Evolución en cirugía bariátrica: del abordaje abierto al bypass biliopancreático con preservación gástrica por vía laparoscópica. Doce años de experiencia / Advances in bariatric surgery: from the open approach to the biliopancreatic bypass with laparoscopic gastric preservation. Twelve years of experience

Introducción: Análisis de los resultados en el tratamiento de la obesidad mórbida tras 12 años de experiencia. Material y métodos Estudio restrospectivo de los pacientes intervenidos por obesidad mórbida desde julio de 1998 hasta abril de 2010. Inicialmente realizamos técnicas abiertas y desde enero de 2005 bypass biliopancreático con preservación gástrica por vía laparoscópica. Resultados Se ha intervenido a 165 pacientes: 65 con abordaje abierto (bypass gástrico y Scopinaro) y 100 laparoscópico. Edad media: 40 años, mujeres: 74%, IMC medio: 48,6±6kg/m2. Superobesos 35%. Estancia media: 7 días. Morbilidad 43 (26%) pacientes. Reintervenciones en postoperatorio inmediato: 7 pacientes. Mortalidad 2 pacientes. Seguimiento del 99,4% durante un periodo mediano de 46 meses (de 1 a 141). En 17 pacientes hubo complicaciones de la gastroyeyunostomía. Siete pacientes se reintervinieron por hernias transmesentéricas. La tasa de sobrepeso perdido fue del 67% (IC95%: 65-72%), 68% (IC95%: 65-72%) y 68% (IC95%: 63-73%) a 12, 36 y 60 meses, respectivamente. La tasa de exceso de IMC perdido fue del 73% (IC95%: 70-76%), 74% (IC95%: 70-79%) y 74% (IC95%: 68-69%) a los 12, 36 y 60 meses, respectivamente. Comparando ambos abordajes, hubo más complicaciones postoperatorias, mayores estancias hospitalarias y más eventraciones en el abordaje abierto y no se han encontrado diferencias significativas en el resto de parámetros analizados. Conclusión Nuestros resultados a largo plazo están dentro de los clasificados como excelentes, con una morbilidad y una mortalidad aceptables. Hemos observado que el abordaje laparoscópico ha supuesto un gran avance debido a una menor agresión quirúrgica, manteniendo una pérdida de peso excelente (AU)

Introduction: An analysis is presented of the results in the treatment of morbid obesity after12 years experience. Material and methods: A retrospective study of patients subjected to surgery for morbidobesity from July 1998 to April 2010. Open techniques were initially used, and from January2005 using biliopancreatic bypass with gastric diversion by a laparoscopic approach. Results: A total of 165 patients have been subjected to surgery, 65 with open surgery (gastricbypass and Scopinaro), and 100 laparoscopic. The mean age was 40 years, with 74% females. The mean BMI was 48.6 6 kg/m2, with 35% super-obese. The mean hospital stay was7 days, with a morbidity of 26% (43 patients). Seven patients required further surgery, and2 patients died. There was 99.4% follow-up during a median period of 46 months (1 to 141).There were complications of the gastro-jejunostomy in 17 patients. Seven patients required further surgery due to transmesenteric hernias. The rate of overweight lost was 67% (95% CI:65-72%), 68% (95% CI: 65-72%) and 68% (95% CI: 63-73%) at 12, 36 and 60 months, respectively. The rate of excess BMI lost was 73% (95% CI: 70-76%), 74% (95% CI: 70-79%) and 74% (95% CI:68-69%) at 12, 36 and 60 months, respectively. Comparing both approaches, there were more post-operative complications, longer hospital stays, and more incisional hernias in the open approach, with no significant differences found in the rest of the parameters analysed. Conclusion: Our long-term results are within those classified as excellent, with acceptable morbidity and mortality. A great advance has been observed in the laparoscopic approach due to the less aggressive surgery, and maintaining an excellent weight loss (AU)

[Advances in bariatric surgery: from the open approach to the biliopancreatic bypass with laparoscopic gastric preservation. Twelve years of experience]. / Evolución en cirugía bariátrica: del abordaje abierto al bypass biliopancreático con preservación gástrica por vía laparoscópica. Doce años de experiencia.

INTRODUCTION: An analysis is presented of the results in the treatment of morbid obesity after 12 years experience. MATERIAL AND METHODS: A retrospective study of patients subjected to surgery for morbid obesity from July 1998 to April 2010. Open techniques were initially used, and from January 2005 using biliopancreatic bypass with gastric diversion by a laparoscopic approach. RESULTS: A total of 165 patients have been subjected to surgery, 65 with open surgery (gastric bypass and Scopinaro), and 100 laparoscopic. The mean age was 40 years, with 74% females. The mean BMI was 48.6±6 kg/m(2), with 35% super-obese. The mean hospital stay was 7 days, with a morbidity of 26% (43 patients). Seven patients required further surgery, and 2 patients died. There was 99.4% follow-up during a median period of 46 months (1 to 141). There were complications of the gastro-jejunostomy in 17 patients. Seven patients required further surgery due to transmesenteric hernias. The rate of overweight lost was 67% (95% CI: 65-72%), 68% (95% CI: 65-72%) and 68% (95% CI: 63-73%) at 12, 36 and 60 months, respectively. The rate of excess BMI lost was 73% (95% CI: 70-76%), 74% (95% CI: 70-79%) and 74% (95% CI: 68-69%) at 12, 36 and 60 months, respectively. Comparing both approaches, there were more post-operative complications, longer hospital stays, and more incisional hernias in the open approach, with no significant differences found in the rest of the parameters analysed. CONCLUSION: Our long-term results are within those classified as excellent, with acceptable morbidity and mortality. A great advance has been observed in the laparoscopic approach due to the less aggressive surgery, and maintaining an excellent weight loss.