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Luigi Angrisani Director - General and Endoscopic Surgery Unit

LINEE GUIDA  PER IL RINFORZO DELLE SUTURE IN CHIRURGIA BARIATRICA Leakage /fistole e sanguinamento dalle linee di sutura: siti ed incidenza. Luigi Angrisani Director - General and Endoscopic Surgery Unit S.Giovanni Bosco Hospital, Naples , Italy. “ S.GIOVANNI BOSCO” EXPERIENCE.

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Luigi Angrisani Director - General and Endoscopic Surgery Unit

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  1. LINEE GUIDA  PER IL RINFORZO DELLE SUTURE IN CHIRURGIA BARIATRICA Leakage/fistole e sanguinamento dalle linee di sutura: siti ed incidenza Luigi Angrisani Director - General and EndoscopicSurgery Unit S.Giovanni Bosco Hospital, Naples, Italy

  2. “S.GIOVANNI BOSCO” EXPERIENCE N=1109 Pts Angrisani 2013

  3. Leak is reported in 1-7 % of patients

  4. Leak rate 1.5% (75% GE junction) Prevention Not too tight sleeve (using larger bougies ≥ 40fr)* Firing the stapler lateral to the angle of His Performing an intraoperative leak test * *

  5. Conclusions • Meanleak rate 2.4% (range 0-7%) • 92% at the GE junction • 79% ofleaksoccurred more than 10 dayspostoperatively • Super-obese ptsleak rate 2.9% vs morbid obese patientsleak rate 2.2% (notsignificant p>0.05) • Stricture rate: 0.5% • Bleeding rate: 0.7% • Boogie sizeof <40Fr isassociatedwithincreasedriskofleak • Oversewing or buttressingof the staplelinedoesnothave a clinicallysignificanteffect on leaks Aurora A et al. SurgEndosc (2012) 26:1509-1515)

  6. Techniquesusedfor LSG

  7. Effectoftechnique on leak rate Overallleak rate: 2.2%

  8. Conclusions Leak rate of approximately 2.4% Clinically significant bleeding and stricture rate of less than 1% Leak at GE junction 89% Greater risk of leak in BMI > 50 kg/m2 Greater risk of leak with smaller bougies (<40 Fr) Oversewing or buttressing of the staple line does not have a clinically significant effect on leak

  9. LAPBAND BIB BYPASS ANGRISANI 2013 Naples, Italy

  10. RESULTS • Complications: intraoperativeleaks in SG pts • N=2/495 (0,4%) • Intra-Operativeconversionto: 1 pt* 1pt Roux en Y limb with Sub-Total Gastrectomy Roux-en-Y GBP with DistalStomach Preservation * Band removal 1 year before ANGRISANI 2013 Naples, Italy

  11. Leak rate: 17/1133 (1.5%)

  12. p value: not statistically significant

  13. Laparoscopic Roux en Y Gastric Bypass N=510(Jan 2000 – Dec2012) • Mortality 1 (0,2%) • Laparotomic Conversion 4 (0.8%) • Gastro-jejunal Leak 2 (0,4%) • Gastro-jejunal Stenosis 3 (0,6%) • Mean Operative Time 140  25 min • Hospital Stay 5  2 days General and Endoscopic Surgery Unit“S. Giovanni Bosco” Hospital - Naples - ItalyDirector: Luigi Angrisani

  14. Laparoscopic Roux en Y Gastric Bypass REOPERATIONS 22/510 (4.3%) Jan 00- Dec 12 Internalhernia N=11 Bowelperforation N=3 Jejuno-jejunostomystenosis N=2 Bowelobstruction / Adhesions N=2 Intussusception N=2 Hemoperitoneum N=1 Proteinmalnutrition N=1 General and Endoscopic Surgery Unit“S. Giovanni Bosco” Hospital - Naples - ItalyDirector: Luigi Angrisani

  15. CONCLUSIONS • The healing time of a SG leakislongerthanGBPs’ leak • Evenif the rate of complications of GBP & SG issimilar, thoseafter SG appear to have a worseoutcomeleading to more aggressive procedures (Total/distalgastrectomy) • Revisionalprocedureshaveanincreasedrisk of leak versus primaryprocedures. Angrisani-Formisano 2013

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