XXI Congresso Nazionale SICOB La Gestione degli insuccessi
XXI Congresso Nazionale SICOB La Gestione degli insuccessi del calo ponderale in Chirurgia Bariatrica Strategie di Trattamento dopo fallimento di Bendaggio Gastrico Maurizio De Luca MD Department of Surgery – Regional Hospital of Vicenza – Italy Cagliari, 25 -27 Aprile 2013
2 LAGB – first choice for obesity surgery Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Two phases of LAGB development Laparoscopic Adjustable Gastric Banding Development phase (pre-2000) Established phase (post-2000) Significant numbers received perigastric implants All pars-flaccida Laparoscopic surgery in its infancy – few surgeons with experience Advanced laparoscopic techniques well established and widely disseminated No specialist obesity surgery centres Many internationally recognised Centres of Excellence Early band technology – high failure rates due to leakage, erosions and tubing/access port probems. Improved band engineering and design, eliminating previous problems and offering innovations – eg development of rapid fixation technology for access port Little experience with band adjustment, erosion, pouch dilatation, prolapse etc Greater recognition of perils of overadjustment and need for close follow-up and early intervention when problems arise. Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Gastric Banding Studies before 2000 Authors Size of Duration of cohort follow-up Implantation Operative Port/tubing Slippage/pouch Erosion Re-operation mortality problems (e. g. dilatation % rate % EWL leakage & infection) Pre-2000 Tolonen et al 280 7 years PF 0 10. 6% 6. 5% 3. 3% 24. 4% 56% at 7 years Steffen et al 824 5 years PF 0 6. 8% 2. 7% 1. 6% Major 16. 5% 57% at 5 years (minor 6. 8%) Chevallier et al 1, 000 7 years PG 37. 8% 0 5. 7% 10. 4% 0. 3% 11% Not reported PF 62. 2% Zehetner et al 190 6 years PF 0 2. 6% 2. 1% 8. 5% 50% after 2 ys Toouli et al 1, 000 8 years PG 4. 2% 0 6. 7% 3. 0% 3. 1% 14. 5% 52% at 8 years 0 7. 5% 8. 5% 0% 8. 8% 52. 7% at 2 PF 95. 8% Chevallier et al 400 2 years PG 94. 5% PF 5. 5% Zinzindohoue et 500 3 years al [36] Ceelen et al PG 77. 4% years 0 7. 8% 8. 6% 0% 10. 4% PF 22. 6% 625 3 years PG 54. 8% at 3 years 0 2. 9% 5. 6% 0% 7. 8% 47. 4%
Gastric Banding Studies before 2000 Authors Size of Duration of cohort follow-up Implantation Operative Port/tubing mortality problems (e. g. Slippage/pouch Erosion Re-operation dilatation % rate % EWL leakage & infection) Pre-2000 Favretti et al 1, 791 12 years PG 77. 8% 0 11. 2% 3. 9% 0. 9% 5. 9% 38. 5% at 10 years PF 21. 5% Vertruyen et al 543 7 years PG 0 2. 9% 4. 6% 0. 9% 6. 8% 52% at 7 years Michelleto et al 684 5 years PG 47% 0 6. 8% 6. 1% 1% 6. 3% 54% at 5 years 0 2. 5% 4. 5% 0. 3% 3. 9% 59. 3% after 8 years PF 53% Weiner R et al 984 8 years RG 58. 7% Mixed 41. 3% O’Brien et al 709 6 years PG 0 3. 6% 12. 5% 2. 8% 18. 9% 57% at 6 years Belachew et al 763 4 years PF 0. 1% 2. 6% 7. 7% 0. 9% 10. 5% 50 -60% at 4 years + Dargent et al 1, 180 7 years PG/PF (not stated) 0. 16% N/S 8. 8% 12. 7% 50% at 7 years Mittermair et al 454 3 years PF 0 9. 7% 2. 0% 3. 1% 7. 9% 72% at 3 years Balsiger et al 196 7 years PF 0 7. 5% 12% 1% 32% 61% at 7 years
Gastric Banding Studies after 2000 Authors Size of Duration of cohort follow-up Implantation Operative Port/tubing Slippage/pouch Erosion Re-operation % EWL mortality problems (e. g. dilatation % rate 2. 3% 0. 2% 8 bands 64. 3% at 4 explanted years 7. 2% 44. 3% at 1 leakage & infection) Post-2000 Ponce et al 1, 014 4 years PG 4. 3% 0 1. 2% PF 95. 7% Ren et al 445 1 year PF 0. 2% 2. 2% 3. 1% 0. 2% year Parikh et al 749 3 years PF 0 2. 4% 2. 9% 0. 1% 10. 7% 52% at 3 years Holloway et al [41] 500 3 years PF 0. 2% 9. 2% 5. 0% 1. 0% n/s 65% at 3 years Sarker et al 409 3 years PF 0. 2% 4. 2% 5. 4% 0. 2% 12. 2% 53. 3% at 3 yrs
