The Efficacy Of Laparoscopic Sleeve Gastrectomy And Laparoscopic Mini Gastric Bypass For Morbid Obesity

BackgroundMorbid obesity (MO) means BMI>40kg/m2or BMI≥35kg/m2with hypertension, hyperlipidemia, hypercholesterolemia, type2diabetes, sleep apnea syndrome, degenerative joint disease, gallstones, gastrointestinal cancer and other comorbidity, surgical treatment should be considered for such patients. LSG was originally used for the first phase of very severe in patients with morbid obesity surgery. Surgical risk in patients with very severe morbid obesity, it is very severe morbid obesity in patients with two-stage surgery, the first phase of the LSG, postoperative BMI decreased and related comorbidity have been alleviated to improve or cure, and then gastric bypass (GBP) or biliopancreatic diversion (BPD), LSG has been made as a separate weight loss surgical weight loss in recent years, it gradually evolved into a stand-alone weight loss procedure. In October1993, Wittgrove and Clark have completed the world’s first laparoscopic Roux-en-Y gastric bypass (LRYGBP), Laparascopic Mini Gastric Bypass (LMGBP) is its improved operation. Our country continue to carry out these weight loss surgery. Our center since april2010to april2011make the LSG30cases and LMGBP8cases, follow-up study that after1year, patients with weight loss related with the incidence of remission or even cure. LMGBP postoperative patients with type2diabetes to significantly alleviate or even cure.This study was designed before the observation LSG and LMGBP surgery, postoperative weight change related with the onset of relief and cure, the incidence of malnutrition and the prevention, treatment, and further explore these two weight loss surgical procedures for MO and such as T2DM comorbidity of the efficacy analysis.Part oneClinical analysis of laparoscopic sleeve gastrectomy for morbid obesityObjectives: To observe the LSG for morbid obesity patients before and after weight change, complication rate, with incidence of remission and cure of patients with nutritional status and trace element deficiency states, in order to evaluate the efficacy and safety of LSG in the country to further promote developed to provide a scientific basis.Methods:LSG a total of30cases of MO patients, including9males (30%) and21females (70%), age (29.7±14.7) years of age, height (168.8±5.7) cm, weight (103.4±12.9)kg, and BMI (38.2±2.6) kg/m2, waist circumference (102.5±8.47) cm; hip (114.5±7.8) cm; waist-hip ratio was0.89±0.23.All patients were excluded by the system checks the secondary obesity, intravenous anesthesia in april2010to april2011to accept the LSG. Preoperative and postoperative January, March, June, a patient monitoring laboratory parameter, each set of data are the mean±standard deviation, the application of SPSS17.0statistical analysis software to analyze each set of data.Result:All30patients were successful were successful implementation of LSG surgery by the same surgical team, laparotomy and surgical deaths. The operative time was (95.7±34.5) min, intraoperative blood loss (29.2±8.4) ml, postoperative hospital stay (4.9±1.7) days, postoperative passage of flatus (1.33±0.61) days. Patients with postoperative wound infection, be dressing and antibiotic treatment were discharged. One patient developed subphrenic infection to be antibiotic anti-infective therapy and were discharged. I not found bleeding, anastomotic leakage, anastomotic stenosis, gastroparesis and other complications. There were no deaths.Weight at6months postoperatively (86.1±13.0) kg (P<0.05); BMI (29.7±1.9)kg/m2,(P<0.05);EWL would you accept%(55.6±6.6)%(P<0.05);waist circumference (91.6±10.5) cm (P<0.05), hip (95.8±7.0) cm (P<0.05),waist-hip ra tioof0.9±0.7(P<0.05).Weight afterlyear (78.8±10.8) kg (P<0.01); BMI (27.8±1.9) kg/m2,(P<0.01); EWL