maurizio de luca md department of surgery – regional hospital of vicenza – italy xxi congresso...
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Maurizio De Luca MD
Department of Surgery – Regional Hospital of Vicenza – ItalyDepartment of Surgery – Regional Hospital of Vicenza – Italy
XXI Congresso Nazionale SICOB
Cagliari, 25-27 Aprile 2013
La Gestione degli insuccessi del calo ponderale in Chirurgia Bariatrica
Strategie di Trattamento dopo fallimento di Bendaggio Gastrico
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
2
LAGB – first choice for obesity surgery
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Laparoscopic Adjustable Gastric Banding Development phase (pre-2000) Established phase (post-2000)
Significant numbers received perigastric implants
All pars-flaccida
Laparoscopic surgery in its infancy – few surgeons with experience
Advanced laparoscopic techniques well established and widely disseminated
No specialist obesity surgery centres Many internationally recognised Centres of Excellence
Early band technology – high failure rates due to leakage, erosions and tubing/access port probems.
Improved band engineering and design, eliminating previous problems and offering innovations – eg development of rapid fixation technology for access port
Little experience with band adjustment, erosion, pouch dilatation, prolapse etc
Greater recognition of perils of over-adjustment and need for close follow-up and early intervention when problems arise.
Two phases of LAGB development
Authors Size of
cohort
Duration of
follow-up
Implantation Operative
mortality
Port/tubing
problems (e.g.
leakage &
infection)
Slippage/pouch
dilatation
Erosion
%
Re-operation
rate
% EWL
Pre-2000
Tolonen et al 280 7 years PF 0 10.6% 6.5% 3.3% 24.4% 56% at 7 years
Steffen et al 824 5 years PF 0 6.8% 2.7% 1.6% Major 16.5%
(minor 6.8%)
57% at 5 years
Chevallier et al 1,000 7 years PG 37.8%
PF 62.2%
0 5.7% 10.4% 0.3% 11% Not reported
Zehetner et al 190 6 years PF 0 2.6% 2.6% 2.1% 8.5% 50% after 2 ys
Toouli et al 1,000 8 years PG 4.2%
PF 95.8%
0 6.7% 3.0% 3.1% 14.5% 52% at 8 years
Chevallier et al 400 2 years PG 94.5%
PF 5.5%
0 7.5% 8.5% 0% 8.8% 52.7% at 2
years
Zinzindohoue et
al [36]
500 3 years PG 77.4%
PF 22.6%
0 7.8% 8.6% 0% 10.4% 54.8% at 3
years
Ceelen et al 625 3 years PG 0 2.9% 5.6% 0% 7.8% 47.4%
Gastric Banding Studies before 2000
Authors Size of
cohort
Duration of
follow-up
Implantation Operative
mortality
Port/tubing
problems (e.g.
leakage &
infection)
Slippage/pouch
dilatation
Erosion
%
Re-operation
rate
% EWL
Pre-2000
Favretti et al 1,791 12 years PG 77.8%
PF 21.5%
0 11.2% 3.9% 0.9% 5.9% 38.5% at 10 years
Vertruyen et al 543 7 years PG 0 2.9% 4.6% 0.9% 6.8% 52% at 7 years
Michelleto et al 684 5 years PG 47%
PF 53%
0 6.8% 6.1% 1% 6.3% 54% at 5 years
Weiner R et al 984 8 years RG 58.7%
Mixed 41.3%
0 2.5% 4.5% 0.3% 3.9% 59.3% after 8 years
O’Brien et al 709 6 years PG 0 3.6% 12.5% 2.8% 18.9% 57% at 6 years
Belachew et al 763 4 years PF 0.1% 2.6% 7.7% 0.9% 10.5% 50-60% at 4years +
Dargent et al 1,180 7 years PG/PF (not stated) 0.16% N/S 8.8% 1.8% 12.7% 50% at 7 years
Mittermair et al 454 3 years PF 0 9.7% 2.0% 3.1% 7.9% 72% at 3 years
Balsiger et al 196 7 years PF 0 7.5% 12% 1% 32% 61% at 7 years
Gastric Banding Studies before 2000
Authors Size of
cohort
Duration of
follow-up
Implantation Operative
mortality
Port/tubing
problems (e.g.