Gastric Banding Studies Before vs After the year 2000 : difference? Efficacy – Weight Loss 50 -60 %EWL before and after 2000 Steffen 57%EWL 824 pts Belachew 55%EWL 763 pts Parikh 52%EWL 749 pts Ponce 64%EWL 1014 pts 5 y 4 y 3 y 4 y before 2000 after 2000 Steffen R, Biertho L, Ricklin T, et al (2003). Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg 13: 404 -411 Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12: 564 -568 Parikh MS, Fielding G, Ren CJ (2005) US experience with 749 laparoscopic adjustable gastric bands: Intermediate outcomes. Surg Endosc 19: 1631 -1635 Ponce J, Paynter S, Fromm R Laparoscopic adjustable gastric banding: 1, 014 consecutive cases. J Am Coll Surg 201: 529 -535 2005 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Efficacy – Weight Loss 137 studies (33 SAGB and 104 LAGB) – 29980 Patients 3 -Year mean weight loss was 53. 3% Cunneen SA, Phillips E, Fielding G et al. Studies of Swedish adjustable gastric band Lap-band: systematic review and meta-analysis. Surg Obes Relat Dis 2008; 4: 174 -85 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
LAGB vs RYGBP – long-term outcomes Systematic review of medium-term weight loss after bariatric operations Evaluation of 43 reports fulfilled the entry criteria (18 RYGBP; 18 LAGB; 7 BPD) %EWL Years of Follow Up O’Brien PE et al. Obes Surg 2006; 16: 1032 -1040
Gastric Banding Studies Before vs After the year 2000 : difference? Operative Mortality No significant difference in Operative Mortality Steffen 0% Favretti 0. % Belachew 0. 1% Parikh 0% Ren 0. 2% 824 pts 1791 pts 763 pts 749 pts 445 pts 5 y 12 y 4 y 3 y 1 y before 2000 after 2000 Steffen R, Biertho L, Ricklin T, et al (2003). Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg 13: 404 -411 Favretti F, Segato G, Ashton D, et al (2007) Laparoscopic adjustable gastric banding in 1, 791 consecutive obese patients: 12 year results. Obese Surg 17: 168 -175 Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12: 564 -568 Parikh MS, Fielding G, Ren CJ (2005) US experience with 749 laparoscopic adjustable gastric bands: Intermediate outcomes. Surg Endosc 19: 1631 -1635 Ren CJ, Weiner M, Allen RW (2004) Favourable early results of gastric banding for morbid obesity: The American experience. Surg Endosc 18: 543 -546 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Operative Mortality 137 studies (33 SAGB and 104 LAGB) – 29980 Patients early mortality ≤ 0. 1% Cunneen SA, Phillips E, Fielding G et al. Studies of Swedish adjustable gastric band Lap-band: systematic review and meta-analysis. Surg Obes Relat Dis 2008; 4: 174 -85 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Gastric Banding Studies Before vs After the year 2000 : difference? Stomach Slippage Drammatically lower stomach slippage rate from Perigastric tecnique vs pars Flaccida tecnique Ponce 20. 5% in PG vs 1. 4% O’Brien four time higher in PG Ponce J, Paynter S, Fromm R Laparoscopic adjustable gastric banding: 1, 014 consecutive cases. J Am Coll Surg 201: 529 -535 2005 O’Brien, PE, Dixon JB, Anderson M. A prospective randomized trial of placement of the laparoscopic adjustable gastric band: comparison of the perigastric and pars flaccida pathways. Obes Surg; 15: 820 -6 2005 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Gastric Banding Studies Before vs After the year 2000 : difference? Gastric Erosion No significant difference in Gastric Erosion Rate Chevallier 0% Favretti 0. 9% Tolonen 3. 3% Watkins 0. 1% Singhal 0. 09% 400 pts 2 y 1791 pts 12 y 280 pts 7 y 2411 pts 3 y 1140 pts 3 y before 2000 after 2000 Chevallier JM, Zinzindohoue F, Douard R, et al (2004) Complications after laparoscopic adjustable gastric banding for morbid obesity: Experience with 1, 000 patients over 7 years. Obes Surg 14: 407 -414 Favretti F, Segato G, Ashton D, et al (2007) Laparoscopic adjustable gastric banding in 1, 791 consecutive obese patients: 12 year results. Obese Surg 17: 168 -175 Tolonen P, Victorzon M, Makela J (2008). 