1 / 33

When ? Indications Contraindications ?

When ? Indications Contraindications ?. Indications. First step in Super Super Morbidly Obese Patient Followed by RYGBP or BPD First step to a Non Bariatric second procedure Followed by Hip replacement, Recurrent Incisional Hernia, pull through procedure for UC, etc. Indications.

erasto
Download Presentation

When ? Indications Contraindications ?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. When ? Indications Contraindications ?

  2. Indications • First step in Super Super Morbidly Obese Patient • Followed by RYGBP or BPD • First step to a Non Bariatric second procedure • Followed by Hip replacement, Recurrent Incisional Hernia, pull through procedure for UC, etc

  3. Indications • Final step in ASA IV Morbidly Obese Patient • Low EF, Heart ort Kidney transplant • Final step if that is the patients choice • Final step in Cohn's disease • Final step in extremes of age • Adolescents ( no needles !!!!!!) • Elderly

  4. Indications • Final Step after failed Malabsorptive procedure • Reversal of JIBP • Final step in poor candidate for RYGBP/BPD • Smoker, Coumadin, etc • Final step in high risk stomach • Chile, Colombia, Japan. High incidence of gastric cancer !!

  5. Technical Considerations How to do it

  6. Surgical technique 7 ports Harmonic scalpel 38 Fr boogie

  7. Jossart et al

  8. LSG first or final step ? Results

  9. LSG as a first step ?

  10. Livingston et al. Annals of Surg. Nov 2002. 576-582 Probability of Developing Complications after Gastric Bypass according to Weight

  11. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004 Apr;14(4):492-7 RESULTS: At 12months: Median weight loss: 44.5 kg, % EWL 45.1%. After 1 year: 40% of the followed patients achieved more than 50% EWL and another 50% needed less medications for their associated co-morbidities Review of the Literature

  12. January 2002 to February 2004 N 2186 Primary bariatric procedures performed. N 123 Consecutive laparoscopic sleeve gastrectomies using a 50 F Bougie N 23 Patients completed the second stage LRYGBP. Sleeve to LGB Schauer et al

  13. Operative time 174 ± 51 min Length of stay 3 ± 1.7 days Death 0 EWL one year 46 % Results of LSG Schauer et al

  14. Change in BMI over Time Schauer et al

  15. Pre-SGL Pre-LRYGB BMI 63 48 ASA IV 56% 1% ASA III 43% 34% ASA II 65 % 0% Co morbidities 10 6 Sleep Apnea 82% 43% T2DM 60% 23% Peripheral edema 100% 0% Down staging Schauer et al

  16. LSG as A Final Step?

  17. RESULTS N 130 LSG between Nov 04 and Jan 07 2.4 female : 1 male Mean age 45.6 (12 -79) years Mean preop. weight was 122.4 (95.5 - 206.1) Kg The mean BMI was 43.2 (30.2 - 75.4) Kg/m2

  18. RESULTS Mean operative time 97 (range: 58 – 180) mins No conversions Mean hospital stay was 3.2 (range: 1 – 19) days. There was no mortality in this series.

  19. RESULTS

  20. Table 1. Total Sample Demographic Characteristics (N=30) Results

  21. DISCUSSION

  22. Conclusions and questions

  23. What will be the %EWL at 15 years when compared to RGBP ? Will the gastric tube dilate ? What is the best size of the boogie ? Will Ghrelin levels drop and stay down as expected ? Questions that remain open to be answered:

  24. What % of SG will be converted to RYGBP ? Will the long term results be as good as other purely restrictive procedures as LAGB/VBG Questions that remain open to be answered:

  25. Not all bariatric patients face the same operative risk Sleeve Gastrectomy is a valid surgical option for weight loss with excellent short term outcomes Conclusions

  26. Unknown long term outcomes May be an option for the very low and very high risk patients Excellent option for the elderly and adolescents Conclusions

  27. Thank you!

More Related