leakage &
infection)
Slippage/pouch
dilatation
Erosion
%
Re-operation
rate
% EWL
Post-2000
Ponce et al 1,014 4 years PG 4.3%
PF 95.7%
0 1.2% 2.3% 0.2% 8 bands
explanted
64.3% at 4
years
Ren et al 445 1 year PF 0.2% 2.2% 3.1% 0.2% 7.2% 44.3% at 1
year
Parikh et al 749 3 years PF 0 2.4% 2.9% 0.1% 10.7% 52% at 3 years
Holloway et al [41] 500 3 years PF 0.2% 9.2% 5.0% 1.0% n/s 65% at 3 years
Sarker et al 409 3 years PF 0.2% 4.2% 5.4% 0.2% 12.2% 53.3% at 3 yrs
Gastric Banding Studies after 2000
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
50-60 %EWL before and after 2000
Steffen 57%EWL 824 pts 5 yBelachew 55%EWL 763 pts 4y before 2000Parikh 52%EWL 749 pts 3y after 2000Ponce 64%EWL 1014pts 4y
Efficacy – Weight Loss
Steffen R, Biertho L, Ricklin T, et al (2003). Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg 13:404-411
Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12:564-568
Parikh MS, Fielding G, Ren CJ (2005) US experience with 749 laparoscopic adjustable gastric bands: Intermediate outcomes. Surg Endosc 19:1631-1635
Ponce J, Paynter S, Fromm R
Laparoscopic adjustable gastric banding: 1,014 consecutive cases. J Am Coll Surg 201:529-535 2005
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
137 studies (33 SAGB and 104 LAGB) – 29980 Patients
3-Year mean weight loss was 53.3%
Cunneen SA, Phillips E, Fielding G et al. Studies of Swedish adjustable gastric band and Lap-band: systematic review and meta-analysis. Surg Obes Relat Dis 2008; 4: 174-85
Efficacy – Weight Loss
LAGB vs RYGBP – long-term outcomesSystematic review of medium-term weight loss after bariatric operationsEvaluation of 43 reports fulfilled the entry criteria (18 RYGBP; 18 LAGB; 7 BPD)
%EWL%EWL
Years of Follow UpYears of Follow Up
O’Brien PE et al. Obes Surg 2006; 16:1032-1040
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
No significant difference in Operative Mortality
Steffen 0% 824 pts 5 yFavretti 0.% 1791 pts 12 yBelachew 0.1% 763 pts 4y before 2000Parikh 0% 749 pts 3y after 2000Ren 0.2% 445 pts 1y
Operative Mortality
Steffen R, Biertho L, Ricklin T, et al (2003). Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg 13:404-411
Favretti F, Segato G, Ashton D, et al (2007) Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obese Surg 17:168-175
Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12:564-568
Parikh MS, Fielding G, Ren CJ (2005) US experience with 749 laparoscopic adjustable gastric bands: Intermediate outcomes. Surg Endosc 19:1631-1635
Ren CJ, Weiner M, Allen RW (2004) Favourable early results of gastric banding for morbid obesity: The American experience. Surg Endosc 18:543-546
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
137 studies (33 SAGB and 104 LAGB) – 29980 Patients
early mortality ≤0.1%
Cunneen SA, Phillips E, Fielding G et al. Studies of Swedish adjustable gastric band and Lap-band: systematic review and meta-analysis. Surg Obes Relat Dis 2008; 4: 174-85
Operative Mortality
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
Drammatically lower stomach slippage rate from Perigastric tecnique vs pars Flaccida tecnique
Ponce 20.5% in PG vs 1.4%
O’Brien four time higher in PG
Stomach Slippage
Ponce J, Paynter S, Fromm R Laparoscopic adjustable gastric banding: 1,014 consecutive cases. J Am Coll Surg 201:529-535 2005
O’Brien, PE, Dixon JB, Anderson M . A prospective randomized trial of placement of the laparoscopic adjustable gastric band: comparison of the perigastric and pars flaccida pathways. Obes Surg;15:820-6 2005
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
No significant difference in Gastric Erosion Rate
Chevallier 0% 400 pts 2 yFavretti 0.9% 1791 pts 12 yTolonen 3.3% 280 pts 7 y before 2000Watkins 0.1% 2411 pts 3y after 2000Singhal 0.09% 1140 pts 3y
Gastric Erosion
Chevallier JM, Zinzindohoue F, Douard R, et al (2004) Complications after laparoscopic adjustable gastric banding for morbid obesity: Experience with 1,000 patients over 7 years. Obes Surg 14:407-414
Favretti F, Segato G, Ashton D, et al (2007) Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obese Surg 17:168-175
