Padova University Hospital Bariatric Unit Mirto Foletto, M.D. SLEEVE OR PLICATION?

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


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


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)


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


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


++ 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%


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


++ 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


++ VSVS

OUTCOME OUTCOME n= 97 n=5n= 97 n=5 n=231n=231

Thanks for your Thanks for your attentionattention

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Padova University Hospital Bariatric Unit Mirto Foletto, M.D. SLEEVE OR PLICATION?