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7th International Congress of the
Spanish Society of Obesity Surgery.Valladolid Spain
May, 2004.
DIMINISHING POSTOPERATIVE RISKS OF GASTRIC BYPASS
• Stenosis• Leak• Bleeding• Chronic Marginal Ulcer• Severe Dumping.
• Stenosis• Leak• Bleeding• Chronic Marginal Ulcer• Severe Dumping.
Failure in Weight Loss or Weight
Regain!!!
Failure in Weight Loss or Weight
Regain!!!One Anastomosis GB
4 Possible Risk Factors .One Anastomosis GB
4 Possible Risk Factors .Two Anastomosis GB
12 Possible Risk Factors Two Anastomosis GB
12 Possible Risk Factors
•Stenosis•Leak•Bleeding
•Stenosis•Leak•Bleeding
•Obstruction•Stenosis•Leak•Bleeding•Volvulus• Intussuception• Internal Hernia
Obstruction??
(OAGB)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM
(OAGB)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM
(OAGB)
KEY STEPS OF THE PROCEDURE
1. BilioPancreatic Limb: between 250 to 350 cm average.
2. Section of Greater Omentum: in supermorbid and central obesity.
3. Hiss Angle, Fat and GE membrane Totally Dissected.
4. Gastric Pouch: length: ~ 15cm, capacity: ~ 30 cc. (calibrated with a 36
French tube). Total dissection of fat in the posterior gastric wall.
5. “Antireflux Mechanism”: afferent loop suspended at least10 cm on the gastric pouch.
6. GastroIleal Anastomosis Side to Side: ~ 2.5 cm. width.
Post-operative X-Ray control
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM
(OAGB)
Radiologic control at 5 years
RESULTS: Patient Characteristics (July 2002 to February 2015)
Age 43 (12 74)
Gender
Female 1599 (61.5%)
Male 1001 (38.5%)
BMI 46 (31 86)
EBW (kg) 65 (28 220)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
Primary Surgery 1495 (57.5%)
Other Previous Open Surgery 627 (24.12%)
Other Associated Procedures 408 (15.69 %)
Previous Bariatric Procedures 70 (2.69%)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
RESULTS: Patient Characteristics (July 2002 to February 2015)
Length of Hospital Stay
Uncomplicated Patients
2.566 (99%)1 day
(15120 h.)
Patients with Major Complications34 (1%)
9 days (432 d.)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
Surgical Early Major Complications
Intraoperative Complications
(resolved by Open Surgery) 4 (0.2%)
Bleeding 2 (0.08 %)
Gastroesophageal Perforation 1 (0.04 %)
Incorrect Gastric Transection 1 (0.04 %)
Immediate Postoperative Complications
(resolved by Open Surgery)6 (0.2%)
Leaks 2 (0.08 %)
Intestinal Obstruction 1 (0.04 %)
Partial Necrosis of Excluded StomachBleeding
1 (0.04 %)2 (0.08%)
Immediate PostoperativeComplications
(resolved by Lap. Surgery)16 (0.8%)
Bleeding 10 (0.4%)
Leaks 2 (0.08 %)
Intestinal Obstruction 3 (0.11 %)
Acute Gastric Distension 1 (0.04 %) TOTAL 26 (1%)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
Complications Treated Conservatively
Leaks 10 (0.4 %)
Acute Pancreatitis 1 (0.04 %)
Infected Hematoma
1 (0.04 %)
Total 12 (0.5%)
Non Surgical Early Major Complications
Mortality Massive
Pulmonary Embolism
1 (0.04 %)
Nosocomial Pneumonia (Post
reintervention)
1 (0.04 %)
DICPost Band reversion
1 (0.04 %)
Total 3 (0.11%)
Mortality
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
Late Complications
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
Gastrointestinal stenosis9 (0.3%)
Pneumatic Dilatation 7 (0.3%)
Prosthesis 2 (0.08%)
AnastomoticUlcer
Medical Treatment 13 (0.5%)
Malnutrition Medical treatment 14 (0.5%)
B1B6 Vitamin(severe deficit)
Medical treatment 3 (0.1%)
Revisional surgery None 0 (0%)
TOTAL 39 (1.5 %)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
Endoscopic Studies at 5Year FollowUpPostop. UGI endoscopic (control) studies planned for all patients completing 5year f/u 1.750 patients completed at least 5Year f/u 602 (34%) underwent UGI endoscopic studies
NO significant acute or chronic lesions foundNO erosive esophagitis or severe alkaline reflux
Findings:Stomal ulcer: 4 (0.7%)Mild / Moderate pouch gastritis: 41 (7%)H. Pylori +: 10 (1.7%)
Percent of mean (and range)
EWL at:
1 year 84% (55 –112%)
2 year 88% (58 –115%)
3 year 81% (55 –103%)
4 year 79% (51 –102%)
5 year 77% (48 –100%)
10 year
12 year
70% (45–98%)
69% (43–98%)
Weight Loss
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
at Two years at Ten years
Dyslipidemia 100% 86%
Type II Diabetes 93% 90%
Arterial Hypertension 98% 87%
Sleep apnea 100% 99%
Severe Comorbidities Resolution Index
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 13-YEAR EXPERIENCE IN 2.600 PATIENTS
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862
IFSO European Database Control(Since January 2010)
BMI Distribution
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862 TOTAL OPERATIONS 2447
IFSO European Database Control(Since January 2010)
Comorbidities Prevalence
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
OAGB RYGB
IFSO European Database Control(Since January 2010)
Previous Comorbidities
30,17 %
16,90 % 14,48 %
84,14 %
51,38 %
77,41 %
36,20 %
6,05 %
19,66 %24,29 %
32,10 %
49,94 %
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
TOTAL OPERATIONS 7862
