Carbajo MA, Ortiz de SJ, García-Lanza C, Pérez MM, Fonseca OG, Castro MJ

Language: Spanish
References: 25
Page: 6-13
PDF size: 156.04 Kb.

ABSTRACT

Objectives: The laparoscopic gastric bypass of a single anastomosis (LGBSA) consists of the obstruction of a long and narrow gastric reservoir of about 25 to 30 cc from the gastroesophageal joint to the end of the minor gastric curvature at the lower level of the «goose’s foot» (Pes Anserinus). Such a reservoir is anastomozed to an intestinal handle in a lateral-lateral position excluded from the feeding course between 250 and 300 cm distal to the Treitz’s angle and designed as an «anti-reflux mechanism». We have analyzed the technique and the results from 1,226 consecutive patients, as well as the experiences obtained from the series. Material and methods: Between July 2002 and June 2008 1,126 patients were subjected to surgery. They were applies a modification of the conventional proximal gastric bypass in «Y» of Roux to LGBSA. The average age was of 43 years old (12-74); the average IMC was of 46 (ranging from 33 to 86) and the average overweight excess was of 65 (ranging from 34 to 220). In 648 patients the LGBSA was primary; in other 256 cases there had been previous abdominal surgeries. In 195 cases the LGBSA was accompanied by other simultaneous surgeries; and in 27 patients it was reconverted from other bariatric surgeries previous to LGBSA. The technical comments, the measures pre- and post-operative, as well as the measures of life quality are exposed here. Results: The average surgical time for the primary bypass was of 87 minutes, and of 112 minutes when there were associated surgeries. The average hospital postoperative stay, when there were no complications, was of 26 hours, and of 9 days in those patients presenting major complications. In four cases (0.3%) this process was reconverted into an open surgery. The percentage of patients who had major

REFERENCES

1. Agras WS, Hammer LD, McNicholas F. Early life risk factors for obesity in childhood: cohort study. BMJ 2005: 1330-1357.

2. Garaulet Aza M. Metabolismo y obesidad. Nutr Hosp 2008; 1(2) Suppl: 43-45.

3. Barness LA, Opitz JM, Gilbert-Barness E. Obesity: genetic, molecular, and environmental aspects. Am J Med Genet A 2007; 143: 3016-3034.

4. Carbajo MA. Vertical ring gastroplasty (VRG) in the treatment of serious clinical obesity. Results and complications. Rev Esp Enferm Digest 1998; 90: 549-552.

5. Carbajo MA. Banda ajustable por laparoscopia (Lap-Band) en el tratamiento de la obesidad grave: Experiencia preliminar. Cir Esp 1998; 63: 185-188.

6. Carbajo MA. Intragastric migration of laparoscopic adjustable gastric band (lap-band) for morbid obesity. J of Laparoendosc & Advanced Surg Techniques 1998; 8: 241-244.

7. Carbajo MA. Left subcostal minilaparotomy in silastic ring vertical gastroplasty and transected Roux-en-Y gastric bypass. Obes Surg 2002; 12: 124-125.

8. Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 2001; 11: 276-280.

9. Fisher BL, Buchwald H, Clark W et al: Mini-gastric bypass controversy (letter). Obes Surg 2001; 11: 773-777.

10. Carbajo MA, García-Caballero M, Osorio D et al. One-anastomosis gastric bypass by laparoscopy: Results of the first 209 patients. Obes Surg 2005; 15: 398-404.

11. Carbajo MA, García-Caballero M, Ortiz de Solórzano J et al. Bypass gástrico laparoscópico-robótico de una sola anastomosis: Resultados preliminares sobre 300 casos. Rev Mexicana de Cir Endosc 2005; 6(1): 5-10.

12. Statement on morbid obesity and its treatment. International Federation for the Surgery of Obesity. Obes Surg 1997; 7: 40-41.

13. Deitel M, Shahi B. Morbid obesity: Selection of patients for surgery. J Am Coll Nutr 1992; 11: 557-462.

14. Carbajo M. Bypass gástrico de una sola anastomosis (BAGUA), asistido con brazo robótico. Técnica y resultados en 500 casos. Manolo Cortez, Eds, Bogotá, Colombia, 2007: 127-144.

15. Kolotkin RL, Crosby RD, Pendelton R et al. Health-related quality of life in patients seeking gastric bypass surgery vs non-treatment-seeking controls. Obes Surg 2003; 13: 371- 377.

16. Cottam DR, Mattar SG, Barinas-Mitchell E et al. The chronic inflammatory hypothesis for the morbidity associated with morbid obesity: implications and effects of weight loss. Obes Surg 2004; 14: 589-600.

17. Suter M, Giusti V, Heraief E et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-years experience. Surg Endosc 2003; 17: 603-609.

18. Papasavas PK, Caushaj PF, McCormick JT et al. Laparoscopic management of complications following laparoscopic Roux-en-Y for morbid obesity. Surg Endosc 2003; 17: 610-614.

19. Lee WJ, Yu PJ, Wang W et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled trial. Ann Surg 2005; 242: 20-28.

20. Gagner M. Laparoscopic reoperative bariatric surgery. Experience from 27 consecutive patients. Obes Surg 2002; 12: 254-260.

21. Boza C, Salinas J, Raddatz A et al. Laparoscopic Roux-en-Y gastric bypass (LRYGB): 1,500 cases and 5 year follow-up. Obes Surg 2008; 18(8): 975.

22. Galvao M, Ramos A, Carlo A. 4,000 cases serie of simplified laparoscopic gastric bypass. Outcomes and complications. Obes Surg 2008; 18(8): 916.

23. Tacchino R, Greco F, Matera D. The single loop gastric bypass: A powerful alternative to standard RYGBP. Obes Surg 2008; 18(8): 920.

24. Chevalier JM, Chakhtoura G, Zinzindoué F et al. Primary results of mini gastric bypass in a french obesity surgery specialized University Hospital. Obes Surg 2008; 18(9): 1130-1133.

25. Tercero F, Khan A, Nimeri A, Boone K Higa K. Laparoscopic revision gastric bypass surgery for chronic marginal ulcers: A 10-years experience. Obes Surg 2008; 18: 911-912.