Tolonen P, Victorzon M, Makela J (2008). 11-year experience with laparoscopic adjustable gastric banding - What happened to the first 123 patients? Obes Surg 18: 251-255
Watkins BM, Ahroni JH, Michaelson R, et al (2008) Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Rel Dis 4 (Suppl):S56-62 Singhal R, Kitchen M, Ndirika S, et al (2008) The “Birmingham” stitch” - Avoiding slippage in laparoscopic gastric banding. Obes Surg 18:359-363
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
Less common rate due to improved band design and surgical technique
Mittermair 9.7% 454 pts 3 yFavretti 11% 1791 pts 12 yTolonen 10.6% 280 pts 7 y before 2000Parikh 0%s 749pts 3y after 2000Singhal 0.35% 1140 pts 3y
Port Tubing leakage and infection
Mittermair RP, Weiss H, Nehoda H, et al (2003) Laparoscopic Swedish adjustable gastric banding: 6-year follow-up and comparison to other laparoscopic bariatric procedures. Obes Surg 13:412-417
Favretti F, Segato G, Ashton D, et al (2007) Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obese Surg 17:168-175
Tolonen P, Victorzon M, Makela J (2008). 11-year experience with laparoscopic adjustable gastric banding - What happened to the first 123 patients? Obes Surg 18: 251-255
Watkins BM, Ahroni JH, Michaelson R, et al (2008) Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Rel Dis 4 (Suppl):S56-62 Singhal R, Kitchen M, Ndirika S, et al (2008) The “Birmingham” stitch” - Avoiding slippage in laparoscopic gastric banding. Obes Surg 18:359-363
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
Drammatically reduced due to improved band design and surgical technique
Steffen major 16.5% - minor 6.8% 824 pts 5yBelachew 10.5% 763 pts 4 y Tolonen 24,4% 280 pts 7 y before 2000Sarker 2.6%s 7409 pts 3y after 2000Singhal 2.1% 1140 pts 3y
Reoperation Rate
Steffen R, Biertho L, Ricklin T, et al (2003). Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg 13:404-411
Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12:564-568
Tolonen P, Victorzon M, Makela J (2008). 11-year experience with laparoscopic adjustable gastric banding - What happened to the first 123 patients? Obes Surg 18: 251-255
Sarker S, Myers J, Serot J, et al (2006) Three-year follow-up weight loss results for patients undergoing laparoscopic adjustable gastric banding at a major university medical center: Does the weight loss persist? Am J Surg 191:372-376
Singhal R, Kitchen M, Ndirika S, et al (2008) The “Birmingham” stitch” - Avoiding slippage in laparoscopic gastric banding. Obes Surg 18:359-363
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
Reduced to the surgical skill
Vertruyen MMicheletto G 60-150 minDargent J before 2000Watkins 40 min after 2000
Length of procedure
Vertruyen M (2002) Experience with Lap-Band system up to 7 years. Obes Surg 12: 569-572 Micheletto G, Roviaro G, Lattuada E, et al (2006) Adjustable gastric banding for morbid obesity. Our experience. Ann Ital Chir 77:397-400
Dargent J (1999) Laparoscopic adjustable gastric banding: Lessons from the first 500 patients in a single institution. Obes Surg 9:446-452
Watkins BM, Ahroni JH, Michaelson R, et al (2008) Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Rel Dis 4 (Suppl):S56-62
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
Reduced up to ambulatory basis
Vertruyen MMicheletto G 3-4 daysDargent J before 2000Watkins ambulatory after 2000Coburn
Hospital Stay
Vertruyen M (2002) Experience with Lap-Band system up to 7 years. Obes Surg 12: 569-572 Micheletto G, Roviaro G, Lattuada E, et al (2006) Adjustable gastric banding for morbid obesity. Our experience. Ann Ital Chir 77:397-400
Dargent J (1999) Laparoscopic adjustable gastric banding: Lessons from the first 500 patients in a single institution. Obes Surg 9:446-452
Watkins BM, Ahroni JH, Michaelson R, et al (2008) Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Rel Dis 4 (Suppl):S56-62
Coburn C et al. Laparoscopic Gastric Banding is Safe in Outpatient Surgical Centres. Obes Surg 2010; Published Online, January.
