The aim of this study is to retrospectively analyze the incidence of complications after two-stage laparoscopic biliopancreatic diversion with duodenal switch (Lap BPD-DS) in high-risk super-obese patients and explore the possible predictive factors of specific complications after laparoscopic sleeve gastrectomy (SG). High-risk patients-body mass index (BMI) > 50 kg/m(2) with at least two major comorbidities: type 2 diabetes, obstructive sleep apnea syndrome (OSAS), hypertension-undergoing two-stage laparoscopic BPD-DS were retrospectively analysed. The SG pouch volume was 100-150 ml; in the second stage, the common channel and the alimentary loop were 100 cm and 150 cm, respectively. Eighty-seven patients (50 female, 57.5%) underwent SG (two open). The mean age was 41.8 +/- A 10.22 years with BMI of 55.2 +/- A 6.69 kg/m(2). Four patients had Prader-Willy syndrome. Fourteen (16.46%) patients (6 female, 42.8%) had postoperative complications such as bleeding, fistula, pulmonary embolism, transitory acute renal failure, and abdominal abscess. One patient died at postoperative day 5 of pulmonary embolism. One patient was reoperated for hemoperitoneum by laparoscopy. The risk of complications after SG was lower in patients where reinforcement of the suture line was used (0.492), while it was higher in men (1.780). Neither difference was statistically significant [p = not significant (NS)]. After 9-24 months, 27 patients (BMI 43 +/- A 8 kg/m(2)) underwent a second stage of BPD-DS (two open). Major postoperative complications were registered in eight patients (29.6%): three bleeding, four duodeno-ileal stenosis and one rhabdomyolysis. Two cases of internal hernia required laparoscopic reoperation. The reoperation rate was 1/85 (1.2%) after SG and 2/27 (7.4%) after second stage. Complications after SG greatly decrease after the learning curve period and can be successfully managed without need of reoperation. Suture-line reinforcement, at least selectively in the middle-upper portion of the staple line and in super-super-obese patients, is recommended to decrease the incidence of specific complications.

Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications / Silecchia, Gianfranco; Casella, Giovanni; Soricelli, Emanuele; Basso, Nicola; Rizzello, Mario; Fioriti, Mariachiara. - In: SURGICAL ENDOSCOPY. - ISSN 0930-2794. - ELETTRONICO. - 23:5(2009), pp. 1032-1037. (Intervento presentato al convegno Annual Meeting of the Society-of-American-Gastrointestinal-and-Endoscopic-Surgeons tenutosi a Las Vegas, NV nel APR 16-22, 2007) [10.1007/s00464-008-0113-8].

Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications

SILECCHIA, Gianfranco;CASELLA, GIOVANNI;SORICELLI, EMANUELE;BASSO, Nicola;RIZZELLO, MARIO;FIORITI, MARIACHIARA
2009

Abstract

The aim of this study is to retrospectively analyze the incidence of complications after two-stage laparoscopic biliopancreatic diversion with duodenal switch (Lap BPD-DS) in high-risk super-obese patients and explore the possible predictive factors of specific complications after laparoscopic sleeve gastrectomy (SG). High-risk patients-body mass index (BMI) > 50 kg/m(2) with at least two major comorbidities: type 2 diabetes, obstructive sleep apnea syndrome (OSAS), hypertension-undergoing two-stage laparoscopic BPD-DS were retrospectively analysed. The SG pouch volume was 100-150 ml; in the second stage, the common channel and the alimentary loop were 100 cm and 150 cm, respectively. Eighty-seven patients (50 female, 57.5%) underwent SG (two open). The mean age was 41.8 +/- A 10.22 years with BMI of 55.2 +/- A 6.69 kg/m(2). Four patients had Prader-Willy syndrome. Fourteen (16.46%) patients (6 female, 42.8%) had postoperative complications such as bleeding, fistula, pulmonary embolism, transitory acute renal failure, and abdominal abscess. One patient died at postoperative day 5 of pulmonary embolism. One patient was reoperated for hemoperitoneum by laparoscopy. The risk of complications after SG was lower in patients where reinforcement of the suture line was used (0.492), while it was higher in men (1.780). Neither difference was statistically significant [p = not significant (NS)]. After 9-24 months, 27 patients (BMI 43 +/- A 8 kg/m(2)) underwent a second stage of BPD-DS (two open). Major postoperative complications were registered in eight patients (29.6%): three bleeding, four duodeno-ileal stenosis and one rhabdomyolysis. Two cases of internal hernia required laparoscopic reoperation. The reoperation rate was 1/85 (1.2%) after SG and 2/27 (7.4%) after second stage. Complications after SG greatly decrease after the learning curve period and can be successfully managed without need of reoperation. Suture-line reinforcement, at least selectively in the middle-upper portion of the staple line and in super-super-obese patients, is recommended to decrease the incidence of specific complications.
2009
biliopancreatic diversion; complications; morbid obesity; risk factors; sleeve gastrectomy
01 Pubblicazione su rivista::01a Articolo in rivista
Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications / Silecchia, Gianfranco; Casella, Giovanni; Soricelli, Emanuele; Basso, Nicola; Rizzello, Mario; Fioriti, Mariachiara. - In: SURGICAL ENDOSCOPY. - ISSN 0930-2794. - ELETTRONICO. - 23:5(2009), pp. 1032-1037. (Intervento presentato al convegno Annual Meeting of the Society-of-American-Gastrointestinal-and-Endoscopic-Surgeons tenutosi a Las Vegas, NV nel APR 16-22, 2007) [10.1007/s00464-008-0113-8].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/118612
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