ANALISI COMPARATIVA DELLA GASTRECTOMIA VERTICALE VS BENDAGGIO GASTRICO VS BYPASS GASTRICO IN PAZIENTI CON BMI<35 PIER PAOLOCUTOLO General and laparoscopic Surgery Unit – S.Giovanni Bosco Hospital, Naples Italy

Bariatric surgery has been widely performed for more than 20 years without any clinical evidence of life survival improvement in operated obese vs non-operated, even if it officially started in 1991 (NIH)

Since 1998 (Noya – Sassari) 16 clinical studies regarding BMI<35 Pts have been published. These papers show a good weight loss in these pts and a significant improvement of DM2, with a rate of mortality of 0.29% and complications of 4%.

SICOB National Registry Pts BMI < 35 (1998 – 2012)

Diabete, OSAS, Ipertensione arteriosa, RGE, Artropatia da carico

Bariatric procedures on N=59 (3.2%) obese Pts with BMI <35 Angrisani 2013

Bariatric Procedures in BMI<35 S.Giovanni Bosco experience April October LAGBLRGBPSG Age36±1035±843±10 BMI preop32±1.633±0.934±0.6 BMI/EWL6months29/3127/5224/75 BMI/EWL1yr28/3625/6423/84 BMI/EWL2yrs27/4423/8223/83 BMI/EWL3yrs26/4624/7625/72 BMI/EWL4yrs27/4224/76--- BMI/EWL5yrs26/4825/70---

Sleeve vs Banding vs Bypass in BMI< 35Pts Mean BMI Kg/m 2 Angrisani 2013

Sleeve vs Banding vs Bypass in BMI< 35Pts EWL% Angrisani 2013

SG pts showed a quicker weight loss compared to GBP pts (better %EWL at 6months and 1 year) but comparable at 2 and 3 years SG and GBP pts showed a better weight loss compared to LAGB pts (p=.001) Sleeve vs Banding vs Bypass in BMI< 35Pts

LapBand in 36 Pts with BMI< 35 BMI Angrisani /36 13/19 3 pts were debanded at 3 years One pt converted to SG after 4 yrs 16/21 8/10

RESULTS 36 Pts with BMI< 35 underwent LASGB 5M/31F; mean age: 36±10 yo; mean preoperative BMI was 32.7±1 (range ) 30-days mortality, intraoperative complications and laparoscopic conversion were absent 3 Pts were debended for gastric pouch, 1 was converted to sleeve gastrectomy

Sleeve vs Banding vs Bypass in BMI< 35Pts Percentage of pts suffering from one or more comorbidities. They all experienced improvement or remission after surgery Comorbidities: DM2, Sleep Apnea, hiatal hernia, ipertension, dislipidemia SG (11/11) GBP (8/12) LAGB (20/36) % of pts

DM2 in BMI<35 Pts S.Giovanni Bosco Experience 2Pts submitted to LRYGBP – (1M/1F) 44+/-2,8y; preop BMI 34,6+/-0.14 One suffered from DM2 since >10 years and was under insuline therapy (>80 U/day) with good glycemic control (HbA1c 6,8%) At 2 years she improved DM2 with HbA1c 6,8% with 3 gr of metformin/day and BMI 28 One male pts was on metformin since 3 years with good glycemic control (HbA1c 6,1%) and after 4 years he is in good glycaemic control (HbA1c 5,6%) in absence of therapy

DM2 in BMI<35 Pts S.Giovanni Bosco Experience 2Pts submitted to SG – (1M/1F) 45+/-5y; preop BMI 33,8+/-0.3 – Both two Pts were under metformin Therapy (one since 1,5 years and one since 8 years) with good glycaemic control (HbA1c 6.6+/-1%) – At 18 months after surgery they were 21,5+/-0,5 Kg/m2 with good glycaemic control (HbA1c 5,6+/-0.3%) in absence of therapy.

CONCLUSIONS Patients with BMI can be submitted to LAGB, SLEEVE e LRYGB as a tailored, safe and effective approach to lose weight at short term follow-up Short-term weight loss of BMI<35 SG patients is comparable to GBP patients and better than LAGB patients SG could improve bariatric comorbidities such as DM2 in low BMI pts.

Laparoscopic Adjustable Gastric Band (LAGB) Roux-en-Y Gastric Bypass (RYGB) Vertical Sleeve Gastrectomy (VSG) BMI<35 GO FOR IT!