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MINI GASTRIC BY-PASS IN ITALY MULTICENTRE REVIEW 2006-2012

MINI GASTRIC BY-PASS IN ITALY MULTICENTRE REVIEW 2006-2012. Università degli Studi di Napoli “ Federico II ” Dipartimento di Scienze Biomediche Avanzate Chirurgia Generale. M. Musella. Mini Gastric Bypass in Italy 2006-2012. Che intervento è? E ’ lecito eseguirlo?

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MINI GASTRIC BY-PASS IN ITALY MULTICENTRE REVIEW 2006-2012

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  1. MINI GASTRIC BY-PASS IN ITALY MULTICENTRE REVIEW 2006-2012 Università degli Studi di Napoli “Federico II” Dipartimento di Scienze Biomediche Avanzate Chirurgia Generale M. Musella M. Musella - SICOB - Cagliari 04/13

  2. Mini Gastric Bypass in Italy 2006-2012 • Che intervento è? • E’ lecito eseguirlo? • E’ vantaggioso eseguirlo? • Quali risultati? M. Musella - SICOB - Cagliari 04/13

  3. Mini Gastric Bypass in Italy 2006-2012 M. Musella - SICOB - Cagliari 04/13

  4. Mini Gastric Bypass in Italy 2006-2012 12-14 cm long gastric pouch M. Musella - SICOB - Cagliari 04/13

  5. Mini Gastric Bypass in Italy 2006-2012 M. Musella - SICOB - Cagliari 04/13

  6. Mini Gastric Bypass in Italy 2006-2012 M. Musella - SICOB - Cagliari 04/13

  7. Mini Gastric Bypass in Italy 2006-2012 200 – 220 cm from Treitz ligament M. Musella - SICOB - Cagliari 04/13

  8. Mini Gastric Bypass in Italy 2006-2012 200 – 220 cm from Treitz ligament M. Musella - SICOB - Cagliari 04/13

  9. Mini Gastric Bypass in Italy 2006-2012 • Che intervento è? • E’ lecito eseguirlo? • E’ vantaggioso eseguirlo? • Quali risultati? M. Musella - SICOB - Cagliari 04/13

  10. Mini Gastric Bypass in Italy 2006-2012 2001 M. Musella - SICOB - Cagliari 04/13

  11. Mini Gastric Bypass in Italy 2006-2012 2005 M. Musella - SICOB - Cagliari 04/13

  12. Mini Gastric Bypass in Italy 2006-2012 2005 M. Musella - SICOB - Cagliari 04/13

  13. Mini Gastric Bypass in Italy 2006-2012 2005 M. Musella - SICOB - Cagliari 04/13

  14. Mini Gastric Bypass in Italy 2006-2012 2008 M. Musella - SICOB - Cagliari 04/13

  15. Mini Gastric Bypass in Italy 2006-2012 2011 M. Musella - SICOB - Cagliari 04/13

  16. Mini Gastric Bypass in Italy 2006-2012 2011 M. Musella - SICOB - Cagliari 04/13

  17. Mini Gastric Bypass in Italy 2006-2012 2012 M. Musella - SICOB - Cagliari 04/13

  18. Mini Gastric Bypass in Italy 2006-2012 2012 M. Musella - SICOB - Cagliari 04/13

  19. Mini Gastric Bypass in Italy 2006-2012 • BiliaryGastritis • Achloridria • Mucosalchronicinflammation • Nitrosoderivateactivation • Gastricstumpcancer M. Musella - SICOB - Cagliari 04/13

  20. Mini Gastric Bypass in Italy 2006-2012 M. Musella - SICOB - Cagliari 04/13

  21. Mini Gastric Bypass in Italy 2006-2012 BiliaryGastritis • Rutledge 2005 (2475 pts.) 0.2% • Carbajo 2005 (209 pts.) 0%* • Chevallier 2008 (100 pts.) 2.0% • Noun 2012 (1000 pts) 0%-5.1%** • Lee 2012 (1163 pts.) 3.7%*** M. Musella - SICOB - Cagliari 04/13

  22. Mini Gastric Bypass in Italy 2006-2012 Biliary Gastritis • Johnson WH, Fernanadez AZ, Farrell TM, Macdonald KG, Grant JP, McMahon RL, Pryor AD, Wolfe LG, DeMaria EJ.(2007) Surgical revision of loop ("mini") gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007 Jan-Feb;3(1):37-41. M. Musella - SICOB - Cagliari 04/13

  23. Mini Gastric Bypass in Italy 2006-2012 Gastric stump cancer • Caygill CP, Hill MJ, Kirkham JS, Northfield TC (1986) Mortality from gastric cancer following gastric surgery for peptic ulcer. Lancet 1(8487):929-31. • Viste A, Bjørnestad E, Opheim P, Skarstein A, Thunold J, Hartveit F, Eide GE, Eide TJ, Søreide O (1986) Risk of carcinoma following gastric operations for benign disease. A historical cohort study of 3470 patients. Lancet 2(8505):502-5. • Lundegårdh G, Adami HO, Helmick C, Zack M, Meirik O (1988) Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med 319:195-200. M. Musella - SICOB - Cagliari 04/13

  24. Mini Gastric Bypass in Italy 2006-2012 Gastricstumpcancer • Fischer AB, GraemN, Jensen OM. Risk of gastriccancerafterBillroth II resection for duodenalulcer (1983) Br JSurg 70:552-4. • TokudomeS, KonoS, Ikeda M, Kuratsune M, Sano C, Inokuchi K, Kodama Y, Ichimiya H, NakayamaF, KaibaraN, et al. (1984) A prospectivestudy on primarygastricstumpcancerfollowingpartialgastrectomy for benigngastroduodenaldiseases. Cancer Res 44:2208-12. M. Musella - SICOB - Cagliari 04/13

