Ricardo Funke

Laparoscopic sleeve gastrectomy in obese adolescents: results in 51 patients

BACKGROUND Adolescent obesity has become an important health problem. Bariatric surgery in this population continues to be a matter of debate. The aim of our study was to present our experience and results with laparoscopic sleeve gastrectomy (LSG) in obese adolescents at the digestive surgery department of the Hospital Clínico Pontificia Universidad Católica de Chile. METHODS Obese adolescent patients <19 years old underwent LSG from January 2006 to October 2009. The percentage of excess weight loss and quality of life were analyzed. RESULTS A total of 51 patients aged <19 years underwent LSG. Of these, 80.4% were girls and aged 15-19 years (mean age 18 ± 1.45). The mean preoperative weight and body mass index was 98 ± 13.3 kg and 38.5 ± 3.7 kg/m(2), respectively. Of these patients, 76% had preoperative co-morbidities, including insulin resistance in 59.2%, dyslipidemia in 23.5%, hepatic steatosis in 16%, and type 2 diabetes mellitus in 3.9%. The operative time was 69 ± 24 minutes, with a 2.8 ± 20.6-day postoperative hospital stay. No conversion to open surgery was necessary. One patient had a suture line leak that required both endoscopic and laparoscopic treatment. The percentage of excess weight loss at 6 months and 1 and 2 years was 94.6%, 96.2%, and 92.9%, respectively. Of the 76% of patients with preoperative co-morbidities, all resolved or improved their condition. In the quality of life survey (Moorehead-Ardelt Quality of Life Questionnaire) conducted, all reported very good or good quality of life after surgery (40% and 60%, respectively). CONCLUSION In our experience, LSG as a treatment of obese adolescent patients is safe, with good short-term weight loss and resolution of co-morbidities.

Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure

BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been established as a reliable bariatric procedure, but questions have emerged regarding its long-term results. Our aim is to report the long-term outcomes of LSG as a primary bariatric procedure. METHODS Retrospective analysis of patients submitted to LSG between 2005 and 2007 in our institution. Long-term outcomes at 5 years were analyzed in terms of body mass index (BMI), excess weight loss (EWL) and co-morbidities resolution. Surgical success was defined as %EWL>50%. Also, we compared long-term results according to preoperative BMI, using Mann-Whitney test. RESULTS A total of 161 LSG were analyzed, and 114 patients (70.8%) were women. The median age was 36 years old (range 16-65), median preoperative BMI was 34.9 kg/m(2) (interquartile range [IQR], 33.3-37.5). A total of 112 patients (70%) completed 5 years of follow-up. At the fifth year, median BMI and %EWL was 28.5 kg/m(2) (IQR: 25.8-31.9) and 62.9% (IQR: 45.3-89.6), respectively, with a surgical success of 73.2% of followed patients. According to preoperative BMI, surgical success was achieved in 80% of patients with BMI<35 kg/m(2), 75% of BMI 35-40 kg/m(2), and 52.6% of BMI>40 kg/m(2), with significant lower %EWL in patients with BMI>40 kg/m(2) (P = .001 and .004). Dyslipidemia and insulin resistance resolution was 80.7% and 84.7%, respectively. A total of 26.7% of patients reported new-onset gastroesophageal reflux symptoms at 5 years. CONCLUSION LSG as a primary procedure is a reliable surgery. We observed positive long-term outcomes of %EWL and co-morbidities resolution. In our series, best results are seen in patients with preoperative BMI<40 kg/m(2).

Bariatric surgery in 1119 patients with preoperative body mass index<35 (kg/m2): results at 1 year

