1. The use of Tisseel® in Bariatric Surgery SICOB Cagliari, 2013 The use of Tisseel ® in Bariatric Surgery Bariatric and Metabolic Unit Desenzano del Garda Fabrizio Bellini Bariatric and Metabolic Unit Desenzano del Garda Fabrizio Bellini

2. The use of Tisseel® in Bariatric Surgery SICOB Cagliari, 2013 of fibrin glue (Tisseel ® ): AIM To asses the effectivenes and the safety - around the anastomoses in LRYGBP in the prevention of anastomotic leaks - sprayed on the abdominoplsty to prevent seromy

3. The use of Tisseel® in Bariatric Surgery “Gastro-jejunal leak” (range 0.1-4.3%) (range 0.1-4.3%) LRYGBP LRYGBP Major Complication Major Complication The efficacy of fibrin sealant in preventing leaks after LRYGBP has been reported in :   NON RANDOMIZED trials - Nguyen et al, Sapala et al (2004), ) - Liu et al (2004), Carbajo & Garcia-Caballero (2005 )  RANDOMIZED trials - Silecchia et al (2008)

4. The use of Tisseel® in Bariatric Surgery SICOB Cagliari, 2013

5. The use of Tisseel® in Bariatric Surgery SICOB Cagliari, 2013 January 2004 al December 2012 290 LRYGBP ( 177 e 113 ) “Simplified tecnique”.  Antecolic  Antegastric  Linear stapler for gastro-jejunostomy  Side to side stapled jejuno-jejunostomy  No closure of the defects

6. The use of Tisseel® in Bariatric Surgery BILIOPANCREATIC LIMB 60 cm ALIMENTARY LIMB 200 cm SIMPLIFIED LAPAROSCOPIC GASTRIC BYPASS

7. The use of Tisseel® in Bariatric Surgery 4 mini leaks “gastro-jejunal ” conservative 1 early “jejunal leak” on surgical intraoperative manipulation lesion Early Complications 5 major ( 1,72%) 290 LRYGBP

8. The use of Tisseel® in Bariatric Surgery SICOB Cagliari, 2013  41 no Tisseel®  84 with Tisseel® 125 Abdominoplasty From January 2004 to December il 2012  1 Postoperative bleeding  1Hematoma  2 long lasting seroma  30% serum production

9. The use of Tisseel® in Bariatric Surgery SICOB Cagliari, 2013

10. The use of Tisseel® in Bariatric Surgery

11. SICOB Cagliari, 2013

12. The use of Tisseel® in Bariatric Surgery SICOB Cagliari, 2013 CONCLUSIONCONCLUSION Effective in the reduction of anastomotic leak Lower % (0%) of leaks compared to international data (4,3%) No prolongation of operative time and p.o. course Reduction of seromy in abdominoplasty Fibrin glue seems:

13. Thank You.