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Gastric BandingStudies Before vs After the year 2000 : difference?
Efficacy – Weight Loss in extreme cases
Torchia F, Mancuso V et al (2008) LapBand system® in super-superobese patients (>60 kg/m2): 4-year results. Obes Surg [Epub ahead of print]
. Fielding GA, Duncombe JE (2005) Laparoscopic adjustable gastric banding in severely obese adolescents. Surg Obes Relat Dis 1:399-405 52. Taylor CJ, Layani L (2006) Laparoscopic adjustable gastric banding in patients > or + 60 years old: Is it worthwhile? Obes Surg 16:1579-1583
Different Studies show that there are not differences in terms of safety and efficacy in Super-obese, Adolescents and Elderly Pts
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
LAGB– long-term outcomes
0 operative mortality
91% follow-up with 5.9% re-operation rate
Mean EWL% at 10 years was approximately 40%
9
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Kg 1307
976 819 690 612 523 381 269 197 125 48 12 3
484
374
317 274 242 204 151 113 70 4115
3
Laparoscopic Gastric Banding for 1800 Patients: 12 Years Results
Results in Super e Morbid Obese (BMI)
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Laparoscopic Gastric Banding for 1800 Patients: 12 Years Results
Results in Super e Morbid Obese (% EWL)
%EWL
1307
976 819 690612
523 381 269 197 12548
12
3
484
374
317 274
242 204 151 113 70 41 153
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Laparoscopic Gastric Banding for 1800 Patients: 12 Years Results
Major Complications Requiring Reoperation (106/1791 pts.; Sept 1993-Dec 2005)
Complications Number Rate of Complications
Reoperation Number Rate of Reoperation
Stomach Slippage +
Pouch Dilatation
70 3.9% • Removal • Repositioning
20
50
1.1%
2.8%
Erosion 16 0.9% Removal 16 0.9%
Psychological Intolerance
14 0.7% Removal 14 0.7%
Miscellaneous
(HIV, Infections, Microperforation)
5 0.27% Removal 5 0.27%
Gastric Necrosis 1 0.05% Gastrectomy 1 0.05%
Total 106 5.9% Total 106 5.9%
Unsatisfactory Results
(Lack of Compliance)
41 2.3% • BPD• Removal• “BandInaro”
5
12
24
0.27%
0.7%
1.3%
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Lap-Band Patients: No Responders
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
… about “no responders”….
Strategie di trattamento dopo fallimento di Bendaggio Gastrico
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
No Responders
• Gastric Bypass and Functional Gastric Bypass
• Sleeve Gastrectomy
• Scopinaro or Duodenal Switch
• Mini Gastric Bypass
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Sleeve GastrectomyVicenza Series
14 Patients (December 2006 to January 2008)
F/M 9/5
14 cases of remedial surgery
5-6 green and blue staple cartridge after full devascularization and mobilization af the greater gastric curve
Running suture by 3-0 Prolene over-sewed the staple-line
Mean operative time was 95 min (70-135)
No peri-operative or post-operative complication
No mortality
cccccccccccccccccccc
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Maurizio De Luca
Gastric Bypass
Small gastric pouchRoux –en-Y gastrointestinal anastomosis
Food Intake reductionEarly satietyPost-prandial discomfortPartial lipid malabsorption
Functional Bypass
Maurizio De Luca
Bilio Pancreatic Diversion
BilioPancreatica Diversion (Scopinaro 1976)
distal gastrectomy gastric reservoir 200-300 mlcommon channel 50 cmalimentary channel 200 cm
Maurizio De Luca
Bilio Pancreatic Diversion
BilioPancreatic Diversion Duodenal Switch (Hess 1988)
vertical gastrectomy gastric reservoir 150-200 mlduodenal switchcommon channel 100cmalimentary channel 150 cm
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Effects of BPD on comorbidities.
