Biomedical subjects

Rafael Bou

Publications and source records attributed to Rafael Bou.

8 recordsLinked to original sources

PubMed2006

[Comparative results between vertical ringed gastroplasty and duodenal switch in morbid obesity].

INTRODUCTION: The only effective long-term treatment for morbid obesity is bariatric surgery. AIM. To compare the long-term results of vertical banded gastroplasty (VBG) and duodenal switch (DS). Quality of life, weight loss and reoperations were evaluated. MATERIAL AND METHODS: A retrospective study of 85 patients with VBG and 49 with DS with a follow-up of more than 5 years was performed. The mean preoperative body mass index (BMI) was 48.8 kg/m2 in VBG patients and 50.33 kg/m2 in DS patients. RESULTS: At 5 years, 87.5% of patients with DS had maintained a percentage of excess weight lost (%EWL) of more than 50%, and were therefore counted as successes, compared with 55% of those with VBG (p < 0.0001). Eight VBG patients (9.4%) and one DS patient (2.04%) required re-operations due to failure of the technique. None of the VBG patients with a %EWL of more than 50% could eat a normal diet, whereas more than 80% of patients with DS had no dietary restrictions. CONCLUSIONS: At 60 months follow up, only the DS patients fulfilled the requirements of the American Society of Bariatric Surgery of %EWL superior to 50% in more than 75% of the patients.

Adult↗

PubMed2006

[Laparoscopic sleeve gastrectomy. A bariatric procedure with multiple indications].

OBJECTIVES: We present our experience with laparoscopic sleeve gastrectomy (LSG), a restrictive bariatric procedure with multiple indications. METHODS: We performed LSG in 30 patients. The technique was performed in: 1) 6 patients with superobesity, as the first stage in laparoscopic duodenal switch; 2) 7 morbidly obese patients with severe comorbidities (4 with cirrhosis); 3) 16 obese patients with a low BMI (35-43); and 4) 1 patient with prior lap band requiring conversion. RESULTS: One patient with a BMI of 74 died (3.2% mortality). The percentage of excess BMI lost was 63.1% at 4-27 months in the 6 patients with superobesity, 76% (69-100) in the 4 cirrhotic patients, 68.5% (58.3-123) at 3-27 months in the 16 obese patients and only 13% in the patient with prior lap-band as this patient had already lost excess weight. CONCLUSION: LSG can be the ideal technique in patients with a BMI > 55 and in morbidly obese patients with severe intercurrent diseases. It is an excellent alternative to banding in patients with low BMI and in those with bands requiring conversion.

Gastrectomy↗

PubMed2006

[One thousand bariatric interventions].

INTRODUCTION: Bariatric surgery is the most effective treatment for morbid obesity. The aim of the present study was to evaluate changes over 29 years of personal experience and in bariatric surgery in general. PATIENTS AND METHOD: One thousand patients underwent surgery from 06-17-1977 to 11-12-2005. Procedures consisted of open gastric bypass (GBP) in 16, vertical banded gastroplasty (VBG) in 129, laparoscopic gastric banding in 3, duodenal switch (DS) in 526, laparoscopic gastric bypass (LGBP) in 44, laparoscopic DS (LDS) in 240 and laparoscopic sleeve gastrectomy (LSG) in 43. RESULTS: Eleven patients died (1.1%): causes were pulmonary embolism in 4 (0.4%), pericardial tamponade in 1, rhabdomyolysis in 1, and multiorgan failure in 5 (0.5%) (1 after intraabdominal bleeding, 4 due to leaks and sepsis). Major morbidity occurred in 60 patients (6%) consisting of leaks in 49 (4.9%), rectal abscesses in 3, intraabdominal abscesses in 3, and intraperitoneal hemorrhages in 5 (0.05%). Minor morbidity occurred in 71 patients (7.1%). Ten patients died in the long-term (1%). The percentage of excess body mass index lost at 5 years was 66.4 in patients with gastroplasty, 78.8 in those with DS and 69.3 in those with gastric bypass. CONCLUSIONS: Bariatric surgery is highly effective and widely accepted among patients and medical centers in Spain, in which the number of publications and mortality (<1%) are acceptable. Most patients undergo laparoscopic surgery.

Adolescent↗

PubMed2006

Total gastrectomy for complications of the duodenal switch, with reversal.

BACKGROUND: Duodenal switch (DS) is one of the most effective techniques for the treatment of morbid obesity and its related co-morbidities, with mortality rates of <1%, but with 9.4% morbidity rates (6.5% due to leaks). We present our experience with 9 patients operated with a DS, who later underwent total gastrectomy (TG) for complications of the sleeve gastrectomy. METHODS: From 1994 to March 2006, 846 patients underwent the DS. 9 patients (1%) underwent TG; 5 were due to gastric leak at the angle of His, 2 were related to leakage at the doudeno-ileal anastomosis (DIA), 1 was for stenosis of the gastric sleeve, and 1 for a gastroparesis. In 3 cases, the DS was the second bariatric operation. Full restoration of bowel anatomy was attempted in all patients. RESULTS: TG has been the final solution for gastric complications of the DS in 9 (1%) of our 846 patients. In all cases, bowel anatomy has been restored, and there was no mortality. Postoperative courses have been difficult and hospital stays have been long in all patients (mean 4.5 months; range 1-10 months), with several episodes of re-do surgery after the TG. The actual BMI and %EBMIL are acceptable. CONCLUSIONS: TG successfully treated all 9 cases with life-threatening complications and difficult reinterventions after DS, without mortality. Restoration of bowel anatomy was done in all cases, with good final results.

