medigraphic.com
SPANISH

Revista de Investigación Clínica

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
  • Contents
  • View Archive
  • Information
    • General Information        
    • Directory
  • Publish
    • Instructions for authors        
  • medigraphic.com
    • Home
    • Journals index            
    • Register / Login
  • Mi perfil

2009, Number 3

Next >>

Rev Invest Clin 2009; 61 (3)

Laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity. Experience at the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran

Romero-Ibargüengoitia ME, Lerman-Garber I, Herrera-Hernández MF, Pablo-Pantoja J, Sierra-Salazar M, López-Rosales F, Zamora-Barrón M, Vargas-Martínez Á, García-García E
Full text How to cite this article

Language: Spanish
References: 35
Page: 186-193
PDF size: 118.58 Kb.


Key words:

Morbid obesity, Bariatric surgery.

ABSTRACT

Introduction. Morbid obesity is a serious health problem associated to a significant reduction in life expectancy. Objective. To evaluate the anthropometric and metabolic changes observed in obese patients, 3, 6 and 12 months after laparoscopic Roux-en-Y gastric bypass surgery and the complications associated with the procedure. Material and methods. Retrospective study that included 128 consecutive obese patients submitted for bariatric surgery at the INCMNSZ (2004-2006). Results. Their mean age was 38 ± 10 years, 83% were women with a BMI of 48 ± 6 Kg/m2. 65% were hypertensives, 55% had hypertriglyceridemia and 34% diabetes. A year after surgery all patients had at least reduced 20% their body weight and the percentage of excess body weight loss was 73%. The prevalence of hypertension, hypertrigliceridemia and diabetes was reduced to 24%, 17% and 12%, respectively (p ‹ 0.001). Four patients died (3%), all of them had a leak of the anastomosis and intra-abdominal abscess. One died because pulmonary embolism, another with a myocardial infarction (after surgical reinterventions) and the other two with sepsis. Conclusions. Laparoscopic Roux-en-Y gastric bypass surgery in morbid obese patients favors significant reductions in body weight and associated co morbidities. This surgery is not free of complications and mortality, reason why it must be done only by surgical and interdisciplinary groups with experience in these procedures.


REFERENCES

  1. Kral JG, Näslund E. Surgical treatment of obesity. Nature Endocrine & Metabol 2007; 3: 547-83.

  2. Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, et al. Executive Summary of the Recommendations of the American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient. Endocrine Practice 2008; 14(3): 318-36.

  3. Valdespino JL, Olaiz G, López Baraja MP, Mendoza L, Palma O, Velázquez Tapia R, Sepúlveda J. Encuesta Nacional de Salud 2000. Tomo 1. Vivienda, Población y utilización de servicios de salud. Cuernavaca Morelos, México: Instituto Nacional de Salud Pública; 2003.

  4. Sánchez CC, Pichardo OE. Epidemiología de la obesidad. Gac Méd Méx 2004; 140: 3-20.

  5. Olaiz Fernández G, Rivera Dommarco J, Shamah Levy T, Rojas R, Villalpando Hernández S, Hernández Ávila M, Sepúlveda Amor J. Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Pública; 2006.

  6. Vagenas K, Panagiotopoulos S, Kegagias I, Nikolaus S, Mead N, Kalfarentzos F. Prospective evaluation of laparoscopic Roux-en-Y gastric bypass in patients with clinically severe obesity. World J Gastroenterol 2008; 14: 6024-9.

  7. De Maria EJ. Bariatric surgery for morbid obesity. N Engl J Med 2007; 356: 2176-83.

  8. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292(14): 1724-37.

  9. Maggard MA, Shugarman LR, Suttorp R. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005; 142: 547-59.

  10. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 23(357): 753-61.

  11. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 23(357): 741-52.

  12. Sjöström L, Lindroos AK, Peltonem M. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683-93.

  13. National Institutes of Health Consensus Development Conference. Gastrointestinal surgery for severe obesity. Am J Clin Nutr 1992; 55: 615-9.

  14. O’Brien PE. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 2006; 144: 625-33.

  15. Stoopen-Margain E, Herrera FM. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: Results of our learning curve in 100 consecutive patients. Obesity Surgery 2004; 14: 201-5.

  16. Suter M, Guisti V, Heralef F, Sizzet F, Clames JM. Laparoscopic Roux-en-Y gastric bypass. Initial 2 year experience. Surg Endosc 2003; 17: 603-9.

  17. Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, Wolfe BM. Laparoscopic versus open gastric bypass: A randomized study of outcomes, quality of life, and costs. Ann Surgery 2001; 234: 279-89.

  18. ADA. Diagnosis and classification of diabetes mellitus. Diabetes Care 2008; 31: 55-60.

  19. National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. U.S. Department of Health and Human Services. National Institutes of Health. National Cholesterol Education Program. Hypertension 2003; 42(6): 1206-52.

  20. Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-97.

  21. Wendy A, Anderson L. Weight loss and health outcomes in African Americans and Whites after gastric bypass surgery. Obesity 2007; 15: 1455-63.

  22. Wilson PW, D’Agostino RB, Sullivan L. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002; 162: 1867-72.

  23. Peeters A, Barendregt D, Willekens F, Mackenbach JP, Al Mamun A, Bonneve L. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003; 138: 24-32.

  24. Alwins S. Gastrointestinal surgery and gut hormones. Curr Opin Endocrinol 2005; 12: 89-98.

  25. Näslund E, Barkeling B, King N, Gutniak M, Blundell JE, Holst JJ, et al. Energy intake and appetite are suppressed by glucagons-like peptid-1 (GLP-1) in obese man. Int J Obes 1999; 23: 304-11.

  26. Carel W, Le Roux MR. Gut hormone profiles following bariatric surgery favor anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 2006; 243: 108-13.

  27. Näslund E, Kral JG. Impact of gastric bypass surgery on gut hormones and glucose homeostasis in type 2 diabetes. Diabetes 2006; 55(Suppl. 2): S92-S97.

  28. Philip R, Schauer M. Laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003; 238: 467-85.

  29. Kenler H, Brolin R. Change in eating behavior after horizontal gastroplasty and Roux en Y gastric bypass. Am J Clin Nutr 1990; 52: 87-92.

  30. Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated metaanalysis. BMJ 2007; 335: 1194-9.

  31. Lara-Esqueda A, Aguilar Salinas C, Velásquez Monroy O, Gomez Perez FJ, Rosas Peralta M, Mehta R, Tapia Conyer R. The body mass index is a less sensitive tool for detecting cases with obesity-associated co-morbidities in short stature subjects. Int J Obesity 2004; 28: 1443-50.

  32. Portenier D, De Maria EJ. Risk scoring systems for weight loss surgery. Advances in Surgery 2008; 42: 313-20.

  33. Mauri S. Nutritional deficiencies following Bariatric Surgery: what happens with gastric bypass? Endocrinol Nutr 2007; 54: 193-9.

  34. Smith CD, Herkes SB, Behrns KE, Fairbanks VF, Kelly KA, Sarr MG. Gastric acid secretion and vitamin B12 absorption after vertical Roux-en-Y gastric bypass for morbid obesity. Ann Surg 1993; 218: 91-6.

  35. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population based analysis. J Am Coll Surg 2004; 199: 543-51.




2020     |     www.medigraphic.com

Mi perfil

C?MO CITAR (Vancouver)

Rev Invest Clin. 2009;61