MINI GASTRIC BY-PASS IN ITALY MULTICENTRE REVIEW 2006-2012 M. Musella Università degli Studi di Napoli “Federico II” Dipartimento di Scienze Biomediche.

Presentazione sul tema: "MINI GASTRIC BY-PASS IN ITALY MULTICENTRE REVIEW 2006-2012 M. Musella Università degli Studi di Napoli “Federico II” Dipartimento di Scienze Biomediche."— Transcript della presentazione:

1 MINI GASTRIC BY-PASS IN ITALY MULTICENTRE REVIEW 2006-2012 M. Musella Università degli Studi di Napoli “Federico II” Dipartimento di Scienze Biomediche Avanzate Chirurgia Generale 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 12-14 cm long gastric pouch M. Musella - SICOB - Cagliari 04/13 Mini Gastric Bypass in Italy 2006-2012

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

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

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

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

9 Che intervento è? E’ lecito eseguirlo? E’ vantaggioso eseguirlo? Quali risultati? M. Musella - SICOB - Cagliari 04/13

10 2001 Mini Gastric Bypass in Italy 2006-2012

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

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

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

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

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

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

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

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

19 Biliary Gastritis Achloridria Mucosal chronic inflammation Nitrosoderivate activation Gastric stump cancer 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 Biliary Gastritis 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 Gastric stump cancer Fischer AB, Graem N, Jensen OM. Risk of gastric cancer after Billroth II resection for duodenal ulcer (1983) Br J Surg 70:552-4. Tokudome S, Kono S, Ikeda M, Kuratsune M, Sano C, Inokuchi K, Kodama Y, Ichimiya H, Nakayama F, Kaibara N, et al. (1984) A prospective study on primary gastric stump cancer following partial gastrectomy for benign gastroduodenal diseases. 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 M. Musella - SICOB - Cagliari 04/13 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.

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 Esophago Gastric cancer 33 esophagogastric cancers (ca) 4 ca (12.1%) following a loop bypass (not better described) 3 ca located in the excluded stomach 1 ca located in the gastric pouch following a 1980 surgery 15 ca (45.4%) following restrictive procedures (LAGB, SG, VBG) 14 ca (42.4%) following RYGBP (5 located in the excluded stomach) M. Musella - SICOB - Cagliari 04/13

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

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 M. Musella - SICOB - Cagliari 04/13 Che intervento è? E’ lecito eseguirlo? E’ vantaggioso eseguirlo? Quali risultati?

41 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 : CentersPatients Musella 52 Piazza 380 Greco 70 Susa 406 De Luca 45 Manno 21 M. Musella - SICOB - Cagliari 04/13 Mini Gastric Bypass in Italy 2006-2012

42 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 Mini Gastric Bypass in Italy 2006-2012

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

44 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 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 Mini Gastric Bypass in Italy 2006-2012

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 miocardio0 casi Ischemia cerebrale1 caso (0,1%) Insufficienza renale acuta0 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 Peri-operative complications M. Musella - SICOB - Cagliari 04/13 Mini Gastric Bypass in Italy 2006-2012

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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53 Mini Gastric Bypass in Italy 2006-2012 Conclusioni 1. E’ un intervento eseguibile senza rischi per il paziente 2. E’ un intervento vantaggioso per il paziente… 3. E’ un intervento che ha dimostrato una efficacia sovrapponibile e in alcuni parametri anche superiore al RYGBP

54 M. Musella - SICOB - Cagliari 04/13 Mini Gastric Bypass in Italy 2006-2012 Mail to: mario.musella@unina.it

55 M. Musella - SICOB - Cagliari 04/13 Mini Gastric Bypass in Italy 2006-2012 Il giorno 17/apr/2013, alle ore 09.46, Dr Rutledge ha scritto: Looks Great! May I advertise it, Please? Translation: 10:30 to 11:30 SESSION III MINIGASTRIC BYPASS: OPINION OF EXPERTS Chairman: C. Giardiello (Caserta) Moderators: L. Square (Catania), A. Susa (Rovigo)