BACKGROUND The use of body mass index (BMI) as the only criterion to indicate bariatric surgery is currently under discussion. There is growing evidence that supports bariatric surgery in carefully selected patients with lower BMI. OBJECTIVES To report our experience in bariatric surgery in>1000 patients with BMI<35 kg/m(2) and their results at 1 year. SETTING University hospital (censored). METHODS A retrospective analysis was performed in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG) with preoperative BMI<35 kg/m(2) from January 2008 to December 2011. Demographic and anthropometric data, preoperative co-morbidities, and perioperative variables were retrieved. Weight loss and co-morbidities progression were analyzed 1 year after surgery and compared among procedures. A P value<.05 was considered significant. RESULTS We identified 1119 patients: mean age 38.8±11.4, 951 (85%) women, preoperative weight 87.5±9.3 kg and BMI 33.1 (31.9-34.1) kg/m(2). Preoperatively, 11.7% had type 2 diabetes mellitus, 25.9% arterial hypertension, 55.6% insulin resistance, and 53.2% dyslipidemia. In total, 283 patients (25.2%) underwent LRYGB and 836 (74.8%) SG. One year after surgery (follow-up: 66.67%) patients reached 24.5 (22.8-26.4) BMI and the percentage of excess of weight loss (%EWL) was 107.9±36.6%. Diabetes, hypertension, insulin resistance, and dyslipidemia remission/improvement rates were 54/39%, 58/29%, 72/17%, and 54/30%, respectively. CONCLUSIONS Bariatric surgery in selected class I obesity patients can safely be performed. We have observed good results in terms of weight loss and co-morbidity improvement/remission. Long-term follow-up is required.

Experiencia de 18 años de cirugía de obesidad en la Pontificia Universidad Católica de Chile

Bariatric surgery is the gold-standard treatment for morbid obesity because it has low morbidity rates in high-volume centers and generates long term sustained weight loss. Aim: To describe our experience in bariatric surgery since the creation of our bariatric program in 1992. Material and Methods: Retrospective analysis of all patients subjected to bariatric surgery from 1992 to December 2010. Data was obtained from the electronic institutional registry. The Procedures performed were open and laparoscopic Roux-en-Ygastric bypass (BPGA and BPGL, respectively), laparoscopic adjustable gastric band (BGAL) and laparoscopic sleeve gastrectomy (GML). Results: A total of 4943 procedures were performed, 768 (16%) BPGA, 2558 (52%) BPGL, 199 (4%) BGAL and 1418 (29%) GML. The number of procedures progressively increased, from 100 cases in 2000 to over 700 cases in 2008. Proportion of femoles and preoperative mean body mass Index fluctuated between 69 and 79% and 35 and 43 kg/m2, respectively, among the different procedures. Early and late complications fluctuated between Oto 1% (higher on BPGA) and 3 to 32.7% (higher on BGAL), respectively. The excess weight lost at five years was 76.1 % in BPGA, 92.5%o in BPGL and 53.7% in BGAL. The figure for GML at three years was 73.7%. Conclusions: The complication rates of this series of patients are similar to those reported in large series abroad. BPGL is still the most effective procedure; however GML is an attractive alternative for less obese patients

Acute and Subacute Leaks

Treatment for obesity has several options. Surgical techniques have shown to be the most effective. Of these techniques, the laparoscopic Roux-en-Y gastric bypass (LRYGB) and the laparoscopic sleeve gastrectomy (SG) are the two most performed.

Bariatric and Metabolic Surgery in Latin America

Obesity could be defined as an excess of body fat, accompanied by an increase of the relation between weight and height. Operationally, obesity can be considered as the condition in which body mass index (BMI) is greater than 30.1 kg/m2.

National Trend in Laparoscopic Gastrectomy for Gastric Cancer: Analysis of the National Register in Chile

Introduction: The laparoscopic approach for the treatment of gastric cancer has many advantages. However, outside Asia there are few large case series. Aim: To evaluate postoperative morbidity, long-term survival, changes in indication, and the results of laparoscopic gastrectomy. Methods: We included all patients treated with a laparoscopic gastrectomy from 2005 to 2014. We compared results across 2 time periods: 2005–2011 and 2012–2014. Median follow-up was 39 months. Results: Two hundred and eleven patients underwent a laparoscopic gastrectomy (median age 64 years, 55% male patients). In 135 (64%) patients, a total gastrectomy was performed. Postoperative morbidity occurred in 29%. A significant increase in the indication of laparoscopic surgery for stages II–III (32 vs. 45%; p = 0.04) and higher lymph node count (27 vs. 33; p = 0.002) were observed between the 2 periods. The 5-year overall survival was 72%. According to the stage, the 5-year overall survival was 85, 63, and 54% for stage I, II, and III respectively (p < 0.001). Conclusions: There was an acceptable rate of postoperative complications and the long-term survival was in accordance with the disease stage. There was a higher indication of laparoscopic surgery in stages II–III disease, and higher lymph node count in the latter period of this study.

A novel potential biomarker to monitor treatment response in gastric cancer.

