Four decades of bariatric surgery in a community hospital of Spain.

INTRODUCTION: Bariatric surgical practice changes in the community setting may be under-reported. We present the developments in a Spanish bariatric surgical practice in the community setting of Alcoy from its origin in 1977 through the present. METHODS: Bariatric surgical techniques employed in a country community setting over the course of nearly four decades were reviewed retrospectively and qualitatively. RESULTS: Surgeons and medical professionals from Alcoy, Spain were involved in the evolution of bariatric surgery patient management and surgical technique from 1977s through 2017. During the last 40 years, 1,475 patients were treated in our clinics. Spanish bariatric surgeons contributed to advances in gastric bypass in the 1970s, vertical banded gastroplasty in the 1980s, bilio-pancreatic diversion/duodenal switch in the 1990s, and innovations associated with laparoscopy from the 1990s onward. Outcomes and approaches to prevention and treatment of bariatric surgical complications are reviewed from a community perspective. Contributions to the bariatric surgical nomenclature and weight-loss reporting are noted. CONCLUSIONS: The practice of bariatric surgery in the community setting must be updated continuously, as in any human and surgical endeavor. Medical professionals in community bariatric practices should contribute their experiences to the field through all avenues of scientific interaction and publication.

Four decades of bariatric surgery in a community hospital of Spain / Cuatro décadas de la cirugía bariátrica en un hospital comarcal

Introduction: Bariatric surgical practice changes in the community setting may be under-reported. We present the developments in a Spanish bariatric surgical practice in the community setting of Alcoy from its origin in 1977 through the present. Methods: Bariatric surgical techniques employed in a country community setting over the course of nearly four decades were reviewed retrospectively and qualitatively. Results: Surgeons and medical professionals from Alcoy, Spain were involved in the evolution of bariatric surgery patient management and surgical technique from 1977s through 2017. During the last 40 years, 1,475 patients were treated in our clinics. Spanish bariatric surgeons contributed to advances in gastric bypass in the 1970s, vertical banded gastroplasty in the 1980s, bilio-pancreatic diversion/duodenal switch in the 1990s, and innovations associated with laparoscopy from the 1990s onward. Outcomes and approaches to prevention and treatment of bariatric surgical complications are reviewed from a community perspective. Contributions to the bariatric surgical nomenclature and weight-loss reporting are noted. Conclusions: The practice of bariatric surgery in the community setting must be updated continuously, as in any human and surgical endeavor. Medical professionals in community bariatric practices should contribute their experiences to the fi eld through all avenues of scientific interaction and publication (AU)

Introducción: los cambios en la práctica de cirugía bariátrica en un hospital comarcal han sido muy importantes. Presentamos la evolución en el Hospital Comarcal de Alcoy desde su origen en 1977 hasta el presente. Métodos: se revisan retrospectivamente las técnicas quirúrgicas bariátricas empleadas en un entorno comarcal a lo largo en cuatro décadas. Resultados: los cirujanos Alcoy, han estado involucrados en la evolución de la gestión de los pacientes de cirugía bariátrica y las técnicas quirúrgicas desde 1977 hasta la actualidad. Durante los 40 años trascurridos, 1.475 pacientes fueron tratados en nuestras clínicas comenzando con la derivación gástrica (DG) en la década de 1970, la gastroplastia vertical anillada (GVA) en la década de 1980, el cruce duodenal (CD) bilio-pancreático en la década de 1990, y con el acceso por vía laparoscópica desde la década de 1990. Los resultados y los enfoques para la prevención y el tratamiento de las complicaciones de la cirugía bariátrica así como la contribución en la nomenclatura de cirugía bariátrica y la notificación de pérdida de peso son revisados desde una perspectiva comarcal. Conclusiones: la práctica de la cirugía bariátrica en el entorno comarcal debe ser actualizada continuamente. Los cirujanos bariátricos pueden contribuir con sus experiencias en el ámbito comarcal con actualizaciones y publicaciones (AU)

[Comparative results between vertical ringed gastroplasty and duodenal switch in morbid obesity]. / Resultado comparativo entre la gastroplastia vertical anillada y el cruce duodenal en la obesidad mórbida.

INTRODUCTION: The only effective long-term treatment for morbid obesity is bariatric surgery. AIM. To compare the long-term results of vertical banded gastroplasty (VBG) and duodenal switch (DS). Quality of life, weight loss and reoperations were evaluated. MATERIAL AND METHODS: A retrospective study of 85 patients with VBG and 49 with DS with a follow-up of more than 5 years was performed. The mean preoperative body mass index (BMI) was 48.8 kg/m2 in VBG patients and 50.33 kg/m2 in DS patients. RESULTS: At 5 years, 87.5% of patients with DS had maintained a percentage of excess weight lost (%EWL) of more than 50%, and were therefore counted as successes, compared with 55% of those with VBG (p < 0.0001). Eight VBG patients (9.4%) and one DS patient (2.04%) required re-operations due to failure of the technique. None of the VBG patients with a %EWL of more than 50% could eat a normal diet, whereas more than 80% of patients with DS had no dietary restrictions. CONCLUSIONS: At 60 months follow up, only the DS patients fulfilled the requirements of the American Society of Bariatric Surgery of %EWL superior to 50% in more than 75% of the patients.

