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

1,935 views
1,580 views

Published on

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

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,935
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
17
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

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

  1. 1. 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
  2. 2. 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
  3. 3. Sleeve Gastrectomy • Popular • Reported Very Good Results • Primarily Gastric Procedure • Problems Weight Regain • Problems New Onset GERD • Chosen by Kular Hospital
  4. 4. Mini-Gastric Bypass • Very Safe/Very Good Results • Gastric + Bypass • Min Weight Regain • Min GERD • High Patient Satisfaction
  5. 5. Kular Hospital • Community Hospital • Rural Small City • Indian Healthcare and Bariatric Surgery • Implications for Selection of Operation • Safety and Effectiveness
  6. 6. 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
  7. 7. 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
  8. 8. LSG v MGB Revisions LSG MGB Revision 21% 2.7% No Revision 79% 97.3%
  9. 9. Total Weight Loss (kg) LSG v MGB LSG MGB Year 1 27 43 Year 2 25 48 Year 5 20 46
  10. 10. 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
  11. 11. 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
  12. 12. LSGxRevisions v MGB-AgeWt Matched (kg) LSG xRevisions MGB AgeWt Match Year 1 34 32 Year 2 32 35 Year 5 15 34
  13. 13. Weight Loss (Kg) Stratified SG & MGB 0 5 10 15 20 25 30 35 40 0 2 4 6 Years Kg SGxRevisions MGBaw
  14. 14. LSGxRevisions v MGB-AgeWt Matched (%EWL) LSG xRevisions MGB AgeWt Match Year 1 69% 63% Year 2 63% 72% Year 3 36% 69%
  15. 15. 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%
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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.
  20. 20. 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.
  21. 21. Bariatric Surgeons Fear Bile reflux From Billroth II General Surgeons Routinely Use the Billroth II
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. Sleeve: Restrictive Procedure with Good Early Results; Poor Long Term Results (Like the Band)

×