELLA GASTRECTOMIA VERTICALE VS BENDAGGIO GASTRICO VS BYPASS GASTRICO IN PAZIENTI CON BMI<35 - PowerPoint PPT Presentation

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ANALISI COMPARATIVA DELLA GASTRECTOMIA VERTICALE VS BENDAGGIO GASTRICO VS BYPASS GASTRICO IN PAZIENTI CON BMI<35

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... 44+/-2,8y; preop BMI 34,6+/-0.14 One suffered from DM2 since 10 years and was under insuline therapy ... in absence of therapy DM2 in BMI – PowerPoint PPT presentation

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Title: ANALISI COMPARATIVA DELLA GASTRECTOMIA VERTICALE VS BENDAGGIO GASTRICO VS BYPASS GASTRICO IN PAZIENTI CON BMI<35


1
ANALISI COMPARATIVA DELLA GASTRECTOMIA VERTICALE
VS BENDAGGIO GASTRICO VS BYPASS GASTRICO IN
PAZIENTI CON BMIlt35
  • PIER PAOLOCUTOLO
  • General 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 BMIlt35 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 lt 35 (1998
2012)
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SICOB National RegistryPts BMI lt 35 (1998
2012)
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Diabete, OSAS, Ipertensione arteriosa, RGE,
Artropatia da carico
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Bariatric procedures on N59 (3.2) obese Pts
with BMI lt35
Angrisani 2013
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Bariatric Procedures in BMIlt35 S.Giovanni Bosco
experienceApril 2000- October 2011
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LAGB LRGBP SG
Age 3610 358 4310
BMI preop 321.6 330.9 340.6
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 BMIlt 35Pts
Mean BMI Kg/m2
Angrisani 2013
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Sleeve vs Banding vs Bypass in BMIlt 35Pts
EWL
Angrisani 2013
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Sleeve vs Banding vs Bypass in BMIlt 35Pts
  • 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)

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LapBand in 36 Pts with BMIlt 35
36/36
BMI
16/21
13/19
8/10
3 pts were debanded at 3 years One pt converted
to SG after 4 yrs
Angrisani 2013
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RESULTS
  • 36 Pts with BMIlt 35 underwent LASGB
  • 5M/31F mean age 3610 yo mean preoperative BMI
    was 32.71 (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 BMIlt 35Pts
SG (11/11) GBP (8/12) LAGB (20/36)
of pts 100 66.6 55.5
  • 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

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DM2 in BMIlt35 PtsS.Giovanni Bosco Experience
  • 2Pts submitted to LRYGBP
  • (1M/1F) 44/-2,8y preop BMI 34,6/-0.14
  • One suffered from DM2 since gt10 years and was
    under insuline therapy (gt80 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 BMIlt35 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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CONCLUSIONS
  • 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 BMIlt35 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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BMIlt35
Roux-en-Y Gastric Bypass (RYGB)
Vertical Sleeve Gastrectomy (VSG)
Laparoscopic Adjustable Gastric Band (LAGB)
GO FOR IT!
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