7th International•Internal Hernia ... B1B6 Vitamin (severe deficit) Medical treatment 3 (0.1%) Revisional surgery None 0 (0%) TOTAL 39

7th International Congress of the

Spanish Society of Obesity Surgery.Valladolid Spain

May, 2004.

DIMINISHING POSTOPERATIVE RISKS OF GASTRIC BYPASS

• Stenosis• Leak• Bleeding• Chronic Marginal Ulcer• Severe Dumping.

• Stenosis• Leak• Bleeding• Chronic Marginal Ulcer• Severe Dumping.

Failure in Weight Loss or Weight

Regain!!!

Failure in Weight Loss or Weight

Regain!!!One Anastomosis GB

4 Possible Risk Factors .One Anastomosis GB

4 Possible Risk Factors .Two Anastomosis GB

12 Possible Risk Factors Two Anastomosis GB

12 Possible Risk Factors

•Stenosis•Leak•Bleeding

•Stenosis•Leak•Bleeding

•Obstruction•Stenosis•Leak•Bleeding•Volvulus• Intussuception• Internal Hernia

Obstruction??

(OAGB)

LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM

(OAGB)


(OAGB)

KEY STEPS OF THE PROCEDURE

1. BilioPancreatic Limb: between 250 to 350 cm average.

2. Section of Greater Omentum: in supermorbid and central obesity.

3. Hiss Angle, Fat and GE membrane Totally Dissected.

4. Gastric Pouch: length: ~ 15cm, capacity: ~ 30 cc. (calibrated with a 36

French tube). Total dissection of fat in the posterior gastric wall.

5. “Antireflux Mechanism”: afferent loop suspended at least10 cm on the gastric pouch.

6. GastroIleal Anastomosis Side to Side: ~ 2.5 cm. width.

Post-operative X-Ray control


(OAGB)

Radiologic control at 5 years

RESULTS: Patient Characteristics (July 2002 to February 2015)

Age 43 (12 74)

Gender

Female 1599 (61.5%)

Male 1001 (38.5%)

BMI 46 (31 86)

EBW (kg) 65 (28 220)

LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS

Primary Surgery 1495 (57.5%)

Other Previous Open Surgery 627 (24.12%)

Other Associated Procedures 408 (15.69 %)

Previous Bariatric Procedures 70 (2.69%)


RESULTS: Patient Characteristics (July 2002 to February 2015)

Length of Hospital Stay

Uncomplicated Patients

2.566 (99%)1 day

(15120 h.)

Patients with Major Complications34 (1%)

9 days (432 d.)


Surgical Early Major Complications

Intraoperative Complications

(resolved by Open Surgery) 4 (0.2%)

Bleeding 2 (0.08 %)

Gastroesophageal Perforation 1 (0.04 %)

Incorrect Gastric Transection 1 (0.04 %)

Immediate Postoperative Complications

(resolved by Open Surgery)6 (0.2%)

Leaks 2 (0.08 %)

Intestinal Obstruction 1 (0.04 %)

Partial Necrosis of Excluded StomachBleeding

1 (0.04 %)2 (0.08%)

Immediate PostoperativeComplications

(resolved by Lap. Surgery)16 (0.8%)

Bleeding 10 (0.4%)

Leaks 2 (0.08 %)

Intestinal Obstruction 3 (0.11 %)

Acute Gastric Distension 1 (0.04 %) TOTAL 26 (1%)


Complications Treated Conservatively

Leaks 10 (0.4 %)

Acute Pancreatitis 1 (0.04 %)

Infected Hematoma

1 (0.04 %)

Total 12 (0.5%)

Non Surgical Early Major Complications

Mortality Massive

Pulmonary Embolism

1 (0.04 %)

Nosocomial Pneumonia (Post

reintervention)

1 (0.04 %)

DICPost Band reversion

1 (0.04 %)

Total 3 (0.11%)

Mortality


Late Complications


Gastrointestinal stenosis9 (0.3%)

Pneumatic Dilatation 7 (0.3%)

Prosthesis 2 (0.08%)

AnastomoticUlcer

Medical Treatment 13 (0.5%)

Malnutrition Medical treatment 14 (0.5%)

B1B6 Vitamin(severe deficit)

Medical treatment 3 (0.1%)

Revisional surgery None 0 (0%)

TOTAL 39 (1.5 %)


Endoscopic Studies at 5Year FollowUpPostop. UGI endoscopic (control) studies planned for all patients completing 5year f/u 1.750 patients completed at least 5Year f/u 602 (34%) underwent UGI endoscopic studies

NO significant acute or chronic lesions foundNO erosive esophagitis or severe alkaline reflux

Findings:Stomal ulcer: 4 (0.7%)Mild / Moderate pouch gastritis: 41 (7%)H. Pylori +: 10 (1.7%)

Percent of mean (and range)

EWL at:

1 year 84% (55 –112%)

2 year 88% (58 –115%)

3 year 81% (55 –103%)

4 year 79% (51 –102%)

5 year 77% (48 –100%)

10 year

12 year

70% (45–98%)

69% (43–98%)

