padova university hospital bariatric unit mirto foletto, m.d. sleeve or plication?
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Padova University HospitalPadova University Hospital
Bariatric UnitBariatric Unit
Mirto Foletto, Mirto Foletto, M.D.M.D.
SLEEVE OR PLICATION?
LAPAROSCOPIC GASTRIC LAPAROSCOPIC GASTRIC PLICATIONPLICATION
OUR DATAOUR DATA FolettoFoletto2011 Jan- 2012 Sep5050 pts (4343 F, F, 7 7 M)
Mean BMI 40.9 40.9 ((33.59-58.0333.59-58.03))Kg/m2
Mean age 36 36 ((16-7216-72))ysys
TECHNICAL DATATECHNICAL DATA
Mean operative time (including endoscopy): Mean operative time (including endoscopy): 73.3 73.3 ((60-11060-110)) minutesminutesIntraoperative endoscopy in all patientsIntraoperative endoscopy in all patientsSingle running row (Prolene 2.0): Single running row (Prolene 2.0): 77 Double row: Interrupted (Vicryl 2.0) + Running (Prolene 2.0) : Double row: Interrupted (Vicryl 2.0) + Running (Prolene 2.0) : 4343No conversion requiredNo conversion requiredConcurrent operations: Concurrent operations: 11 ColecistectomyColecistectomyMean hospital stay: Mean hospital stay: 3.83.8 daysdays
LAPAROSCOPIC SLEEVE LAPAROSCOPIC SLEEVE GASTRECTOMYGASTRECTOMY
OUR DATA OUR DATA FolettoFoletto
2005 Feb - 2012 Jul2005 Feb - 2012 Jul
333333 patients (102102 M, 231231 F) Mean age 47.13 ± 10.8947.13 ± 10.89 ys
Mean BMI 47.77 ± 8.8147.77 ± 8.81 Kg/m2
Mean weight 131.95 ± 29.06131.95 ± 29.06 Kg
LSG RESULTS LSG RESULTS FolettoFoletto
Primary LSG 231Primary LSG 231
Metabolic Metabolic comorbiditiescomorbidities
45%45%
Psychological Psychological distressdistress
4.8%4.8%
SuperobesitySuperobesity 19.5%19.5%
Super-superobesitySuper-superobesity 2.7%2.7%
Klinefelter S.Klinefelter S. 0.6%0.6%
Prader Willi S.Prader Willi S. 0.6%0.6%
Conversion LSG 102
FailureFailure 15.9%15.9%
ComplicationsComplications 9.6%9.6%
BGR cxBGR cx•SlippageSlippage•ErosionErosion•RuptureRupture•IntoleranceIntolerance
•n=27n=27•n=3n=3•n=1n=1•n=1n=1
VBG cxVBG cx
Stenosis+FistulaStenosis+Fistula •n=1n=1
INDICATIONSINDICATIONS
Mean operative time Mean operative time 88.05 ± 40.5588.05 ± 40.55 minutesminutes
Laparotomy conversion rate 3,3%Laparotomy conversion rate 3,3%
Mean hospital stay Mean hospital stay 4.52 ± 2.844.52 ± 2.84 daysdays
TECHNICAL DATATECHNICAL DATA
LGCP OUR DATALGCP OUR DATA FolettoFoletto
COMPLICATIONSCOMPLICATIONS
Nausea in Nausea in 40%, 40%, well tolerated,well tolerated, treated with i.m steroids up to POD3treated with i.m steroids up to POD3
Acute Gastric Acute Gastric
Prolapse (POD-10)Prolapse (POD-10)11 FundectomyFundectomy
Late Gastric Late Gastric Prolapse Prolapse
(>6 months)(>6 months)
33 2 Take down 2 Take down PlicationPlication
1 Fundectomy1 Fundectomy
OUR DATAOUR DATA FolettoFoletto
LATE RE-DO SURGERYLATE RE-DO SURGERY
Mean time after Plication: Mean time after Plication: 7,57 7,57 monthsmonths
Failure 11 Fundectomy Fundectomy11 Sleeve Gastrectomy Sleeve Gastrectomy 22 Replication Replication
Complication 22 Fundectomy Fundectomy 2 2 Take down PlicationTake down Plication
GASTRIC GASTRIC PROLAPSEPROLAPSE
RESIDUAL RESIDUAL GASTRIC GASTRIC FUNDUSFUNDUS
OUR DATAOUR DATA FolettoFoletto
OUTCOMEOUTCOMEn Mean BMI (Kg/m2) Mean %EBL
1st Month 50 37.8 20.6
3rd Month 50 35.9 33.5
6th Month 50 33.1 42.1
9th Month 31 33.4 52
1st year 31 32.8 55
18th Month 13 34.1 49.7
2nd year 2 35.9 59.5
OUR DATAOUR DATA FolettoFoletto
OUTCOMEMean %EBL
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
1stmonth
3rdmonth
6thmonth
9thmonth
12thmonth
18thmonth
24thmonth
(Time)
(%E
BL
)
Mean %EBL
50
50
50
3131 13 2
LSG RESULTS LSG RESULTS FolettoFoletto
COMPLICATIONS COMPLICATIONS • Overall complication rateOverall complication rate 11.4%11.4%
