7th International Congress of the Spanish Society of Obesity Surgery. Valladolid Spain May, 2004.
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2 7th International Congress of the Spanish Society of Obesity Surgery. Valladolid Spain May, 2004.
3 DIMINISHING POSTOPERATIVE RISKS OF GASTRIC BYPASS Stenosis Stenosis Leak Leak Bleeding Bleeding Stenosis Stenosis Leak Leak Bleeding Bleeding Chronic Chronic Marginal Marginal Ulcer Ulcer Severe Severe Dumping. Dumping. Obstruction Stenosis Leak Bleeding Volvulus Intussuception Internal Hernia Obstruction?? Failure in Weight Loss or Weight Regain!!! Two Anastomosis GB 12 Possible Risk Factors (OAGB) One Anastomosis GB 4 Possible Risk Factors.
4 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM (OAGB)
5 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM (OAGB) KEY STEPS OF THE PROCEDURE 1. Bilio Pancreatic Limb: between 250 to 350 cm average. 2. Section of Greater Omentum: in supermorbid and central obesity. 3. Hiss Angle, Fat and G E 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. Anti reflux Mechanism : afferent loop suspended at least10 cm on the gastric pouch. 6. Gastro Ileal Anastomosis Side to Side: ~ 2.5 cm. width.
6 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM (OAGB) Post-operative X-Ray control Radiologic control at 5 years
7 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS RESULTS: Patient Characteristics (July 2002 to February 2015) Age 43 (12 74) Female Gender Male 1599 (61.5%) 1001 (38.5%) BMI 46 (31 86) EBW (kg) 65 (28 220)
8 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS RESULTS: Patient Characteristics (July 2002 to February 2015) Primary Surgery Other Previous Open Surgery 1495 (57.5%) 627 (24.12%) Other Associated Procedures 408 (15.69 %) Previous Bariatric Procedures 70 (2.69%)
9 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS Uncomplicated Patients (99%) Length of Hospital Stay Patients with Major Complications 34 (1%) 1 day ( h.) 9 days (4 32 d.)
10 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS Surgical Early Major Complications Bleeding 2 (0.08 %) Intraoperative Complications (resolved by Open Surgery) 4 (0.2%) Gastro esophageal Perforation 1 (0.04 %) Incorrect Gastric Transection 1 (0.04 %) Immediate Postoperative Complications (resolved by Open Surgery) 6 (0.2%) Immediate Postoperative Complications (resolved by Lap. Surgery) TOTAL 16 (0.8%) Leaks 2 (0.08 %) Intestinal Obstruction 1 (0.04 %) Partial Necrosis of Excluded Stomach Bleeding 1 (0.04 %) 2 (0.08%) Bleeding 10 (0.4%) Leaks 2 (0.08 %) Intestinal Obstruction 3 (0.11 %) Acute Gastric Distension 1 ( (1%)%)
11 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS Non Surgical Early Major Complications Complications Treated Conservatively Mortality Mortality Leaks 10 (0.4 %) Massive Pulmonary Embolism 1 (0.04 %) Acute Pancreatitis 1 (0.04 %) Nosocomial Pneumonia (Post reintervention) 1 (0.04 %) Infected Hematoma 1 (0.04 %) DIC Post Band reversion 1 (0.04 %) Total 12 (0.5%) Total 3 (0.11%)
12 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS Late Complications Pneumatic Dilatation Gastro intestinal stenosis 9 (0.3%) Prosthesis 7 (0.3%) 2 (0.08%) Anastomotic Ulcer Medical Treatment 13 (0.5%) Malnutrition Medical treatment 14 (0.5%) Medical treatment 3 (0.1%) B1 B6 Vitamin (severe deficit) Revisional surgery TOTAL None 0 (0%) 39 (1.5 %)
13 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS Endoscopic Studies at 5 Year Follow Up Postop. UGI endoscopic (control) studies planned for all patients completing 5 year f/u patients completed at least 5 Year f/u 602 (34%) underwent UGI endoscopic studies NO significant acute or chronic lesions found NO erosive esophagitis or severe alkaline reflux Findings: Stomal ulcer: 4 (0.7%) Mild / Moderate pouch gastritis: 41 (7%) H. Pylori +: 10 (1.7%)
14 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS Weight Loss 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 70% (45 98%) 12 year 69% (43 98%)
15 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13YEAR EXPERIENCE IN PATIENTS Severe Comorbidities Resolution Index at Two years at Ten years Dyslipidemia 100% 86% Type II Diabetes 93% 90% Arterial Hypertension 98% 87% Sleep apnea 100% 99%