11 -year experience with laparoscopic adjustable gastric banding - What happened to the first 123 patients? Obes Surg 18: 251 -255 Watkins BM, Ahroni JH, Michaelson R, et al (2008) Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Rel Dis 4 (Suppl): S 56 -62 Singhal R, Kitchen M, Ndirika S, et al (2008) The “Birmingham” stitch” - Avoiding slippage in laparoscopic gastric banding. Obes Surg 18: 359 -363 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Gastric Banding Studies Before vs After the year 2000 : difference? Port Tubing leakage and infection Less common rate due to improved band design and surgical technique Mittermair Favretti Tolonen Parikh Singhal 9. 7% 11% 10. 6% 0%s 0. 35% 454 pts 3 y 1791 pts 12 y 280 pts 7 y 749 pts 3 y 1140 pts 3 y before 2000 after 2000 Mittermair RP, Weiss H, Nehoda H, et al (2003) Laparoscopic Swedish adjustable gastric banding: 6 -year follow-up and comparison to other laparoscopic bariatric procedures. Obes Surg 13: 412 -417 Favretti F, Segato G, Ashton D, et al (2007) Laparoscopic adjustable gastric banding in 1, 791 consecutive obese patients: 12 year results. Obese Surg 17: 168 -175 Tolonen P, Victorzon M, Makela J (2008). 11 -year experience with laparoscopic adjustable gastric banding - What happened to the first 123 patients? Obes Surg 18: 251 -255 Watkins BM, Ahroni JH, Michaelson R, et al (2008) Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Rel Dis 4 (Suppl): S 56 -62 Singhal R, Kitchen M, Ndirika S, et al (2008) The “Birmingham” stitch” - Avoiding slippage in laparoscopic gastric banding. Obes Surg 18: 359 -363 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Gastric Banding Studies Before vs After the year 2000 : difference? Reoperation Rate Drammatically reduced due to improved band design and surgical technique Steffen Belachew Tolonen Sarker Singhal major 16. 5% - minor 6. 8% 824 pts 5 y 10. 5% 763 pts 4 y 24, 4% 280 pts 7 y before 2000 2. 6%s 7409 pts 3 y after 2000 2. 1% 1140 pts 3 y Steffen R, Biertho L, Ricklin T, et al (2003). Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg 13: 404 -411 Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12: 564 -568 Tolonen P, Victorzon M, Makela J (2008). 11 -year experience with laparoscopic adjustable gastric banding - What happened to the first 123 patients? Obes Surg 18: 251 -255 Sarker S, Myers J, Serot J, et al (2006) Three-year follow-up weight loss results for patients undergoing laparoscopic adjustable gastric banding at a major university medical center: Does the weight loss persist? Am J Surg 191: 372 -376 Singhal R, Kitchen M, Ndirika S, et al (2008) The “Birmingham” stitch” - Avoiding slippage in laparoscopic gastric banding. Obes Surg 18: 359 -363 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Gastric Banding Studies Before vs After the year 2000 : difference? Length of procedure Reduced to the surgical skill Vertruyen M Micheletto G Dargent J Watkins 60 -150 min 40 min before 2000 after 2000 Vertruyen M (2002) Experience with Lap-Band system up to 7 years. Obes Surg 12: 569 -572 Micheletto G, Roviaro G, Lattuada E, et al (2006) Adjustable gastric banding for morbid obesity. Our experience. Ann Ital Chir 77: 397 -400 Dargent J (1999) Laparoscopic adjustable gastric banding: Lessons from the first 500 patients in a single institution. Obes Surg 9: 446 -452 Watkins BM, Ahroni JH, Michaelson R, et al (2008) Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Rel Dis 4 (Suppl): S 56 -62 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Gastric Banding Studies Before vs After the year 2000 : difference? Hospital Stay Reduced up to ambulatory basis Vertruyen M Micheletto G Dargent J Watkins Coburn 3 -4 days ambulatory before 2000 after 2000 Vertruyen M (2002) Experience with Lap-Band system up to 7 years. Obes Surg 12: 569 -572 Micheletto G, Roviaro G, Lattuada E, et al (2006) Adjustable gastric banding for morbid obesity. Our experience. Ann Ital Chir 77: 397 -400 Dargent J (1999) Laparoscopic adjustable gastric banding: Lessons from the first 500 patients in a single institution. Obes Surg 9: 446 -452 Watkins BM, Ahroni JH, Michaelson R, et al (2008) Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Rel Dis 4 (Suppl): S 56 -62 Coburn C et al. Laparoscopic Gastric Banding is Safe in Outpatient Surgical Centres. Obes Surg 2010; Published Online, January. Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Gastric Banding Studies Before vs After the year 2000 : difference? Efficacy – Weight Loss in extreme cases Different Studies show that there are not differences in terms of safety and efficacy in Super-obese, Adolescents and Elderly Pts Torchia F, Mancuso V et al (2008) Lap. Band system® in super-superobese patients (>60 kg/m 2): 4 -year results. Obes Surg [Epub ahead of print]. Fielding GA, Duncombe JE (2005) Laparoscopic adjustable gastric banding in severely obese adolescents. Surg Obes Relat Dis 1: 399 -405 52. Taylor CJ, Layani L (2006) Laparoscopic adjustable gastric banding in patients > or + 60 years old: Is it worthwhile? Obes Surg 16: 1579 -1583 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
9 LAGB– long-term outcomes Ø 0 operative mortality Ø 91% follow-up with 5. 9% re-operation rate Ø Mean EWL% at 10 years was approximately 40% Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Laparoscopic Gastric Banding for 1800 Patients: 12 Years Results in Super e Morbid Obese (BMI) 484 3 374 317 Kg 274 242 204 151 113 70 381 269 197 41 15 1307 976 819 690 612 523 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it 125 48 12 3
Laparoscopic Gastric Banding for 1800 Patients: 12 Years Results in Super e Morbid Obese (% EWL) 3 976 819 690 612 523 381 269 197 125 204 151 113 70 41 12 48 317 274 %EWL 374 242 1307 484 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it 15 3
Laparoscopic Gastric Banding for 1800 Patients: 12 Years Results Major Complications Requiring Reoperation (106/1791 pts. ; Sept 1993 -Dec 2005) Complications Number Rate of Complications Stomach Slippage + Pouch Dilatation 70 3. 9% Erosion 16 0. 9% Psychological Intolerance 14 Miscellaneous (HIV, Infections, Microperforation) Number Rate of Reoperation 20 50 1. 1% 2. 8% Removal 16 0. 9% 0. 7% Removal 14 0. 7% 5 0. 27% Removal 5 0. 27% Gastric Necrosis 1 0. 05% Gastrectomy 1 0. 05% Total 106 5. 9% Unsatisfactory Results (Lack of Compliance) 41 2. 3% 5 12 24 0. 27% 0. 7% 1. 3% Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it Reoperation • Removal • Repositioning • BPD • Removal • “Band. Inaro”
Lap-Band Patients: No Responders Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Strategie di trattamento dopo fallimento di Bendaggio Gastrico … about “no responders”…. Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
No Responders • Gastric Bypass and Functional Gastric Bypass • Sleeve Gastrectomy • Scopinaro or Duodenal Switch • Mini Gastric Bypass Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Sleeve Gastrectomy Vicenza Series Ø 14 Patients (December 2006 to January 2008) ØF/M 9/5 Ø 14 cases of remedial surgery Ø 5 -6 green and blue staple cartridge after full devascularization and mobilization af the greater gastric curve ØRunning suture by 3 -0 Prolene over-sewed the staple-line ØMean operative time was 95 min (70 -135) ØNo peri-operative or post-operative complication ØNo mortality Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it cccccccccc
Gastric Bypass Small gastric pouch Roux –en-Y gastrointestinal anastomosis Food Intake reduction Early satiety Post-prandial discomfort Partial lipid malabsorption Functional Bypass Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it Maurizio De Luca
Bilio Pancreatic Diversion Bilio. Pancreatica Diversion (Scopinaro 1976) Ø distal gastrectomy Øgastric reservoir 200 -300 ml Øcommon channel 50 cm Øalimentary channel 200 cm Maurizio De Luca
Bilio Pancreatic Diversion Bilio. Pancreatic Diversion Duodenal Switch (Hess 1988) Ø vertical gastrectomy Øgastric reservoir 150 -200 ml Øduodenal switch Øcommon channel 100 cm Øalimentary channel 150 cm Maurizio De Luca
