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

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

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  1. ANALISI COMPARATIVA DELLA GASTRECTOMIA VERTICALE VS BENDAGGIO GASTRICO VS BYPASS GASTRICO IN PAZIENTI CON BMI<35 PIER PAOLOCUTOLO General and laparoscopic Surgery Unit – S.Giovanni Bosco Hospital, Naples Italy

  2. 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)

  3. 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%.

  4. SICOB National RegistryPts BMI < 35 (1998 – 2012)

  5. SICOB National RegistryPts BMI < 35 (1998 – 2012)

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

  7. Bariatric procedures on N=59 (3.2%) obese Pts with BMI <35 Angrisani 2013

  8. Bariatric Procedures in BMI<35 S.Giovanni Bosco experienceApril 2000- October 2011 11 36 12

  9. Sleeve vs Banding vs Bypass in BMI< 35Pts Mean BMI Kg/m2 Angrisani 2013

  10. Sleeve vs Banding vs Bypass in BMI< 35Pts EWL% Angrisani 2013

  11. Sleeve vs Banding vs Bypass in BMI< 35Pts • 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)

  12. LapBand in 36 Pts with BMI< 35 36/36 BMI 16/21 13/19 8/10 3 pts were debanded at 3 years One pt converted to SG after 4 yrs Angrisani 2013

  13. 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

  14. 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

  15. 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

  16. 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.

  17. CONCLUSIONS • 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.

  18. BMI<35 Roux-en-Y Gastric Bypass (RYGB) Vertical Sleeve Gastrectomy (VSG) Laparoscopic Adjustable Gastric Band (LAGB) GO FOR IT!

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