Adult↗

PubMed2006

Re-sleeve gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) started as the restrictive part of the more complex laparoscopic duodenal switch (LDS) operation. There is no long-term experience with the isolated LSG. The main concern about the isolated LSG is the possibility of dilatation of the gastric pouch, long-term loss of restrictive function and weight regain. Laparoscopic re-sleeve gastrectomy (LRSG) has been used sparingly, but it also may become a possibility if more patients have the isolated LSG. METHODS: 2 patients with BMI 58 and 65 respectively, underwent LSG as the first stage of the LDS. Later, when the patients regained some weight and their gastric pouch was found to be too large, the LRSG/DS was done. RESULTS: The patient with BMI 58 had an initial drop to BMI 34 and regained weight to BMI 46, but after the LRSG/DS her BMI is 36 at 4 months. The BMI patient with BMI 65 had a drop to BMI 42, and after the LRSG/DS his BMI is 33 at 3 months later. CONCLUSION: LRSG may become necessary after gastric tube dilatation or insufficient original gastric volume reduction. LRSG is feasible, available and easy to perform when the resulting gastric pouch is too large or dilates after the original LSG.

Adult↗

PubMed2005

Comparative analysis of vertical banded gastroplasty and duodenal switch at five years follow-up.

BACKGROUND: Bariatric surgery is the only effective long-term treatment for morbid obesity. We compared long-term results of the vertical banded gastroplasty (VBG) and biliopancreatic diversion with duodenal switch (DS). Quality of life (QoL), weight loss (WL), and reoperation were evaluated. METHODS: This is a retrospective study of 85 of 129 patients with VBG and 49 of 743 patients with DS, with follow-up >5 years. Mean preoperative BMI of the VBG patients was 48.8 kg/m2 and for the DS patients was 50.3 kg/m2. RESULTS: Percent excess weight loss (%EWL) at 5 years for VBG patients was 56.4% and for DS patients 70.6% (P<0.0001). 8 VBG patients (9.4%) and 1 DS patient (2.0%) required re-operation due to failure of the technique. None of the VBG patients could eat a normal diet, while 80% of the DS had no restriction in the quality of their intake. CONCLUSIONS: At 60 months follow-up, only the DS patients fullfilled the ASBS requirements of %EWL >50 in over 75% of the patients.

Adult↗

PubMed2005

Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation.

BACKGROUND: The use of the laparoscopic sleeve gastrectomy (LSG), a restrictive operation, in different settings, is presented. METHODS: 31 patients underwent LSG in the following groups: 1) 7 patients with very high BMI as a first stage of the duodenal switch (DS); 2) 7 morbidly obese patients with severe medical conditions; 3) 16 obese patients with lower BMI (35-43); and 4) 1 patient converted from a prior gastric banding. RESULTS: 1 patient with BMI 74 died, a 3.2% mortality. The percentage of excess BMI loss (%EBMIL) in group 1 above was 63.1% from 4-27 months. The %EBMIL of the cirrhotics in group 2 was 76.0% (69-100%). The %EBMIL in group 3 patients was 68.5% (58.3-123%) at 3-27 months. The %EBMIL of the group 4 patient is 13% because she had previously lost almost all of her EBMI. CONCLUSION: LSG may become the ideal operation for staging in patients with BMI >55, for treating morbidly obese patients with severe medical conditions, as an excellent alternative to adjustable bands in lower BMI patients, or for conversion of gastric banding patients.

Bariatric Surgery↗

PubMed2004

Clinical hepatic impairment after the duodenal switch.

BACKGROUND: Nonalcoholic steatohepatitis (NASH) is the most common histological finding in morbidly obese patients undergoing liver biopsy. Biliopancreatic diversion has been widely used for the treatment of morbid obesity and hepatic steatosis, and very few cases of liver impairment as a complication of this operation have been reported. METHODS: During the last 9 years, 470 morbidly obese patients were operated by means of a biliopancreatic diversion with duodenal switch ( BPD-DS), and 93 of them were performed laparoscopically. RESULTS: 10 cases of clinical hepatic impairment occurred after the BPD-DS. The clinical course of these patients ranged from transient subclinical alterations of liver function tests to severe cases of jaundice and one death from liver failure. CONCLUSION: Randomized prospective studies with standardization of BPD-DS are needed, to know the real incidence of hepatic impairment and the proper treatment for this condition. Careful follow-up and correction of possible malnutrition should be addressed to avoid hepatic impairment and/or progression of liver disease.

Adult↗