Laparoscopic Mini-Gastric Bypass Versus Roux-En-Y Gastric Bypass: 5-Year Results and Final Report of a Randomized Trial
Presenter: W. J. Lee (Min-Sheng General Hospital, Taoyuan, Taiwan)
Co-authors: J. Chen1, K. Ser1
1Min-Sheng General Hospital, Taoyuan, Taiwan
Background We had previously reported a randomized study evaluated the surgical morbidity and 2-year results of laparoscopic mini-gastric bypass (LMGBP) versus laparoscopic Roux-en-Y gastric bypass (LRYGBP). We now reported the final result after 5-year follow-up.
Methods 282 patients received LMGBP for the treatment of morbid obesity were recruited from our comprehensive obesity surgery center and compared with 40 patients received LRYGBP who were included in the previous randomized trial. Minimum follow-up was 5 years (from 5 to 8 years). The changes in body weight loss, BMI, quality of life and late complication were determined at follow-up. . Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI).
Result There was no difference in preoperative clinical parameters between the two groups. All procedures were successfully carried out with no deaths in either group.
Surgical time was significantly longer for LRYGBP (205 minutes vs. 148 minutes for LMGBP, p < 0.05).
The complication rate was higher for LRYGBP (20% vs. 7.5%, p < 0.05).
Excess weight loss and mean BMI at 5 years for LRYGBP and LMGB were 60.1% vs. 72.1%, p = 0.072) and (29.2 vs. 27.1, p = 0.30) separately.
Post-operative GQILI increased significantly after operation in both groups without difference.
Late complications and revision rates were similar in the two groups.
Follow-up study disclosed an improvement of obesity-related clinical parameters in both groups without significant difference.
Conclusion This study demonstrates that LMGBP is an effective treatment for morbid obesity and can improve quality of life similar to LRYGBP. LMGBP is simpler and safer procedure than LRYGBP and no proven disadvantage after five year follow-up. LMGBP can be regarded as a simpler and safer alternative surgical procedure to LRYGBP.
Tuesday, July 21, 2009
Conclusion This study demonstrates that LMGBP is an effective treatment for morbid obesity and can improve quality of life similar to LRYGBP. LMGBP is simpler and safer procedure than LRYGBP and no proven disadvantage after five year follow-up. LMGBP can be regarded as a simpler and safer alternative surgical procedure to LRYGBP
Sleve Gastrectomy More Dangerous than MGB
Perforation and leaks(3.15%), intraluminal bleeding(2.72%) and hemoperitoneum(2.15%) were the more frequent complications, out of the total complication rate of 11.46%. Mortality was reported in 6/698(0.85%) patients, 3 of which received multiple reoperations and subsequently died of respiratory complications and sepsis.
Perforation and leaks(3.15%), intraluminal bleeding(2.72%) and hemoperitoneum(2.15%) were the more frequent complications, out of the total complication rate of 11.46%. Mortality was reported in 6/698(0.85%) patients, 3 of which received multiple reoperations and subsequently died of respiratory complications and sepsis.
Sleeve Gastrectomy more dangerous than MGB
Result The total study cohort contains more than 6000 patients. From January 2006 to December 2008, more than 500 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study. The mean body mass index (BMI) of all patients was 48.8 kg/m2. The BMI of patients undergoing SG was 54.5 kg/m2. In total, 73.8% of the patients were female and 26.2% of the patients were male. There were no significant differences between patients undergoing SG. The general complication rate after SG was 14.1%, and the surgical complication rate was 9.4%. The postoperative mortality rate was 1.4%.
Result The total study cohort contains more than 6000 patients. From January 2006 to December 2008, more than 500 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study. The mean body mass index (BMI) of all patients was 48.8 kg/m2. The BMI of patients undergoing SG was 54.5 kg/m2. In total, 73.8% of the patients were female and 26.2% of the patients were male. There were no significant differences between patients undergoing SG. The general complication rate after SG was 14.1%, and the surgical complication rate was 9.4%. The postoperative mortality rate was 1.4%.
Opiod Sparing Anesthesia in Mini-Gastric Bypass Using Dexmedetomidine, Ketamine and Remifentanil, Propofol Total Intravenous Anesthesia (TIVA)
Presenter: R. Rutledge (Centers for Laparocopic Obesity Surgery, Henderson, United States of America)
Background Anesthetic management of morbidly obese patients is problematic with particular concerns re: difficult airway, respiratory depression/failure and post operative nausea and vomiting (PONV). Opiod sparing techniques may allow improved management of these difficult patients.
Methods Mini-Gastric Bypass MGB patients were treated with either TIVA (remifentanil & propofol) with (TKD) or without (TNO) opiod sparing doses of supplemental ketamine (50-100 mg) and dexmedetomidine (100 μg IV over 10 minutes.) We compared post-anesthetic recovery analogue pain score (APS) and narcotic use (# of doses), post operative nausea and vomiting (PONV) and overall patient satisfaction.
Result Over a two year period 720 patients underwent MGB, 343 TKD patients and 377 TNO patients. The mean age 39 + 8, 85% female, mean BMI 45 + 7, mean operative time 39 + 5 min. No patient required reintubation for respiratory depression. In comparing the two groups the TKD patients had: significantly lower mean APS, fewer doses of rescue narcotics, a higher mean respiratory rate in recovery room, less PONV and higher levels of patient satisfaction.