Resultado comparativo entre la gastroplastia vertical anillada y el cruce duodenal en la obesidad mórbida / Comparative results between vertical ringed gastroplasty and duodenal switch in morbid obesity

Introducción. Sólo la cirugía bariátrica ha demostrado ser eficaz en el control de la obesidad mórbida. Objetivo. Comparar los resultados a largo plazo de la gastroplastia vertical anillada (GVA) y el cruce duodenal (CD). Se estudia la evolución de la pérdida de peso, el número de reintervenciones y la calidad de vida. Material y método. Se trata de un estudio retrospectivo que incluye a 85 pacientes con GVA y a 49 con CD, con un seguimiento no inferior a 5 años. En la GVA la media del índice de masa corporal (IMC) fue de 48,8 kg/m2, y en el CD de 50,33 kg/m2. Resultados. A los 5 años, el 87,5% de los pacientes con CD mantenía un PSP > 50% y, por tanto, fueron considerados éxitos, frente a un 55% en la GVA (p 80% afirmó no tener ningún tipo de restricción en la dieta. Conclusiones. A los 60 meses de seguimiento, sólo el grupo con CD cumple el requisito de la ASBS (American Society of Bariatric Surgery) de mantener un PSP > 50% en el 75% de los pacientes a largo plazo (AU)

Introduction. The only effective long-term treatment for morbid obesity is bariatric surgery. Aim. To compare the long-term results of vertical banded gastroplasty (VBG) and duodenal switch (DS). Quality of life, weight loss and reoperations were evaluated. Material and methods. A retrospective study of 85 patients with VBG and 49 with DS with a follow-up of more than 5 years was performed. The mean preoperative body mass index (BMI) was 48.8 kg/m2 in VBG patients and 50.33 kg/m2 in DS patients. Results. At 5 years, 87.5% of patients with DS had maintained a percentage of excess weight lost (%EWL) of more than 50%, and were therefore counted as successes, compared with 55% of those with VBG (p < 0.0001). Eight VBG patients (9.4%) and one DS patient (2.04%) required re-operations due to failure of the technique. None of the VBG patients with a %EWL of more than 50% could eat a normal diet, whereas more than 80% of patients with DS had no dietary restrictions. Conclusions. At 60 months follow up, only the DS patients fulfilled the requirements of the American Society of Bariatric Surgery of %EWL superior to 50% in more than 75% of the patients (AU)

Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation.

BACKGROUND: The use of the laparoscopic sleeve gastrectomy (LSG), a restrictive operation, in different settings, is presented. METHODS: 31 patients underwent LSG in the following groups: 1) 7 patients with very high BMI as a first stage of the duodenal switch (DS); 2) 7 morbidly obese patients with severe medical conditions; 3) 16 obese patients with lower BMI (35-43); and 4) 1 patient converted from a prior gastric banding. RESULTS: 1 patient with BMI 74 died, a 3.2% mortality. The percentage of excess BMI loss (%EBMIL) in group 1 above was 63.1% from 4-27 months. The %EBMIL of the cirrhotics in group 2 was 76.0% (69-100%). The %EBMIL in group 3 patients was 68.5% (58.3-123%) at 3-27 months. The %EBMIL of the group 4 patient is 13% because she had previously lost almost all of her EBMI. CONCLUSION: LSG may become the ideal operation for staging in patients with BMI >55, for treating morbidly obese patients with severe medical conditions, as an excellent alternative to adjustable bands in lower BMI patients, or for conversion of gastric banding patients.

Comparative analysis of vertical banded gastroplasty and duodenal switch at five years follow-up.

BACKGROUND: Bariatric surgery is the only effective long-term treatment for morbid obesity. We compared long-term results of the vertical banded gastroplasty (VBG) and biliopancreatic diversion with duodenal switch (DS). Quality of life (QoL), weight loss (WL), and reoperation were evaluated. METHODS: This is a retrospective study of 85 of 129 patients with VBG and 49 of 743 patients with DS, with follow-up >5 years. Mean preoperative BMI of the VBG patients was 48.8 kg/m2 and for the DS patients was 50.3 kg/m2. RESULTS: Percent excess weight loss (%EWL) at 5 years for VBG patients was 56.4% and for DS patients 70.6% (P<0.0001). 8 VBG patients (9.4%) and 1 DS patient (2.0%) required re-operation due to failure of the technique. None of the VBG patients could eat a normal diet, while 80% of the DS had no restriction in the quality of their intake. CONCLUSIONS: At 60 months follow-up, only the DS patients fullfilled the ASBS requirements of %EWL >50 in over 75% of the patients.