55 Background: Gastric cancer (GC) is the second leading cause of death from cancer worldwide. No clinical useful biomarkers that detect early gastric cancer and have prognostic/predictive value are available. DNA methylation of promoter region of Reprimo (RPRM), a p53-dependent G2 arrest mediator candidate gene, has been postulated as a potential biomarker for early diagnosis of GC (Clin Cancer Res. 2008;14:6264-9). Since RPRM has been found methylated in more than >90% of GC cases, we evaluate RPRM as a biomarker for monitoring response to treatment. METHODS We enrolled 28 patients with GC. Staging classification was carried out by AJCC system and evaluation of clinical response by RECIST criteria. DNA was obtained from plasma/serum by Proteinase K/quiagen and bisulfite converted by EZ DNA Methlyation Direct Kit (Zymo Research). Absolute quantification of DNA Methylation in serum/plasma of RPRM was performed by MethyLight technology. The IRB of PUC approved this study. All patients gave informed consent. RESULTS Among 28 patients with histological diagnoses of GC, average age was 64 y.o.(38-81 y.o.), male/female ratio 1.3/1, number of cases stage I 2, stage II 4, stage III 8, stage IV 13 and In situ or with preneoplastic lesions 3 patients. 13 patients underwent total gastrectomy and 19 cases received standard chemotherapy (CHM), 6 of them on a neoadjuvancy basis. At initial diagnoses, RPRM was detected in 67,8% (19/28) of patients (X 1049,7 copies per mL[49-11991]). 79% of patients had an objective response with one patient developing a complete response. In cases with clinical response, and at least two detections of RPRM, agreement was 81% with RPRM levels. At the end of study, one third of the patients finally died of gastric cancer. Interestingly, the average initial level of RPRM was higher on those with a fatal outcome (1822 vs 483 copies per mL). The two highest levels were seen on patients who developed a rapid progressive disease and died within months of diagnosis. CONCLUSIONS RPRM could be a potential biomarker to monitor treatment-response in GC. Levels of RPRM may anticipate clinical progression. All these findings should be evaluated in a large, prospective clinical trial.

Evaluation of reprimo, a p53-dependent G2 arrest mediator candidate, for monitoring response to treatment in gastric carcinoma.

e14503 Background: Gastric cancer (GC) is the second leading cause of cancer death worldwide. No clinically usefull biomarkers that detect early gastric cancer and have prognostic/predictive value are available. DNA methylation of promoter region of Reprimo (RPRM), a p53-dependent G2 arrest mediator candidate gene, has been postulated as a potential biomarker for early diagnosis of GC (Clin Cancer Res. 2008;14:6264-9). Since RPRM has been found methylated in more than >90% of GC cases, we evaluate RPRM for monitoring response to treatment. METHODS We enroll 14 patients with GC. Staging classification was carried out by AJCC system and evaluation of clinical response by RESIST criteria. DNA was obtained from plasma/serum by Proteinase K/quiagen and bisulfite converted by EZ DNA Methlyation Direct Kit (Zymo Research). Absolute quantification of DNA Methylation in serum/plasma of RPRM was performed by MethyLight technology. The IRB of PUC approved this study. All patients gave informed consent. RESULTS Among 14 patients with histological diagnoses of GC, average age was 64 y.o.(38-81 y.o.), male/female ratio 2.3/1, low/high-risk counties 1.6/1, stage III (3 cases), stage IV (10 cases) and 1 undefinded. Three patients underwent total gastrectomy and 11 cases received standard chemotherapy (CHM), 2 with neoadjuvant CHM. At initial diagnoses, RPRM was detected in 78% (11/14) of plasma/serum (967/471 copies per mL), respectively. All 3 negative RPRM cases suggest familial criteria of hereditary GC. In cases with clinical response, and at least three detections of RPRM, agreement was 100%. At 3 months of treatment, levels of RPRM were 226/0 copies per mL, plasma/serum, respectively. Currently, progression of disease has been found in 1 case. In this case, RPRM anticipate in 2 months this clinical progression. CONCLUSIONS RPRM could be a potential biomarker for monitoring response to treatment in GC. Both, plasma or serum could be used for this detection. Levels of RPRM anticipate clinical progression. RPRM might not be usefull for monitoring hereditary GC. All these findings should be evaluated in a large, prospective clinical trial.