PIER PAOLOCUTOLO General and laparoscopic Surgery Unit – S.Giovanni Bosco Hospital, Naples Italy

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

• 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)

• 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%.

SICOB National RegistryPts BMI < 35 (1998 – 2012)

SICOB National RegistryPts BMI < 35 (1998 – 2012)

Diabete, OSAS, Ipertensione arteriosa, RGE, Artropatia da carico

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

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 ---

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

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

• 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

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

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

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

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

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.

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.

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!