¿Por qué el Bypass Gástrico de Una Anastomosis (OAGB/BAGUA) es una técnica segura y eficaz?: EVIDENCIAS

¿Qué tipo de patología queremos tratar y controlar? La obesidad mórbida es una Enfermedad Inflamatoria Crónica. Peligrosa, grave y de alto riesgo cardiovascular. Progresiva e incontrolable por cualquier procedimiento conservador. Incurable y de fatales consecuencias para la salud y la vida.

¿Cuáles son los objetivos de una cirugía bariátrica "ideal"? Erradicar o controlar el sobrepeso a largo plazo (> 10 años). Resolver, mejorar o controlar las comorbilidades graves y el riesgo cardiovascular a largo plazo (> 10 años). Mejorar la calidad de vida y evitar una muerte prematura. Integrar a los pacientes a su vida personal, social y familiar.

Which must be the principles and criteria of an “IDEAL” bariatric procedure?: Evidence Must be safe Must eliminate and control all the associated co-morbidities To loose and keep the weight lost in life time term. Minimum incidence of postoperative and long-term complication To maintain a good quiality of life Easy to reproduce Short time in surgery No more than 24/48hrs in hospital bed Easily management of mal-absortion Do not need any kind of prosthetic supplies. To be easily checked and debated in data bases. To be done in a continuous and follow- up program . Minimum blood lost Do not need ICU Minimum post-surgery pain. Patient feels grateful with it. As easily reversible as reviewed by laparoscopic approach. That does not produce nausea or vomiting Fast recovery and aloud the patient to walk at the next day. Aloud the patient returning to work in a week. Minimum risk of PTE Minimum risk of gastro-jejunostomy ulcers The process must be guided by a distinguished Center of Excellence or by The European Accreditation Council of the International Federation of Obesity Surgery Societies. Columnas iguales

Balon, POSE, APOLLO, Endobarrier, Gastroplastia Endoscópica... ¿Qué procedimientos, endoscópicos o quirúrgicos, podemos utilizar?: Evidencia Endoscópicos: Balon, POSE, APOLLO, Endobarrier, Gastroplastia Endoscópica... Ninguno de ellos es capaz de demostrar una eficacia real a medio plazo ¡¡¡ Quirúrgicos: 1.- Cirugías simples (restrictivas) --- BG, GVA, PG, GV ** Resultados buenos (50-65% EIMCP) a corto y medio plazo. Fracaso a largo plazo (< 50% EIMCP a 10 años) 2.- Cirugías complejas: --- BGYR estándar **Resultados buenos (50-65% EIMCP) a medio plazo. No se mantienen resultados > del 50% pacientes ( ̴50-65% EIMCP a 10 años)] --- CD-DB. *Resultados excelentes a largo plazo (> 75% EIMCP > 10 años) ** Mayor índice de morbimortalidad y complicaciones a largo plazo. --- OAGB/BAGUA ** Menor índice de morbimortalidad y complicaciones a largo plazo.

Disminuir los riesgos perioperatorios del Bypass Gástrico Estenosis Fuga Sangrado Úlcera Marginal Crónica Dumping severo. Estenosis Fuga Sangrado Hernia interna Obstrucción Estenosis Fuga Sangrado Vólvulo Intususcepción Obstrucción?? REGANANCIA DE PESO Dos Anastomosis 12 Posibles Factores de Riesgo Una Anastomosis 4 Posibles Factores de Riesgo

