Gastrectomia en Manga y Switch Duodenal ¿Es lo que veremos en Cirugía Bariatrica?

En los últimos meses han aparecido varios trabajos sobre el desarrollo de 2 técnicas en cirugía bariatrica. Hay menos de 100 articulos en PUBMED a la fecha, pero la tendencia es que más grupos quirúrgicos estan implementando la técnica. Incluso en Chile, al menos un grupo (UC) ya inicio su experiencia.

Las técnicas son:
GASTRECTOMÍA EN MANGA LAPAROSCÓPICA (Sleeve Gastrectomy)
SWITCH DUODENAL LAPAROSCÓPICO

Ha continuación encontrarán 02 abstracts respecto a esta técnicas. Los invitó a conocer estos procedimientos porque serán tema de discusión en los próximos meses (Congresos).

Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity.
Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P.
Department of Surgery, University of Pittsburgh Medical Centre, Veterans Hospital, Pittsburgh, PA, USA.
Surg Endosc. 2006 Jun;20(6):859-63

BACKGROUND: The surgical treatment of obesity in the high-risk, high-body-mass-index (BMI) (>60) patient remains a challenge. Major morbidity and mortality in these patients can approach 38% and 6%, respectively. In an effort to achieve more favorable outcomes, we have employed a two-stage approach to such high-risk patients. This study evaluates our initial outcomes with this technique. METHODS: In this study, patients underwent laparoscopic sleeve gastrectomy (LSG) as a first stage during the period January 2002-February 2004. After achieving significant weight loss and reduction in co-morbidities, these patients then proceeded with the second stage, laparoscopic Roux-en-Y gastric bypass (LRYGBP). RESULTS: During this time, 126 patients underwent LSG (53% female). The mean age was 49.5 +/- 0.9 years, and the mean BMI was 65.3 +/- 0.8 (range 45-91). Operative risk assessment determined that 42% were American Society of Anesthesiologists physical status score (ASA) III and 52% were ASA IV. The mean number of co-morbid conditions per patient was 9.3 +/- 0.3 with a median of 10 (range 3-17). There was one distant mortality and the incidence of major complications was 13%. Mean excess weight after LSG at 1 year was 46%. Thirty-six patients with a mean BMI of 49.1 +/- 1.3 (excess weight loss, EWL, 38%) had the second-stage LRYGBP. The mean number of co-morbidities in this group was 6.4 +/- 0.1 (reduced from 9). The ASA class of the majority of patients had been downstaged at the time of LRYGB. The mean time interval between the first and second stages was 12.6 +/- 0.8 months. The mean and median hospital stays were 3 +/- 1.7 and 2.5 (range 2-7) days, respectively. There were no deaths, and the incidence of major complications was 8%. CONCLUSION: The staging concept of LSG followed by LRYGBP is a safe and effective surgical approach for high-risk patients seeking bariatric surgery.

Laparoscopic duodenal switch for morbid obesity.
Gagner M, Boza C.
New York Presbyterian Hospital, Department of Surgery, Joan and Sanford I Weill Medical College of Cornell University, New York, NY 10021, USA.
Expert Rev Med Devices. 2006 Jan;3(1):105-12.

Laparoscopic duodenal switch gives a consistent excess weight loss of 70-80% with acceptable long-term nutritional complications. It is especially indicated for super-obese patients with a body mass index greater than 50 kg/m(2). A systematic review of the literature and results of open and laparoscopic duodenal switch is thoroughly presented. Also presented for the authors' surgical colleagues are some technical details concerning their preferred method. Meta-analysis now demonstrate a low mortality rate for the laparoscopic procedure close to 0.5%, and operative times close to 200 min. Laparoscopic duodenal switch is likely to increase in popularly for the treatment of morbid obesity, especially with the recent advent of laparoscopic sleeve gastrectomy for higher-risk patients.