Conclusion Morbidly obese patients present a serious anesthetic challenge to the surgeon and anesthesiologist. The short operative time of the Mini-Gastric Bypass (39 min) allows the use of opiod sparing techniques that decrease respiratory depression and PONV caused by narcotics. This decreases the need for narcotics, improves pain score, decrease PONV and improves overall patient satisfaction.
Presenter: R. Rutledge (Centers for Laparocopic Obesity Surgery, Henderson, United States of America)
Background Anesthetic management of morbidly obese patients is problematic with particular concerns re: difficult airway, respiratory depression/failure and post operative nausea and vomiting (PONV). Opiod sparing techniques may allow improved management of these difficult patients.
Methods Mini-Gastric Bypass MGB patients were treated with either TIVA (remifentanil & propofol) with (TKD) or without (TNO) opiod sparing doses of supplemental ketamine (50-100 mg) and dexmedetomidine (100 μg IV over 10 minutes.) We compared post-anesthetic recovery analogue pain score (APS) and narcotic use (# of doses), post operative nausea and vomiting (PONV) and overall patient satisfaction.
Result Over a two year period 720 patients underwent MGB, 343 TKD patients and 377 TNO patients. The mean age 39 + 8, 85% female, mean BMI 45 + 7, mean operative time 39 + 5 min. No patient required reintubation for respiratory depression. In comparing the two groups the TKD patients had: significantly lower mean APS, fewer doses of rescue narcotics, a higher mean respiratory rate in recovery room, less PONV and higher levels of patient satisfaction.
Conclusion Morbidly obese patients present a serious anesthetic challenge to the surgeon and anesthesiologist. The short operative time of the Mini-Gastric Bypass (39 min) allows the use of opiod sparing techniques that decrease respiratory depression and PONV caused by narcotics. This decreases the need for narcotics, improves pain score, decrease PONV and improves overall patient satisfaction.
Laparoscopic gastric banding is a simple and safe ... Still, it results in overall < 50% of Excess Weight Loss in both short and long term follow up and is accompanied by a significant reoperation rate either due to complications or due to treatment failure. ** Thus, LAGB should no longer be considered as the procedure of choice for obesity and reliable selection criteria must be developed for its use if at all.***
Long-Term Results After Laparoscopic Gastric Banding for Morbid Obesity. 13 Years Follow Up in a Single University Unit
Presenter: A. Konstantinos (Bichat Claude Bernard Hospital, Paris, France)
Co-authors: A. Lasati1, K. Sandrine1, P. Mongol1, D. Chosidow 1, K. Sandrine1, R. Lara1, J. P. Marmuse1
1Bichat Claude Bernard Hospital Paris France
Long-Term Results After Laparoscopic Gastric Banding for Morbid Obesity. 13 Years Follow Up in a Single University Unit
Presenter: A. Konstantinos (Bichat Claude Bernard Hospital, Paris, France)
Co-authors: A. Lasati1, K. Sandrine1, P. Mongol1, D. Chosidow 1, K. Sandrine1, R. Lara1, J. P. Marmuse1
1Bichat Claude Bernard Hospital Paris France
http://ping.fm/b4lz6
I had the MGB in Florida under Dr. P almost 2 years ago. The steps
initially seemed daunting, but once I sat down and did it, it was
easy. It made me appreciate that there was a doctor who actually
wanted me informed about bariatric surgery and wasn't just ready to
operate when I paid the money. All of the claims on the CLOS website
were almost like "it's too good to do be true"... but I can say it has
been one of the best decisions of my life.
I was 355 pounds and miserable. I was proud of what I did, but I
wasn't proud of myself. My back was hurting and I knew if I didn't
get my weight down, I would be facing yet a second back operation.
On August 28th of 2007 I had the surgery and each day has been an
incredible journey. I went from 355 pounds, size 48 pants to 180
pounds and 34 pants.
There are times I wish I was a multi-millionaire and I'd pay for all
my obese friends to have the same life changing experience.
My biggest let down was that our insurance refused to cover it. We
pulled the money out of retirement savings but my theory was this...
"If like keeps like this, I'm not sure I'll even make it to retirement
age. Even if I do, I'm not going to enjoy it. So let's just bite
the bullet now."
I can say unequivocally, that every day of the last 2 years I haven't
had one minute of regret of doing the MGB. Go for it! It'll change
your life.
Les
I had the MGB in Florida under Dr. P almost 2 years ago. The steps
initially seemed daunting, but once I sat down and did it, it was
easy. It made me appreciate that there was a doctor who actually
wanted me informed about bariatric surgery and wasn't just ready to
operate when I paid the money. All of the claims on the CLOS website
were almost like "it's too good to do be true"... but I can say it has
been one of the best decisions of my life.
I was 355 pounds and miserable. I was proud of what I did, but I
wasn't proud of myself. My back was hurting and I knew if I didn't
get my weight down, I would be facing yet a second back operation.
On August 28th of 2007 I had the surgery and each day has been an
incredible journey. I went from 355 pounds, size 48 pants to 180
pounds and 34 pants.
There are times I wish I was a multi-millionaire and I'd pay for all
my obese friends to have the same life changing experience.
My biggest let down was that our insurance refused to cover it. We
pulled the money out of retirement savings but my theory was this...
"If like keeps like this, I'm not sure I'll even make it to retirement
age. Even if I do, I'm not going to enjoy it. So let's just bite
the bullet now."
I can say unequivocally, that every day of the last 2 years I haven't
had one minute of regret of doing the MGB. Go for it! It'll change
your life.
Les
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