• Medical complication rateMedical complication rate 2.4% 2.4%• Hypertension 0.9%Hypertension 0.9%• Respiratory 1.5%Respiratory 1.5%
• Surgical complicationsSurgical complications 9.3% 9.3%• Leaks 2.1%Leaks 2.1%• Bleeding 5.1%Bleeding 5.1%• Stenosis 1.2%Stenosis 1.2%• Spleno-mesentheric thrombosis 0.6%Spleno-mesentheric thrombosis 0.6%• Perigastric hematoma 0.9%Perigastric hematoma 0.9%
• Perioperative mortality 0%Perioperative mortality 0%• Deaths Deaths (> POD-30 (2 LSG-related(> POD-30 (2 LSG-related) n=5) n=5
CONCURRENT OPERATIONSCONCURRENT OPERATIONSAGB removal 12.3%AGB removal 12.3%Colecistectomy 4.2%Colecistectomy 4.2%Crura repair 1.8%Crura repair 1.8%Incisional hernia repair 0.6%Incisional hernia repair 0.6%
POST LSG SURGERYPOST LSG SURGERYReintervention rate 7.8%Reintervention rate 7.8%Mean time postLSG Mean time postLSG ((mos)mos)
29.92±14.7829.92±14.78Duodenal Switch 3.3%Duodenal Switch 3.3%Re-sleeve 3.3%Re-sleeve 3.3%(with crura repair in 8 pts)(with crura repair in 8 pts)Tot Gastrectomy 0.6%Tot Gastrectomy 0.6%
RESULTS RESULTS FolettoFoletto
OUTCOME (Reinhold's criteria)OUTCOME (Reinhold's criteria)
nn %%
SUCCESSSUCCESS
%EBL > 50%%EBL > 50%
at 2 yearsat 2 years
6868 51.1%51.1%
FAILUREFAILURE
%EBL < 20%%EBL < 20%
at 2 yearsat 2 years2828 21.1%21.1%
Mean %EBL
32,33
44,97
51,93 48,72
39,58
36,85
41
0
10
20
30
40
50
60
3 months 6 months 1 year 2 years 3 years 4 years 5 years
Time after SG
%E
BL
Mean %EBLn=304
n=272
n=213 n=133
n=62
n=40
n=23
RESULTS RESULTS FolettoFoletto (overall)(overall)
RESULTS RESULTS FolettoFoletto
LSG ILSG I LSG convLSG conv
Females Females p=0,00p=0,00
63.2%63.2% 83.3%83.3%
Weight Weight (Kg) SG(Kg) SG p=0,00p=0,00
135.84 ± 135.84 ± 28.4828.48
123.14 ± 123.14 ± 28.5728.57
BMI(Kg/mBMI(Kg/m22) ) SGSG p=0,000p=0,000
48.78 ±8.4648.78 ±8.46 45.50 ±9.2145.50 ±9.21
++ VS
n = 97 n = 5 n = 231n = 97 n = 5 n = 231
LSG ILSG I LSG convLSG conv
OR time OR time (min) (min) p=0,000p=0,000
75.55 ± 75.55 ±
31.531.5 116.29 ± 116.29 ±
44.4844.48
LaparotomyLaparotomy p=0,002p=0,002
1.3%1.3% 7.8%7.8%
Hospital stay Hospital stay (gg)(gg) p=0,000 p=0,000
3.95 ± 3.95 ± 1.37 1.37
5.82 ± 4.47 5.82 ± 4.47
PATIENTS CHARACTERISTICS TECHNICAL DATAPATIENTS CHARACTERISTICS TECHNICAL DATA
RESULTS RESULTS FolettoFoletto
++ VSn = 97 n = 5 n = 231n = 97 n = 5 n = 231
COMPLICATIONSCOMPLICATIONS
LSG ILSG I LSG LSG convconv
Reintervention Reintervention rate rate p=0,000p=0,000 3%3% 18.6%18.6%
Resleeve Resleeve p=0,06p=0,06
1.3%1.3% 6.9%6.9%
LSG ILSG I LSG convLSG conv
Overall Overall complications complications p=0,045p=0,045
9.1%9.1% 16.7%16.7%
Surgical Surgical complications complications p=0,025p=0,025
6.9%6.9% 14.7%14.7%
Perigastric Perigastric HematomaHematoma p=0,01 p=0,01
00 2.9%2.9%
Leaks Leaks p=0,000p=0,000 00 6.9%6.9%
SURGERY AFTER LSGSURGERY AFTER LSG
RESULTS RESULTS FolettoFoletto
++ VSVS
OUTCOME OUTCOME
LSG ILSG I LSG LSG convconv
SUCCESS %EBL > SUCCESS %EBL > 50% at 2 years50% at 2 yearsP=0,000P=0,000
68.1%68.1% 31.1%31.1%
FAILUREFAILURE
%EBL < 20% at 2 %EBL < 20% at 2 yearsyearsP=0,000P=0,000
5.65%5.65% 39.3%39.3%
n= 97 n=5n= 97 n=5 n=231n=231
Mean %EBL in Converted SG and Primary SG
30,59
39,12 41,8734,82 32,89
38,37 40,37
33,12
54,71
32,99
44,8247,82
57,29 60,49
0,00
10,00
20,00
30,00
40,00
50,00
60,00
70,00
Time after SG
%E
BL Conv. SG
Primary SGn=18
n=8
n=95n=20
n=7 n=139
n=6 n=71
n=4 n=19
n=28 n=1
n=18n=3
n= number of patients
RESULTS RESULTS FolettoFoletto
++ VSVS
OUTCOME OUTCOME n= 97 n=5n= 97 n=5 n=231n=231
Thanks for your Thanks for your attentionattention
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