Transcript apc-gastric vs combined procedure

GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR
CONTROL OF OBESITY
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Introduction
•The history of bariatric surgery is filled with
failed
•Primary Gastric Procedures (PGP)
•(e.g. jaw wring, horizontal gastroplasty, silicone
ring and vertical banded gastroplasty, LAP BAND,
Sleeve etc.)
Methods
Review of published studies of gastric cancer patients
treated with either
1. Primary Gastric Procedure (PGP) or
2. Combined Gastro-Intestinal Procedure (CGIP) on
weight loss and diabetes.
Results
75 Gastric Cancer Patients 1996-2009
Improvement in DM status was
7.5 times higher in CGIP than in PGP patients
(Kang "Influence of gastrectomy for stomach cancer on
type 2 diabetes mellitus..." J Korean Surg Soc 2012
Jun.)
229 Gastric Cancer Patients,
the DM remission or improvement rate was higher in
the CGIP than PGP group
(67% vs. 49%, P=0.02)
(Lee, “Comparative study of diabetes mellitus
resolution according to reconstruction type after
gastrectomy”, Obes Surg. 2012 Aug).
Results
Results Primary Gastric Procedures (PGP) vs Combined
Gastro-Intestinal Procedures (CGIP):
403 gastric cancer patients with DM.
PGP vs. CGIP
Reduction in BMI 7.6 vs. 11.4 (5)
Diabetes Improve/Resolve:
CGIP 37% vs. CGIP 52%
(Outcome after gastrectomy in gastric cancer patients
..., Kim et.al., Korea, World J Gastro 2012, Jan.)
Resolution of Diabetes
71% CGIP resolution improvement
(Zervos “Amelioration of insulin requirement in
patients undergoing duodenal bypass for reasons other
than obesity...” J Am Coll Surg. 2010 May)
RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
Conclusions
1. Bariatric surgery history is replete with failed
Primary Gastric Procedures for obesity,
2. Physiologically it is easy to see how an excess of 2,
000 calories a day can be ingested as liquid/soft
calories (Coke and Cake) thus “Beating” the
operations’ “gastric restriction” Band/Sleeve.
3. Studies in Gastric Cancer patients show that
Combined Gastro-Intestinal Procedures outperform
Primary Gastric Procedures
4. Primary Gastric Procedures can be predicted to fail
even following initial success (see Lap Band(r))
5, Operations designed to treat obesity need long
term treatment success should have a Combined
Gastro-Intestinal Component.