Effects of BPD on comorbidities. Scopinaro N, Adami FA, Marinari GM et al. Bilio. Pancreatic Diversion: Two Decades of Experience. Update: Surgery for the Morbidly Obese Patient. F-D Communication. Deitel M, Cowan G, 2000, Chap 23, 227 -258 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Duodenal Switch Complication (Hess: 440 pts. ) Medical perioperative complication Deep vein thrombofiblitis Non-fatal pulmonary embolism Pneumonia ARDS Surgical Complication Splenectomy (incidental) Duodenal Leak Distal Roux-en-Y Leak Post-op bleeding (requiring surgery) Abscess (not related to leaks) Late Surgical complication Duodenal stoma obstruction Small Bowel obstruction 0. 75% 0. 25% 0. 75% 1. 5% Hess DS. Biliopancreatic Diversion with Duodenal Switch. Obes Surg. 8, 267 -282, 1998 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Nutrients Most at Risk Iron Calcium Zinc Vitamin. D Vitamin A Vitamin K Protein Dolen K et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004; 240 -51 Slater GH, Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointestinal Surg 2004; 8: 48 -65 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
. BPD Standad and BPD DS prevalence side-effects (p<0. 0001 by Fisher t-test) Marceau P. , Hould F, Lebel S et al. Malabsorbitive Obesity Surgery. The Surgical Clinics of North America. 2001, 81, 5, 1113 -1127 Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Mini Gastric Bypas Omega Loop Long Limb Gastric Bypass Single Anastomosis 20 -30 ml Gastric pouch One gastro-jejunal anastomosis with a diameter of 1. 5 -2 cm L-L anastomosis and non T-L anastomosis Antireflux Stitches Omega Loop 200 -220 cm (different mechanism of Billroth II) Antecolic anastomosis (avoiding holes in the mesocolon) Less surgery compared with GBP and BPD Low peri-operative comorbidities compared with GBP and BPD Long Term Weight Loss as BPD (75% EWL at 10 yrs) Resolution or improvement of Diabetes in 89% of Pts at 7 yrs Resolution of hyperlipidemia in 92% of Pts at 7 yrs Absence of BPD side effects (like diarrhea, hemorrhoids, proctitis etc. ) Absence metabolic side effects of BPD (protein malnutrition) One Anastomosis Gastric Bypass: a simple, safe and efficient surgical procedure for treating morbid obesity M Garcia Caballero and M Carbajo Nutricion Hospitalaria, XIX, (6) 372 -375, 2004 Maurizio De Luca
BARIATRIC SURGERY Sequential Treatment LAP BAND Treated (72% of pts) Undertreated Malabsorption Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it Treated (Comorbidities)
BARIATRIC SURGERY Sequential Treatment LAP BAND Treated (72% of pts) Undertreated No compliant Patients Single Anastomosis Omega Loop Gastric Bypass Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it Malapsorbitive procedure
Conclusion 1 § The majority of Studies shows that LAGB is a safe and effective procedure § Operative mortality of 0 -0. 1% § Excess Weight Loss (%EWL) of 50 -60% § Commensurate to this degree of weight loss, almost all studies show substantial improvements in obesity related comorbidities such as Hypertension, Type II Diabetes, and Dyslipidemia § LAGB has been shown to be both safe and effective in super-obese, adolescents, older patients Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
Conclusion 2 § The lessons from the development phase (before 2000) of LAGB taught , in the estabilished phase (after 2000), surgical techniques and band technologies § There is no agreement, to date, regarding: 1. LAGB indications 2. role of the multidisciplinary team 3. algorithm of band inflation 3 parameters of paramount importance for: • further weight loss • further reduction of reoperation rate § Redo Surgery in case of failure of LAGB is easy to be performed (sleeve gastrectomy, gastric bypass, mini gastric bypass, BPD) Maurizio De Luca MD Executive Surgeon General Secretary of Italian Society of Bariatric Surgery Email: nnwdel@tin. it
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