Scopinaro N, Adami FA, Marinari GM et al. BilioPancreatic Diversion: Two Decades of Experience. Update: Surgery for the Morbidly Obese Patient. F-D Communication. Deitel M, Cowan G, 2000, Chap 23, 227-258
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Duodenal Switch
Complication (Hess: 440 pts.)
Medical perioperative complicationDeep vein thrombofiblitis 0.75%Non-fatal pulmonary embolism 0.5%Pneumonia 0.5%ARDS 0.25%
Surgical ComplicationSplenectomy (incidental) 0.75%Duodenal Leak 1.5%Distal Roux-en-Y Leak 0.25%Post-op bleeding (requiring surgery) 0.5%Abscess (not related to leaks) 0.25%
Late Surgical complicationDuodenal stoma obstruction 0.75%Small Bowel obstruction 1.5%
Hess DS. Biliopancreatic Diversion with Duodenal Switch. Obes Surg. 8, 267-282, 1998
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
Nutrients Most at Risk
Iron
Calcium
Zinc
VitaminD
Vitamin A
Vitamin K
Protein
Dolen K et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004; 240-51
Slater GH, Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointestinal Surg 2004; 8: 48-65
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
BPD Standad and BPD DS prevalence side-effects
Marceau P., Hould F, Lebel S et al. Malabsorbitive Obesity Surgery. The Surgical Clinics of North America. 2001, 81,5, 1113-1127
.
(p<0.0001 by Fisher t-test)
Maurizio De Luca
Less surgery compared with GBP and BPD
Low peri-operative comorbidities compared with GBP and BPD
Long Term Weight Loss as BPD (75% EWL at 10 yrs)
Resolution or improvement of Diabetes in 89% of Pts at 7 yrs
Resolution of hyperlipidemia in 92% of Pts at 7 yrs
Absence of BPD side effects (like diarrhea, hemorrhoids, proctitis etc.)
Absence metabolic side effects of BPD (protein malnutrition)
20-30 ml Gastric pouch
One gastro-jejunal anastomosis with a diameter of 1.5-2 cm
L-L anastomosis and non T-L anastomosis
Antireflux Stitches
Omega Loop 200-220 cm (different mechanism of Billroth II)
Antecolic anastomosis (avoiding holes in the mesocolon)
Mini Gastric BypasOmega Loop Long Limb Gastric Bypass Single Anastomosis
One Anastomosis Gastric Bypass: a simple, safe and efficient surgical procedure for treating morbid obesityM Garcia Caballero and M CarbajoNutricion Hospitalaria, XIX, (6) 372-375, 2004
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
BARIATRIC SURGERY Sequential Treatment
LAP BAND
Treated
(72% of pts)
Undertreated
Malabsorption
Treated(Comorbiditie
s)
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
BARIATRIC SURGERY Sequential Treatment
LAP BAND Treated
(72% of pts)
Undertreated
Single Anastomosis Omega Loop Gastric Bypass
Malapsorbitive procedure
No compliant Patients
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
The majority of Studies shows that LAGB is a safe and effective procedure
Operative mortality of 0-0.1%
Excess Weight Loss (%EWL) of 50-60%
Commensurate to this degree of weight loss, almost all studies show substantial improvements in obesity related comorbidities such as Hypertension, Type II Diabetes,and Dyslipidemia
LAGB has been shown to be both safe and effective in super-obese, adolescents, older patients
Conclusion 1
Maurizio De Luca MD Executive SurgeonGeneral Secretary of Italian Society of Bariatric SurgeryEmail: [email protected]
The lessons from the development phase (before 2000) of LAGB taught , in the estabilished phase (after 2000), surgical techniques and band technologies
There is no agreement, to date, regarding:1. LAGB indications2. role of the multidisciplinary team3. algorithm of band inflation
Redo Surgery in case of failure of LAGB is easy to be performed(sleeve gastrectomy, gastric bypass, mini gastric bypass, BPD)
Conclusion 2
3 parameters of paramount importance for:• further weight loss• further reduction of reoperation rate