16 (Since January 2010) BMI Distribution TOTAL OPERATIONS 717 OAGB TOTAL OPERATIONS RYGB TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
17 (Since January 2010) Co morbidities Prevalence TOTAL OPERATIONS 717 OAGB TOTAL OPERATIONS RYGB TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
18 (Since January 2010) Previous Co morbidities 84,14 % 77,41 % 51,38 % 49,94 % 36,20 % 32,10 % 30,17 % 19,66 % 16,90 % 14,48 % 24,29 % 6,05 % TOTAL OPERATIONS 717 TOTAL OPERATIONS OAGB RYGB
19 (Since January 2010) Previous Co morbidities 39,90 % 35,23 % 24,11 % 16,45 % 2,66 % 8,51 % 11,98 % TOTAL OPERATIONS 2447 GB 16,63 % 23,74 % 28,32 % 7,29 % TOTAL OPERATIONS 7862 SG 34,29 %
20 (Since January 2010) Hospital Stay TOTAL OPERATIONS 717 OAGB TOTAL OPERATIONS RYGB TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
21 (Since January 2010) Intra operative Complications % % % Gastrointestin Injury Bleeding al perforation Liver Failure vascular % % Injury Other splenic % Deaths TOTAL OPERATIONS 717 OAGB TOTAL OPERATIONS 2447 GB TOTAL OPERATIONS RYGB TOTAL OPERATIONS 7862 SG
22 g G pl en ic er at a Bl ion l ee di ng om Le in ak al W Ab ou sc nd es W s I n ou f ec nd tio De n hi sc en An ce as to Ob Int m st es ot ru t i Ga ic ct na st St io l ric ric n /S tu to re m al Ul ce Li r ve Li r ve Fa rf ilu a r Voilu e m re iti ng Ot he r In tr aab d co m iti n Ot he r Vo m G pl en ic er a a Bl tio l In ee n tr di ang Ab do Le m in ak al W A ou nd bsc W es ou s nd Infe c De tio In te n hi st sc in e nc al An e Ob as st to ru m ct ot io n ic Ga St st ric ri c tu /S re to m al Ul ce r co m (Since January 2010) Post operative Complications % % 0,17 % % % % % % % % % TOTAL OPERATIONS 717 TOTAL OPERATIONS OAGB RYGB %
23 GB TOTAL OPERATIONS 7862 SG Ot he r co m Ge pl n ic er at a Bl ion l In e tr ed ain Ab g do m L in ea al k A W bs ou ce nd ss W ou In fe nd ct In De io te n st hi in sc al en Ob An ce as st ru to ct m io ot Ga n i c st S ric tr ic /S tu to re m al Ul ce Li ve r rf ai lu re Vo m iti ng TOTAL OPERATIONS 2447 Ot he r G pl en ic er a a Bl tion l In e tr ed ain Ab g do m L ea in al k Ab W ou sc es nd W s ou In nd fe In c tio D te eh st n is in ce al nc An O bs e as t ru to m ct io ot Ga n ic st S ric tr ic /S tu to re m al Ul Li ve cer rf ai lu re Vo m iti ng co m (Since January 2010) Post operative Complications
24 (Since January 2010) Post operative Complications
25 (Since January 2010) General Complications 0.56% TOTAL OPERATIONS 717 OAGB 4.32% TOTAL OPERATIONS RYGB 4.02% 7.23% TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
26 (Since January 2010) General Complications: Esophageal 0.63% 0% TOTAL OPERATIONS 717 TOTAL OPERATIONS RYGB OAGB 1.4% 4% TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
27 (Since January 2010) General Complications: Gastric 0.28% TOTAL OPERATIONS 717 OAGB 0.17% 1.55% TOTAL OPERATIONS RYGB 0.28% TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
28 (Since January 2010) General Complications: Metabolic 0.49% 0.28% TOTAL OPERATIONS 717 OAGB TOTAL OPERATIONS RYGB 0.04% 1.21% TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
29 (Since January 2010) General Complications: Hepatobillary 1.05% 0% TOTAL OPERATIONS 717 TOTAL OPERATIONS OAGB RYGB 0.21% 1.66% TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
30 (Since January 2010) General Complications: Non specific 0.56% 0% TOTAL OPERATIONS 717 OAGB 0.25% TOTAL OPERATIONS RYGB 0.16% TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862 GB SG
31 (Since January 2010) % EWL at 36 Months TOTAL OPERATIONS 717 OAGB TOTAL OPERATIONS RYGB
32 (Since January 2010) % EWL at 36 Months TOTAL OPERATIONS 2447 GB TOTAL OPERATIONS 7862 SG
33 Evolution of % EWL
34 Evolution of % EBMIL
35 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN PATIENTS CONCLUSIONS 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.
36 LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN PATIENTS CONCLUSIONS 2.Excellent results in our long term follow up in regards to EWL, EBMIL, resolution of co morbidities and quality of life make OAGB a safe and effective technique, and a powerful alternative for the treatment of morbid and super morbid obesity after a 13 year experience.
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