  25. Mini Gastric Bypass in Italy 2006-2012 Gastric stump cancer M. Musella - SICOB - Cagliari 04/13

  26. Mini Gastric Bypass in Italy 2006-2012 Gastric stump cancer M. Musella - SICOB - Cagliari 04/13

  27. Mini Gastric Bypass in Italy 2006-2012 Gastric stump cancer Bassily R, Smallwood RA, Crotty B. (2000) Risk of gastric cancer is not increased after partial gastrectomy. J Gastroenterol Hepatol. Jul;15(7):762-5. The records of a total of 569 patients who had a partial gastrectomy for peptic ulcer disease at Repatriation General Hospital, Heidelberg, between 1957 and 1976 were reviewed. Duration of follow up was 17.3 years (range 1-41 years). The expected number of cancers in this population was 6.5. Assuming all survivors were free of gastric cancer, the standardized incidence ratio was 1.39 (95% confidence intervals 0.64-2.65, P=0.313). The risk of gastric cancer was not increased after partial gastrectomy in this Australian population. M. Musella - SICOB - Cagliari 04/13

  28. Mini Gastric Bypass in Italy 2006-2012 Esophago Gastric cancer M. Musella - SICOB - Cagliari 04/13

  29. Mini Gastric Bypass in Italy 2006-2012 EsophagoGastriccancer • 33 esophagogastriccancers (ca) • 4 ca (12.1%) following a loop bypass (notbetterdescribed) • 3 calocated in the excludedstomach • 1 calocated in the gastricpouchfollowing a 1980 surgery • 15 ca (45.4%) followingrestrictiveprocedures (LAGB, SG, VBG) • 14 ca (42.4%) following RYGBP (5 located in the excludedstomach) M. Musella - SICOB - Cagliari 04/13

  30. Mini Gastric Bypass in Italy 2006-2012 • Che intervento è? • E’ lecito eseguirlo? • E’ vantaggioso eseguirlo? • Quali risultati? M. Musella - SICOB - Cagliari 04/13

  31. Mini Gastric Bypass in Italy 2006-2012 M. Musella - SICOB - Cagliari 04/13

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  40. Mini Gastric Bypass in Italy 2006-2012 • Che intervento è? • E’ lecito eseguirlo? • E’ vantaggioso eseguirlo? • Quali risultati? M. Musella - SICOB - Cagliari 04/13

  41. Mini Gastric Bypass in Italy 2006-2012 Dal 11/07/2006 al 31/12/2012 abbiamo valutato i risultati ottenuti dall’esecuzione del Mini Gastric Bypass laparoscopico, per la cura dell’obesità e di alcune comorbilità associate ad essa, eseguiti nei seguenti centri : M. Musella - SICOB - Cagliari 04/13

  42. Mini Gastric Bypass in Italy 2006-2012 Sono stati eseguiti un totale di 974 interventi 475 pazienti maschi (28%) 499 pazienti femmine (71,69%) BMI medio = 48 ± 4,579 Età media della popolazione = 39,45 anni M. Musella - SICOB - Cagliari 04/13

  43. Mini Gastric Bypass in Italy 2006-2012 Main Preoperative Parameters M. Musella - SICOB - Cagliari 04/13

  44. Mini Gastric Bypass in Italy 2006-2012 • Calibre of the bougie : • 42 fr (380 patients) • 40 fr (70 patients) • 36 fr (524 patients) Loop lenght : 224.6 ± 23.2 cm M. Musella - SICOB - Cagliari 04/13

  45. Size of the blue cartdrige linear stapler (gastrojejunal anastomosis): • 30 mm (70 patients) • 45 mm (451 patients) • 60 mm (453 patients) • Stapler holes closure method: • Double layer running 2-0 suture (573 patients) • Single layer running 2-0 suture (21 patients) • Interrupted 2-0 stitches (380 patients) • Reinforcement of the suture line: • Fibrin sealant (52 patients) • Oversewing (45 patients) M. Musella - SICOB - Cagliari 04/13

  46. Mini Gastric Bypass in Italy 2006-2012 In 451 patients an anti-biliary reflux mechanism was provided. All 974 patients were checked by an intraoperative methylene blue test at the end of the procedure M. Musella - SICOB - Cagliari 04/13

  47. TOTALE PAZIENTI DECEDUTI • 2/974 = 0,2% • PAZIENTI DECEDUTI PER COMPLICANZE NON RELATIVE ALLA PROCEDURA • 1/974 = 0,1% • Trombo-embolia polmonare 3 casi (0,3%) di cui 1 decesso (25%) • Infarto del miocardio 0 casi • Ischemia cerebrale 1 caso (0,1%) • Insufficienza renale acuta 0 casi • PAZIENTI DECEDUTI PER COMPLICANZE RELATIVE ALLA PROCEDURA: • 1/974 = 0,1% • LEAK ANASTOMOSI = 3 casi (0,3%) di cui 1 decesso (33%) • LEAK TUBULO GASTRICO= 5 casi (0,5%) • LEAK MONCONE GASTRICO= 2 casi (0,2%) • BLEEDING= 25 casi (2,5%) • EMORRAGIE DIGESTIVE= 9 casi (0,9%) M. Musella - SICOB - Cagliari 04/13

  48. Mini Gastric Bypass in Italy 2006-2012 Peri-operative complications M. Musella - SICOB - Cagliari 04/13

  49. Follow up outcome M. Musella - SICOB - Cagliari 04/13

  50. Follow up complication rate M. Musella - SICOB - Cagliari 04/13

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