would you accept%(67.9±5.6)%(P<0.01); waist circumference (82.2±12.1) cm (P<0.01),hipcircumference (88.5±6.7) cm(P<0.01), waisttohipratio of0.9±0.1(P<0.01). Patientswith hypertension, fattyliver, MS, etc. associated with the incidence is clearly improved. Conclusion:1、LSG treatment of MO early (≤1year) to good effect.2、LSG compared with LRYGBP operation is relatively simple, does not change the physiological state of the gastrointestinal tract, likely to be accepted by the patients,Easy to carry out large-scale.3、LSG MO MS associated with fatty liver, hypertension and comorbidity well, to achieve improvement and part of the cure4、LSG can be as LAGB and LVGB, postoperative weight loss one of the alternative procedure when the patients who failed the second weight loss surgery.5、With T2DM, the MO of this group of patients had no LSG on T2DM treatment effect, to be further studied. Part2The laparoscopic modified gastric bypass for morbid obesity associated with type2diabetes mellitusObjectives:Observe the MO combined with T2DM the line LMGBP operative weight change, incidence of complications, comorbidity mitigation and cure of nutritional status of patients and trace element deficiency states, in order to evaluate the efficacy and safety of LMGBP mechanism to investigate the treatment of T2DM for LMGBP in the country to further promote the development to provide a scientific basis.Methods:LMGBP group of eight cases of patients, including3males and5females, age (39.5±7.7) years, height(169.3±7.3) cm, body weight (116.3±19.3) kg, and BMI (40.4±5.1) kg/m2, waist circumference (109.0±10.4)cm,(106.6±8.4) cm, hip circumference, waist-hip ratio (1.03±0.09). Preoperatively diagnosed by the system checks to rule out secondaryobesity. In April2010to April 2011in intravenous anesthesia to accept LMGBP, andbefore surgery, after surgery in January, March, June,1-year patient monitoringlaboratory parameters. Each set of data are the mean±standard deviation, andapplication of SPSS17.0statistical analysis software to analyze each set of data.Result:Alleight patients were successfully completed bythesame surgical team LMG BP,operativetime (129.6±9.2) min, intraoperativebloodloss (52.3±9.7) ml, andpost operative hospital days (5.6±1.1) days, total hospitalThe number of days (8.5±1.1) days. Onepatientdeveloped subphrenicinfection be cured after antibiotic anti-infective treatment,1patient the March issue of anastomotic stricture after dilation treatment to bewithin a good recovery. I no bleeding, anastomotic leakage, gastroparesis, such as surgery-related complications,and goodrecovery. Therewereno deaths.6cases wereass ociatedwith hairloss, be oral Centrum tablets and adjustyourdiet treatmentof symptoms clearly improve.Weight at6months postoperatively (86.1±13.0) kg (P<0.05); BMI (29.7±1.9)kg/m2,(P<0.05);EWL would you accept%(55.6±6.6)%(P<0.05);waist circumference (91.6±10.5) cm (P<0.05), hip (95.8±7.0) cm(P<0.05),waist-hip rati oof0.9±0.7(P<0.05).Weight afterlyear (78.8±10.8) kg (P<0.01);BMI (27.8±1.9) kg/m2,(P<0.01); EWLwouldyouaccept%(67.9±5.6)%(P<0.01);waistcircumfere nce (82.2±12.1) cm (P<0.01),hipcircumference (88.5±6.7) cm (P<0.01), waist to hipratio of0.9±0.1(P<0.01). Patientswith hypertension, fattyliver, MS, etc. associat ed with the incidence is clearly improved.Concluson:1、A LMGBP is effective treatment for morbid obesity surgical weight loss.2、LMGBP surgical procedure is simple, intraoperative and postoperative complication rate, a clear effect of weight loss, due to technical reasons can not be carried out the LRYGBP units and individuals, can be first carried out LMGBP.3、LMGBP for the treatment of T2DM in exact with LRYGBP effect quite worthy of promotion.4、In view of LMGBP of T2DM good effect, might be considered not associated with obesity patients with T2DM.