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Il bypass gastrico per via laparoscopica Roux-en-Y con il posizionamento dell`impianto GABP RING mantiene la perdita di peso nel paziente a lungo termine

Un obiettivo importante alla base della chirurgia bariatrica è la perdita di peso e il suo mantenimento a lungo termine. L’efficacia del posizionamento dell’impianto GABP RING in aggiunta al by pass gastrico è stata valutata in un follow up di 4 anni, pubblicato in BMC Surgery.

Questo è il primo rapporto dei risultati milticentrici ottenuti dopo quattro anni.

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Banded gastric bypass maintains weight loss according to a study thought to be the first report of up to four years using the GaBP ring (Bariatec Corporation), published in BMC Surgery 

Although gastric bypass is the gold standard of bariatric surgery some patients show insufficient weight loss or weight regain. It is believed that dilation of the pouch or the pouch outlet may be the cause, but by banding the bypass surgeons overcome the dilation by placing an implant around the pouch or pouch outlet.

A total of 183 (118 women and 65 men) consecutive bariatric patients who agreed for GaBP implant were operated with banded gastric bypass between August 2007 and December 2010 at the Antwerp Medical Center, Belgium, the University of Schleswig-Holstein, the University of Freiburg, Germany, and the International Medical Centre, Jeddah, Kingdom of Saudi Arabia.

The mean BMI before the operation was 42.8 and mean excess weight was 60.9 kg. Patient weight and BMI were recorded prior to the operation, three and six months after the operation and at one, two, three and four years post-op.

All the cases were performed laparoscopically and a vertical tubular pouch 5–6cm was formed using linear staplers. The GaBP Ring was placed 4cm from the angle of and closed and fixed with two sutures. Rings with a circumference of 6.5cm (diameter of closed ring is 1.9cm) were used in all patients. The alimentary limb was created by dividing the jejunum 50cm below the ligament of Treitz. A gastroenterostomy was performed in an antecolic manner using a circular stapler or hand sewing anastomosis and the integrity of the anastomosis was tested with methylene blue.

In the perioperative and early postoperative period there were 8 (4.3%) complications, including:

  • One case of an intraoperative bleeding (0.5%) which made a splenectomy necessary
  • Two patients had postoperative intraabdominal bleedings and another two developed intraluminal bleedings which could be treated conservatively (2.1%)
  • In two cases (1%) an intestinal perforation was observed which resulted in revisionary surgery, but it was not necessary to remove the rings
  • One patient had a cardiac arrest (0.5%) in the early postoperative period with complete recovery

Outcomes

The results revealed that at six months follow up data was available for 147 patients: the mean EWL was 60% with a mean BMI 30.1. After one year mean EWL reached 75.3% with a mean BMI27 (n=110). After two and three years the EWL was 78.8% (n=49) and 79.9% (n=35). There was a mean EWL of 85% after four years. Thirteen patients finished a four year follow up period and mean BMI after 4 years was 25.2.

“We assume that ring implantation on the gastric pouch can indeed prevent pouch outlet and first jejunal limb dilation,” the authors write. “Since outlet dilation will probably not occur in the first year after gastric bypass, the effect of the banding is likely to be seen in a more than three year follow up.”

They note that banded bypass is not routinely used by most bariatric surgeons and state that it might be due to the fear of additional complications like infection, band or ring erosion, migration or stenosis. However, in this series they witnessed no ring-related complications besides one case where the ring was broken and had to be replaced.

Conclusion

“To our knowledge this is the first report of up to four years multicenter results using the GaBP ring for banded gastric bypass surgery. In the four year follow up we see a good weight loss in the first year and a further slight weight loss up to year four with no regain of weight,” the authors conclude. “However, one limitation of our study is that to date only 13 patients completed the four year follow. We assume that banding the pouch can prevent pouch outlet dilation and thus reduce the need for revisionary operations after gastric bypass surgery. We are looking forward to see the results of multicenter prospective comparison of banded and conventional gastric bypass.”

Owen Haskins – Editor in chief, Bariatric News

Riferimento Pubmed: (http://www.ncbi.nlm.nih.gov/pubmed/25391401.

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