Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
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Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India

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Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India ...

Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
  Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions

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    Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India Presentation Transcript

    • Five Year Outcome Sleeve Gastrectomy & Mini-Gastric Bypass: From a Community Hospital in Punjab, India Dr K S Kular Kular Medical Education & Research Society Kular Group of Institutes drkskular@gmail.com www.kularhospital.com
    • Sleeve Vs MGB • Sleeve • MGB • Kular Hospital • Sleeve v MGB (Hint: MGB Better) •    Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux • Conclusions
    • Sleeve Gastrectomy • Popular • Reported Very Good Results • Primarily Gastric Procedure • Problems Weight Regain • Problems New Onset GERD • Chosen by Kular Hospital
    • Mini-Gastric Bypass • Very Safe/Very Good Results • Gastric + Bypass • Min Weight Regain • Min GERD • High Patient Satisfaction
    • Kular Hospital • Community Hospital • Rural Small City • Indian Healthcare and Bariatric Surgery • Implications for Selection of Operation • Safety and Effectiveness
    • Kular Hospital • 5 year follow up • Prospectively collected bariatric database of 104 MGB and 118 LSG • Five year follow-up was achieved in 72 MGB and 76 LSG
    • Revisions • 2 (2.7%) of MGB patients 1 for bile reflux 1 for weight regain • 16 (21%) LSG patients 13 for weight regain 3 for Gastro-Esophageal Acid Reflux ). • There was no mortality or leak
    • LSG v MGB Revisions LSG MGB Revision 21% 2.7% No Revision 79% 97.3%
    • Total Weight Loss (kg) LSG v MGB LSG MGB Year 1 27 43 Year 2 25 48 Year 5 20 46
    • Raw Weight Loss (kg) 46 43 48 20 27 25 0 10 20 30 40 50 60 0 2 4 6 Years Post Op Kg MGB SG
    • Total Weight Loss (kg) LSG v MGB LSG MGB Year 1 27 43 Year 2 25 48 Year 3 20 46 Includes 16 (21%) Revisions of Failed LSG pts
    • LSGxRevisions v MGB-AgeWt Matched (kg) LSG xRevisions MGB AgeWt Match Year 1 34 32 Year 2 32 35 Year 5 15 34
    • Weight Loss (Kg) Stratified SG & MGB 0 5 10 15 20 25 30 35 40 0 2 4 6 Years Kg SGxRevisions MGBaw
    • LSGxRevisions v MGB-AgeWt Matched (%EWL) LSG xRevisions MGB AgeWt Match Year 1 69% 63% Year 2 63% 72% Year 3 36% 69%
    • LSGxRevision v MGB-AgeWt Match (Resolution Co-Morbidities) LSG xRevisions MGB AgeWt Match Diabetes 76% 92% Hyperlipidemia 66% 88% Sleep Apnea 84% 96% GERD 35% 82%
    • Patient Satisfaction 5=Excellent, 2=Dissatisfied LSG MGB 1 month 2 5 6 months 3 5 1 year 3 5 3 years 3 5 5 years 2 4
    • 1 month 6 month 1 year 3 Years 5 Years SG MGB0 1 2 3 4 5 SG MGB Mean Patient Satisfaction 5 Extremely satisfied 4 Satisfied 3 Medium 2 Dissatisfied 1 Very Dissatisfied
    • 1 month 1 year 5 years SG MGB 0 1 2 3 4 5 Nausea Vomiting SG MGB Likelihood of Complaint of Nausea and Vomiting Score; Likelihood: 5 Extremely Likely, 4 Somewhat Likely, 3 Medium, 2 Unlikely, 1 Very Unlikely
    • How Likely to Recommend LSG/MGB to Friends & Family How Likely to Recommend LSG 2 Unlikely MGB 5 Extremely Likely Likelihood to Refer a Friend or Family Member: 5 Extremely Likely, 4 Somewhat Likely, 3 Medium, 2 Unlikely, 1 Very Unlikely.
    • Volume Food Intake @ 5 yrs Estimated Volume of Food Intake LSG 75% MGB 25% Likelihood to Refer a Friend or Family Member: 5 Extremely Likely, 4 Somewhat Likely, 3 Medium, 2 Unlikely, 1 Very Unlikely.
    • Bariatric Surgeons Fear Bile reflux From Billroth II General Surgeons Routinely Use the Billroth II
    • Gastric Cancer Surgeons Routinely Use MGB Type Billroth II Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. Lee J, Kim D, Kim W.Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea. Proximal Stomach Loop Proximal Stomach Loop
    • Non-MGB Bariatric Surgeons Fear Billroth II & Bile Reflux General Surgeons Use the Billroth II Every Day Bariatric Surgeons Have Forgotten their General Surgery Training
    • Bile Reflux Not a Problem GERD in LSG = Problem • 72 MGB Patients • Followed 5 Years • Bile Reflux • 2 patients 2.7% • Sleeve => 24% GERD • GERD => Esophageal Cancer
    • Conclusions • Kular Hospital; Rural India Requires • Extremely High Levels of Safety and Effectiveness • Sleeve and MGB chosen for reports of safety and efficacy • Report on the Results 5 years Later
    • Sleeve; Good News Bad News • LSG was as reported; Safe, simple operation with good short term weight loss (Like the Lap Band) • But (as reported) • Patient Satisfaction Low, Referral Rate Low • Inc Food Intake, New Onset GERD, Weight Regain, Revision Rate High
    • MGB; All Good News • MGB was as reported; Safe, simple operation with good short term and long term weight loss • and as reported: • Patient Satisfaction High Referral Rate High • Food Intake, New GERD, Weight Regain, Revision Rates All Low
    • Sleeve: Restrictive Procedure with Good Early Results; Poor Long Term Results (Like the Band)