ABSTRACT
BACKGROUND: The duodenal switch (DS) is a variant of the biliopancreatic diversion (BPD), with a vertical subtotal gastrectomy and pylorus preservation. METHODS: DS was used to treat morbid obesity in 125 patients, with mean BMI 50, with 65% of the patients super obese (SO). Patients have been followed for an intermediate period. RESULTS: The percentage of excess weight loss (%EWL) was > 70% at 1 year, and reached 81.4% at 5 years when 97% of the patients had a %EWL > 50%. Comorbidities were cured or improved in all patients. CONCLUSION: DS was very effective for the treatment of the morbid obesity in the SO patients.
Subject(s)
Biliopancreatic Diversion/adverse effects , Biliopancreatic Diversion/methods , Gastrectomy/adverse effects , Gastrectomy/methods , Obesity, Morbid/surgery , Adolescent , Adult , Aged , Biliopancreatic Diversion/mortality , Body Mass Index , Esophagitis, Peptic/etiology , Esophagitis, Peptic/prevention & control , Female , Follow-Up Studies , Gastrectomy/mortality , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity, Morbid/classification , Obesity, Morbid/diagnosis , Postgastrectomy Syndromes/etiology , Postgastrectomy Syndromes/prevention & control , Protein-Energy Malnutrition/etiology , Reoperation , Severity of Illness Index , Suture Techniques , Treatment Outcome , Weight LossABSTRACT
El cruce duodenal es una variante de la derivación biliopancreática. Se describen la técnica, su morbimortalidad, los resultados intermedios, los efectos secundarios y las indicaciones como una técnica mixta para el tratamiento de la obesidad mórbida. El porcentaje de sobrepeso perdido se incrementa del 70 por ciento al año hasta el 81,37 por ciento a los 5 años (AU)
Subject(s)
Adult , Humans , Obesity, Morbid/therapy , Obesity, Morbid/surgery , DuodenumABSTRACT
INTRODUCCIÓN: la derivación gástrico es el patrón oro de las técnicas de cirugía bariátrica. La derivación gástrica por laparoscopia (DGxLP) es una técnica avanzada y novedosa para el tratamiento de la obesidad mórbida. MATERIAL Y MÉTODOS: se han intervenido 27 pacientes y en 17 casos se pudo completar la intervención por laparoscopia. Se describe la técnica en detalle. RESULTADOS: el porcentaje de sobrepeso perdido supera el 70% a los 12 y 18 meses y son superponibles a la misma operación por laparotomía. CONCLUSIONES: es una técnica compleja, con muchos detalles y la curva de aprendizaje es muy difícil. Las fugas es la complicación más grave (AU)
AIMS: gastric bypass is the gold standard in bariatric surgery. The Roux-en-Y laparoscopic gastric bypass is a new advanced technique for the surgical management of morbid obesity. METHODS: twenty-seven patients were operated on by laparoscopy and in 17 of them the technique was successfully completed. The surgical steps are described. RESULTS: percentage excess weight loss EWL) at 12 and 18 months was more than 70%, and similar to that obtained with the open technique. CONCLUSIONS: this is a complex technique involving multiple details and a difficult learning curve. Leaks are the most dangerous complication (AU)
Subject(s)
Humans , Gastric Bypass/methods , Laparoscopy/methods , Obesity, Morbid/surgery , Bariatric Surgery/methods , Informed Consent , Treatment OutcomeABSTRACT
Introducción. El bypass gástrico es el "patrón oro" de las técnicas de cirugía bariátrica. El bypass gástrico por laparoscopia es una técnica avanzada y novedosa para el tratamiento de la obesidad mórbida. Paciente y métodos. Se han intervenido 16 pacientes y sólo en 6 casos se pudo completar la intervención por laparoscopia. Se describe la técnica en detalle. Resultados. El porcentaje de sobrepeso perdido supera el 70 por ciento a los 12 y 18 meses, y es superponible a la misma operación por laparotomía. Conclusión. Es una técnica compleja, con muchos detalles, y la curva de aprendizaje es muy difícil pero de un futuro innegable (AU)
Subject(s)
Female , Male , Humans , Gastric Bypass/methods , Gastric Bypass , Laparoscopy/methods , Laparoscopy , Obesity, Morbid/surgery , Obesity, Morbid/physiopathology , Obesity, Morbid/therapy , Anastomosis, Surgical/trends , Anastomosis, Surgical , Intestinal Obstruction/complications , Intestinal Obstruction/surgery , Intestinal Obstruction/therapy , Body Mass IndexABSTRACT
BACKGROUND: Optimal evaluation of the results of surgery for morbid obesity requires a long-term follow-up for at least 5 years. METHODS: One hundred patients were operated by vertical banded gastroplasty (VBG) and revised with a follow-up of no less than 5 years. Sixty patients were morbidly obese with a body mass index (BMI) of between 40 and 50 kg/m2, and 40 were super-obese with a BMI of >50 kg/m2. Follow-up included 93 patients (93%). RESULTS: Initial surgical mortality was nil. Twenty-five patients required surgery for complications related to the technique (25%) and one patient died due to pulmonary embolism after a re-stapling operation. The percentage excess weight loss was 54.3%, and the BMI was 33 kg/m2 for the 84 patients followed to 5 years post VBG. Only 40 out of 92 patients (43.5%), obtained the weight loss benefit due to the operation. None of them is able to eat a regular diet, and the quality of food intake has been severely affected in some of them. CONCLUSIONS: VBG is, in our experience, a safe and technically simple operation, but the long-term results are questionable. The reoperation rate was high, and weight loss and quality of life are superior with other operations.
Subject(s)
Gastroplasty , Obesity, Morbid/surgery , Adolescent , Adult , Aged , Body Mass Index , Diet , Follow-Up Studies , Gastroplasty/adverse effects , Humans , Middle Aged , Patient Satisfaction , Postoperative Complications , Quality of Life , Reoperation , Weight LossABSTRACT
BACKGROUND: The duodenal switch (DS), as a modification of the bilio-pancreatic diversion (BPD), is a 'complex' hybrid operation. METHODS: Sixty patients were operated on during the last 3 years. RESULTS: Two patients died early (3.3%); two late deaths occurred at 4 and 7 months, one due to liver failure and the other due to malnutrition and refeeding syndrome (3.57%); three patients required conversions (5.3%). The two early deaths and all the patients who required conversions had a previous vertical banded gastroplasty. Eleven patients had minor liver abnormalities corrected with medications, and one patient had severe diarrhea for more than a year. Eleven female patients have iron deficiency anemia that requires parenteral supplementation. Mean percent excess weight loss was 86% at 2.5 years. CONCLUSIONS: The DS has been, in our experience, an unsafe operation with unacceptably high operative and postoperative mortality. The conversion rate is acceptable. Weight loss, quality of food intake and life have been excellent. Inadequate follow-up can be dangerous if patients fail to report for regular visits.