Bypass gástrico

Bypass gástrico

Dr Ricardo Funke Profesor Asistente de Cirugía Departamento de Cirugía Digestiva Pontificia Universidad Católica de Chile

SUMMARY OF NIH CONSENSUS DEVELOPMENT CONFERENCE STATEMENT FOR GASTRO-INTESTINAL SURGERY FOR SEVERE OBESITY, 1991 BMI ≥ 40 Kg/m2 Patients whose BMI exceeds 40 are potential candidates for surgery if they strongly desire substantial weight loss. In certain instances, less severely obese patients (BMI 35-40) may be considered 2 (+) for surgery in the presence of highrisk co-morbid conditions such as d iabetes BMI 35 Kg/m co-morbid conditions mellit us or sleep apnea. Also included are obesity related physical problems interfering with lifestyle such as e mployment, family function and ambulation. Patients seeking therapytry for severe obesity for the firsttreatment time should be considered Patients should non-surgical first for treatment in a non-surgical program with integrated components of a dietary regimen, appropriate exercise, and behavioral modification and support. Gastric restrictive or bypass procedures could berisks considered for well-i nformed Patients must understand involved and motivated patients with acceptable operative risks. Patients who are candidates for surgical procedures should be selected carefully after evaluation by a multidisciplinary team with medical, surgical, psychiatric, Multi-disciplinary team approach and nutritional expe rtise. The operation should be performed by a surgeon substantially expe rienced with the approp riate procedures and working in a clinical setting with adequate support Experienced surgeon for all aspects of management and assessment. Lifelong medical surveillance after surgical therapy is a necessity.

Life-long follow-up

Cirugía y obesidad

Buchwald. Obes Surg 2009 19:1605–1611

Cirugía y obesidad

Buchwald. Obes Surg 2009 19:1605–1611

Bypass Gástrico: 5 claves

Bypass Gástrico: 5 claves 1. Aislamiento del cardias

Bypass Gástrico: 5 claves

2. Bypass del estómago distal

Bypass Gástrico: 5 claves

3. Bypass del duodeno y yeyuno proximal

Bypass Gástrico: 5 claves

4. Exposición del yeyuno e ileon a nutrientes no digeridos

Bypass gástrico 1. Ha demostrado buenos resultados a largo plazo 2. Bajo porcentaje de complicaciones en centros de alto volumen 3. Buena resolución de co-morbilidades

2007

Adams T. et al. Long-Term Mortality after Gastric Bypass Surgery N Engl J Med 2007; August 23

n = 75

2007

n = 782

PSPP = % sobrepeso pérdido

Cir Esp. 2008;83(2):71-7

PEIMCP = % exceso IMC pérdido

Higa K. et al, Surgery for Obesity and Related Diseases , 2011

%EWL: %EWL menor 50%: Morbilidad: Mortalidad:

57 % 33,2% 35% 0%

Higa K. et al, Surgery for Obesity and Related Diseases , 2011

136 estudios, alrededor de 22,000 pacientes. 0.5% mortalidad

Buchwald, et al. Bariatric Surgery: A Systematic Review and Meta-Analysis, JAMA 2004; 292:1724-1737

Podnos, et al. Complications after Laparoscopic Gastric Bypass. Arch Surg 2003; 138: 957-961

Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): 2215 cases and 5 Year Follow-up

Department of Digestive Surgery Hospital Clínico Pontificia Universidad Católica de Chile Santiago, Chile

Rev Med Chile 2012, en revisión

Técnica quirúrgica

Results mean ± SD

range

Female (n, %)

1630, 75.1%

Age (years)

37.2 ±11.0

14 – 72

Weight (kg)

109.8 ±18.8

67.7 - 235.9

BMI (kg/m2)

40.6 ± 5.2

30.3 – 70.7

Preoperative Comorbidities % Arterial Hypertension (HTN)

30.7

Type 2 Diabetes (T2D)

8.9

Insuline Resistance (IR)

45.5

Dyslipidemia

54.3

Hypothyroidism

10.5

Obstructive Sleep Apnea

5.3

Preoperative BMI > 50

40-50

30-35

35-40

Results mean ± SD Conversion (%)

range

1.3 %

Operative time (min) 110.8 ± 42.6

40 - 400

Hospital stay (days)

1 - 136

3.6 ± 6.3

Cholecystectomy (%) 18.9 % Mortality

0%

Learning curve Cases 1 - 750

751 - 1500

p

Operating time (min)

116,9 ± 47,6

104,8 ± 36,1