Weight Loss


at Two years at Ten years

Dyslipidemia 100% 86%

Type II Diabetes 93% 90%

Arterial Hypertension 98% 87%

Sleep apnea 100% 99%

Severe Comorbidities Resolution Index


TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455


IFSO European Database Control(Since January 2010)

BMI Distribution

COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG

OAGB RYGB

SGGB




Comorbidities Prevalence


OAGB RYGB

SGGB


OAGB RYGB


Previous Comorbidities

30,17 %

16,90 % 14,48 %

84,14 %

51,38 %

77,41 %

36,20 %

6,05 %

19,66 %24,29 %

32,10 %

49,94 %


TOTAL OPERATIONS 7862

SGTOTAL OPERATIONS 2447

GB


Previous Comorbidities

24,11 %

2,66 %8,51 %

16,45 %11,98 %

39,90 %35,23 %

7,29 %

16,63 %23,74 %

28,32 %34,29 %





Hospital Stay


OAGB RYGB

SGGB


Intraoperative Complications


OAGBTOTAL OPERATIONS 11455

RYGB

SGGB

Bleeding LiverFailure

Injurysplenic

OtherGastrointestinal perforation

Injuryvascular

Deaths

% % % % % %




OAGB RYGB


Postoperative Complications


0,17

Gen

eral

com

plic

atio

nBl

eedi

ng

Leak

Intra-

Abdo

min

al A

bsce

ss

Wou

nd In

fect

ion

Wou

nd D

ehisce

nce

Inte

stin

al O

bstruc

tion

Anas

tom

otic S

trictu

re

Gas

tric

/Sto

mal

Ulc

er

Vom

iting

Oth

er

Gen

eral

com

plic

atio

nBl

eedi

ng

Leak

Intra-

Abdo

min

al A

bsce

ss

Wou

nd In

fect

ion

Wou

nd D

ehisce

nce

Inte

stin

al

Obs

truc

tion

Anas

tom

otic S

trictu

re

Gas

tric

/Sto

mal

Ulc

er

Live

r Fai

lure

Vom

iting

Oth

er

%

%

%

%%

%%

%% %

%

%

Live

r Fai

lure



SGTOTAL OPERATIONS 2447

GB



COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSGGen

eral

com

plic

atio

nBl

eedi

ng

Leak

Intra-

Abdo

min

al A

bsce

ss

Wou

nd In

fect

ion

Wou

nd D

ehisce

nce

Inte

stin

al O

bstruc

tion

Anas

tom

otic

Stric

ture

Gas

tric

/Sto

mal

Ulcer

Li

ver F

ailu

reVo

miti

ng

Oth

er

Gen

eral

com

plic

atio

nBl

eedi

ng

Leak

Intra-

Abdo

min

al A

bsce

ss

Wou

nd In

fect

ion

Wou

nd D

ehisce

nce

Inte

stin

al O

bstruc

tion

Anas

tom

otic

Stric

ture

Gas

tric

/Sto

mal

Ulc

er

Live

r Fai

lure

Vom

iting

Oth

er







General Complications


OAGB RYGB

SGGB

0.56% 4.32%

4.02% 7.23%




General Complications: “Esophageal”


OAGB RYGB

SGGB

0.63%

1.4% 4%

0%




General Complications: “Gastric”


OAGB RYGB

SGGB

0.28% 1.55%

0.17% 0.28%




General Complications: “Metabolic”


OAGB RYGB

SGGB

0.28% 0.49%

0.04% 1.21%




General Complications: “Hepatobillary”


OAGB RYGB

SGGB

1.05%

0.21% 1.66%

0%




General Complications: “Non specific”


OAGB RYGB

SGGB

0.56%

0.25% 0.16%

0%

TOTAL OPERATIONS 11455 RYGB

TOTAL OPERATIONS 717 OAGB


% EWL at 36 Months


TOTAL OPERATIONS 2447 GB

TOTAL OPERATIONS 7862 SG


% EWL at 36 Months


IFSO European Database Control

Evolution of % EWL


IFSO European Database Control

Evolution of % EBMIL


1.The OAGB (BAGUA) technique in our experience does not reduce the “complexity” of the surgical procedure, but significantly reduces operative time and lenght of hospital stay compared to other complex techniques; it also substantially decreases both early and late complication rates.

CONCLUSIONS

LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: BYPASS:

13-YEAR EXPERIENCE IN 2.600 PATIENTS 13-YEAR EXPERIENCE IN 2.600 PATIENTS

2.Excellent results in our longterm followup in regards to EWL, EBMIL, resolution of comorbidities and quality of life make OAGB a safe and effective technique, and a powerful alternative for the treatment of morbid and supermorbid obesity after a 13year experience.

CONCLUSIONS

LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: BYPASS:

13-YEAR EXPERIENCE IN 2.600 PATIENTS 13-YEAR EXPERIENCE IN 2.600 PATIENTS

CENTER OF EXCELLENCE FOR THE STUDY AND OBESITY SURGERY TREATMENT

Documents

7th International•Internal Hernia ... B1B6 Vitamin (severe deficit) Medical treatment 3 (0.1%) Revisional surgery None 0 (0%) TOTAL 39