   Carbajo M, Garcia-Caballero M, Toledano M, Osorio D, Garacia-Lanza C, Carmona JA. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg 2005;15:398-404. Rutledge R. Hospitalization before and after mini-gastric bypass surgery. Int J Surg 2007;5:35-40. Piazza L, Ferrara F, Leanza S, Coco D, Sarvà S, Bellia A, Di Stefano C, Basile F, Biondi A. Laparoscopic mini-gastric bypass: short-term single-institute experience. Updates Surg 2011;63:239-42. Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg 2012;22:1827-34. Musella M, Sousa A, Greco F, De Luca, Manno E, Di Stefano C, Milone M, Bonfanto R, Segato G, Antonino A, Piazzo L. The laparoscopic mini-gastric bypass: The Italian experience: outcomes from 974 consecutive cases in a multi-center review. Surg Endosc 2014;28:156-63. Musella M, Milone M. Still “controversies” about the mini gastric bypass? Obes Surg 2014;24”:643-4. Kim MJ, Hur KY. Short-term outcomes of laparoscopic single anastomosis gastric bypass (LSAGB) for the treatment of type 2 diabetes in lower BMI (<30 kg/m(2)) patients. Obes Surg 2014;24:1044-51. Lee WJ, Chong K, Lin YH, Wei JH, Chen SC. Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg 2014;24:1552-62. Kular KS, Manchanda N, Rutledge R.  Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: A report from the Indian sub-continent. Obes Surg 2014;24:1724-8.  Georgiadou D, Sergentanis TN, Nixon A, Diamantis T, Tsigris C, Psaltopoulou T. Efficacy and safety of laparoscopic mini-gastric bypass. A systematic review. Surg Obes Relat Dis 2014;10:984-91. Musella M. Milone M, Gaudioso D, Bianco P, Palumbo R, Bellini M, Milone F. A decade of bariatric surgery. What have we learned? Outcome in 520 patients from a single institution. Int J Surg 2014;12 Suppl 1:S183-8. Garciacaballero M, Reyes-Ortiz A, Garcia M, Martinez-Moreno JM, Toval JA, Garcia A, Minquez A, Osorio D, Mata JM, Miralles F. Changes of body composition in patients with BMI 23-50 after tailored one anastomosis gastric bypass (BAGUA): influence of diabetes and metabolic syndrome. Obes Surg 2014;24:2040-7. Carbajo MA, Jimenez JM, Castro MJ, Ortiz-Solorzano J, Arango A. Outcomes and weight loss, fasting blood glucose and glycosylated hemoglobin in a sample of 415 obese patients, included in the database of the European Accreditation Council for Excellence Centers for Bariatric Surgery with Laparoscopic One Anastomosis Gastric Bypass. Nutr Hosp 2014;30:1032-8. Carbajo MA, Vazquez-Pelcastre, Aparicio-Ponce R, Luque de Lyon E, Jimenez JM, Ortiz-Solarzano J, Castro MJ. 12-year old adolescent with super morbid Luque-de Leon, E.,Carbajo MA, Conversion of one-anastomosis gastric bypass (OAGB) is rarely needed if standard operative techniques are performed. Obes Surg 2016:26: 1588-91. Carbajo MA, Fong-Hirales A, Luque-de-Leon E, Molina-Lopez JF, Ortiz-de-Solorzano J. Weigth loos and improvement of lipid profiles in morbidly obeses patients after laparoscopic one-anatomosis gastric bypass: 2-years follow-up. Surgical Endoscopic. DOI 10.1007/s00464-016-4990-y. Carbajo MA, Luque-de-Leon E. Differentiating mini-gastric bypass/one-anastomosis gastric bypass from the single-anastomosis duodenoileal bypass procedures. Surg Obes relat Dis 2016:12; 933-4 Musella M, Apers J, Rheinwalt K, Ribeiro R, Manno E, Greco F, Milone M, Di Stefano C, Guler S, Van Lessen IM, Guerra A, Maglio MN, Bonfanti R, Novotna R, Coretti G, Piazza L. Efficacy of bariatric surgery in type 2 diabetes mellitus remission: the role of mini gastric bypass/one anastomosis gastric bypass and sleeve gastrectomy at 1 year of follow-up. A European survey. Obes Surg 2015 Sep 4 [Epub ahead of print].obesity, treated with laparoscopic one anastomosis gastric bypass (LOAGB/BAGUA): A case report after 5-year follow-up. Nutr Hosp 2015;31:2327-32. Carbajo MA, Luque-de-Leon E, Jiminez JM, Ortiz-de-Solorzano J, Perez-Miranda M, Castro-Alija M. Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg Online First 25 Oct 2016 doi:10.1007/s11695-016-2428-1. Jammu GS, Sharma R. An eight-year experience with 189 type 2 diabetic patients after mini-gastric bypass. Integrative Obesity and Diabetes. 2016;2(4);246–9. doi: 10.15761/IOD.1000154. References ok

Weight Loss, weight regain, and convertions to Roux-en- Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy Felsenreich DM, Langer FB, et al Surg Obes Relat Dis,2016 feb s1550 53 patients with complete 10-year-follow-up 36% were converted for weight reganain or reflux at a median of 36 months a mean percent excess weight loss of 53 ± 25% was achieved by only 32 patients ok CONCLUSION: Within a long-term follow-up of 10 years o more after SG, a high incidence of both significant weigth regain (59% of patients) and intractable reflux was observed, leading to conversion

Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up K. Higa, T. Ho. F. Tercero, T. Yunus, K. Bone SOARD, 2011; 7: 516-525 242 patients *Follow up (rate 26% at 10 years) *Average %EWL at 10 years after surgery was 57,1% ± 33,9% *1 of 4 patients had inadequate weight loss (Biron’s definition) *33.2% failed to achieve an EWL of <50% *35% of the patients had ≥ 1 complication during follow-up - Internal Hernia rate was 16% - Gastro-yeyunal stenosis rate was 4.9% - Marginal ulcer rate was 4.5% *Only 18% remained nutritionally intact during follow-up 33% at 2 years 7% at 10 years ok CONCLUSION: ”Althought our goal has been to improve the health and quality of life of our patients, MEASUREMENTS OF SUCCESS REMAIN NEBULOUS”

CONCLUSION: Higher level of execess weigth loos are archived. Long-Term outcomes after biliopancreatic diversion with and without duodenal switch: 2-,5-, and 10 year data Sethi M, Chau E, et al. Surg Obes Relat Dis. 2016;9 S1550 *100 patients. Mean follow 8.2 years (range 1-15 yr) active follow up 72% EWL 68% AT 10-15 years. 37% of patients developed long term complications requiring surgery CONCLUSION: Higher level of execess weigth loos are archived. Although nutricional deficiencies and post operative complications are common.

Methods: Initial 1200 patients submitted to laparoscopic OAGB between 2002 and 2008 were analyzed after a 6–12-year FU. Mean age was 43 years (12–74) and body mass index (BMI) 46 kg/m2 (33–86). There were 697 (58 %) without previous or simultaneous abdominal operations, 273 (23 %) with previous, 203 (17 %) with simultaneous, and 27 (2 %) performed as revisions. Conclusions: Laparoscopic OAGB is safe and effective. It reduces difficulty, operating time, and early and late complications of Roux-en-Y gastric bypass. Long-term weight loss, resolution of comorbidities, and degree of satisfaction are similar to results obtained with more aggressive and complex techniques. It is currently a robust and powerful alternative in bariatric surgery.

%EWL y BMI. Evidences:

Distribución de los procedimientos quirúrgicos EAC-BS 2017

IFSO- European Database Control Intra-operative Complications COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG IFSO- European Database Control (Since January 2010) Intra-operative Complications Bleeding Liver Failure Injury splenic Other Gastrointestinal perforation vascular Deaths % TOTAL OPERATIONS 938 TOTAL OPERATIONS 14161 OAGB RYGB TOTAL OPERATIONS 2542 TOTAL OPERATIONS 16225 GB SG

IFSO- European Database Control Post-operative Complications COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG IFSO- European Database Control (Since January 2010) Post-operative Complications

IFSO- European Database Control General Complications COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG IFSO- European Database Control (Since January 2010) General Complications 0.56% 4.06% TOTAL OPERATIONS 938 TOTAL OPERATIONS 14161 OAGB RYGB 3.96% 4.29% TOTAL OPERATIONS 2542 TOTAL OPERATIONS 16225 GB SG

European database register of IFSO Center of Excellence from Jan 2010-2016 comparative EWL study between OAGB vs RYGB, SG, and GB: Evidence 86,54% 63,75% 39,29% 20,56%

European database register of IFSO Center of Excellence from Jan 2010-2016 comparative EBMIL study between OAGB vs RYGB, SG, and GB: Evidence 107,86% 71,88% 47,82% 23,65%

From a presentation by Scott Shikora at MISS, courtesy post by Phil Schauer

¿Por qué el Bypass Gástrico de Una Sola Anastomosis (OAGB/BAGUA) es una técnica segura y eficaz?: EVIDENCIAS Conclusiones Después de casi tres décadas, hemos eliminado las técnicas restrictivas, aunque mantenemos la GV para casos selectivos. Nuestra experiencia con BGYR no fue la deseable por sus complicaciones peri- operatorias y medianos resultados a largo plazo.

¿Por qué el Bypass Gástrico de Una Sola Anastomosis (OAGB/BAGUA) es una técnica segura y eficaz?: EVIDENCIAS Conclusiones El OAGB/BAGUA es una técnica más malabsortiva y más restrictiva que el BGYR. Técnicamente es más sencilla y reproducible. Los resultados son mejores a largo plazo. Sin embargo requiere conocimientos y experiencia en cirugía bariátrica, no estando exenta de posibles graves complicaciones y recomendando su aprendizaje con expertos.

¿Por qué el Bypass Gástrico de Una Sola Anastomosis (OAGB/BAGUA) es una técnica segura y eficaz?: EVIDENCIAS Conclusiones Con más de 14 años de experiencia, el OAGB-BAGUA presenta excelentes resultados a largo plazo. Es una técnica segura y eficaz para el control de la OM y SM y se ha mostrado muy útil para la Metabólica y la de Rescate. Las ventajas superan con creces a los posibles efectos adversos y representa actualmente una robusta alternativa en Cirugía Bariátrica y Metabólica.

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