SGTOTAL OPERATIONS 2447
GB
IFSO European Database Control(Since January 2010)
Previous Comorbidities
24,11 %
2,66 %8,51 %
16,45 %11,98 %
39,90 %35,23 %
7,29 %
16,63 %23,74 %
28,32 %34,29 %
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862 TOTAL OPERATIONS 2447
IFSO European Database Control(Since January 2010)
Hospital Stay
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
IFSO European Database Control(Since January 2010)
Intraoperative Complications
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGBTOTAL OPERATIONS 11455
RYGB
SGGB
Bleeding LiverFailure
Injurysplenic
OtherGastrointestinal perforation
Injuryvascular
Deaths
% % % % % %
TOTAL OPERATIONS 717
TOTAL OPERATIONS 2447 TOTAL OPERATIONS 7862
TOTAL OPERATIONS 717
OAGB RYGB
IFSO European Database Control(Since January 2010)
Postoperative Complications
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
0,17
Gen
eral
com
plic
atio
nBl
eedi
ng
Leak
Intra-
Abdo
min
al A
bsce
ss
Wou
nd In
fect
ion
Wou
nd D
ehisce
nce
Inte
stin
al O
bstruc
tion
Anas
tom
otic S
trictu
re
Gas
tric
/Sto
mal
Ulc
er
Vom
iting
Oth
er
Gen
eral
com
plic
atio
nBl
eedi
ng
Leak
Intra-
Abdo
min
al A
bsce
ss
Wou
nd In
fect
ion
Wou
nd D
ehisce
nce
Inte
stin
al
Obs
truc
tion
Anas
tom
otic S
trictu
re
Gas
tric
/Sto
mal
Ulc
er
Live
r Fai
lure
Vom
iting
Oth
er
%
%
%
%%
%%
%% %
%
%
Live
r Fai
lure
TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862
SGTOTAL OPERATIONS 2447
GB
IFSO European Database Control(Since January 2010)
Postoperative Complications
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSGGen
eral
com
plic
atio
nBl
eedi
ng
Leak
Intra-
Abdo
min
al A
bsce
ss
Wou
nd In
fect
ion
Wou
nd D
ehisce
nce
Inte
stin
al O
bstruc
tion
Anas
tom
otic
Stric
ture
Gas
tric
/Sto
mal
Ulcer
Li
ver F
ailu
reVo
miti
ng
Oth
er
Gen
eral
com
plic
atio
nBl
eedi
ng
Leak
Intra-
Abdo
min
al A
bsce
ss
Wou
nd In
fect
ion
Wou
nd D
ehisce
nce
Inte
stin
al O
bstruc
tion
Anas
tom
otic
Stric
ture
Gas
tric
/Sto
mal
Ulc
er
Live
r Fai
lure
Vom
iting
Oth
er
IFSO European Database Control(Since January 2010)
Postoperative Complications
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862 TOTAL OPERATIONS 2447
IFSO European Database Control(Since January 2010)
General Complications
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
0.56% 4.32%
4.02% 7.23%
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862 TOTAL OPERATIONS 2447
IFSO European Database Control(Since January 2010)
General Complications: “Esophageal”
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
0.63%
1.4% 4%
0%
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862 TOTAL OPERATIONS 2447
IFSO European Database Control(Since January 2010)
General Complications: “Gastric”
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
0.28% 1.55%
0.17% 0.28%
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862 TOTAL OPERATIONS 2447
IFSO European Database Control(Since January 2010)
General Complications: “Metabolic”
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
0.28% 0.49%
0.04% 1.21%
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862 TOTAL OPERATIONS 2447
IFSO European Database Control(Since January 2010)
General Complications: “Hepatobillary”
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
1.05%
0.21% 1.66%
0%
TOTAL OPERATIONS 717 TOTAL OPERATIONS 11455
TOTAL OPERATIONS 7862 TOTAL OPERATIONS 2447
IFSO European Database Control(Since January 2010)
General Complications: “Non specific”
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
OAGB RYGB
SGGB
0.56%
0.25% 0.16%
0%
TOTAL OPERATIONS 11455 RYGB
TOTAL OPERATIONS 717 OAGB
IFSO European Database Control(Since January 2010)
% EWL at 36 Months
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
TOTAL OPERATIONS 2447 GB
TOTAL OPERATIONS 7862 SG
IFSO European Database Control(Since January 2010)
% EWL at 36 Months
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
IFSO European Database Control
Evolution of % EWL
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
IFSO European Database Control
Evolution of % EBMIL
COMPARATIVECOMPARATIVE:: OAGB OAGB vs.vs. RYGB RYGB vs.vs. GB GB vs. vs. SGSG
1.The OAGB (BAGUA) technique in our experience does not reduce the “complexity” of the surgical procedure, but significantly reduces operative time and lenght of hospital stay compared to other complex techniques; it also substantially decreases both early and late complication rates.
CONCLUSIONS
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: BYPASS:
13-YEAR EXPERIENCE IN 2.600 PATIENTS 13-YEAR EXPERIENCE IN 2.600 PATIENTS
2.Excellent results in our longterm followup in regards to EWL, EBMIL, resolution of comorbidities and quality of life make OAGB a safe and effective technique, and a powerful alternative for the treatment of morbid and supermorbid obesity after a 13year experience.
CONCLUSIONS
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: BYPASS:
13-YEAR EXPERIENCE IN 2.600 PATIENTS 13-YEAR EXPERIENCE IN 2.600 PATIENTS
CENTER OF EXCELLENCE FOR THE STUDY AND OBESITY SURGERY TREATMENT