Scientific Abstracts. 2014.National Symposium of Bariatric and Metabolic Surgery

8/19/2019 Scientific Abstracts. 2014.National Symposium of Bariatric and Metabolic Surgery

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Oral Presentations


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The Sixth National Symposium of Bariatric and Metabolic Surgery • December 6th

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%arcinomul hepatocelular de&'oltat pe ficatul gras nonalcoolic( )'aluarea riscului la pacien*ii cu obe&itate +i

sindrom metabolicHepatocellular Carcinoma in Nonalcoholic Liver Disease. Risk Assessment in Patients with Morbid Obesit

and Metabolic !ndrome

Roxana Maria Livadariu, V. Drug, Anca Trifan, Lidia Ionescu, R. Dănilă, D. TimofteUniversitatea de Medicină i !armacie "#r. T. $o%a&, '%italul "'f. '%iridon&, Iai, Rom(nia

)arcinomul *e%atocelular devine din ce +n ce mai mult asociat cu oe-itatea, sindromul metaolic i ficatul grasnonalcoolic./iectivul studiului este de a sulinia %rinci%alii factori incrimina0i +n a%ari0ia *e%atocarcinomului la %acien0ii cu oe-itatei sindrom metaolic.Materiale i metode1 Am anali-at sistematic datele din literatură legate de rela0ia +ntre *e%atocarcinom, modificărilemetaolice i sindromul de inflama0ie cronică ce caracteri-ea-ă %acientul cu oe-itate. De asemenea, am studiat

retros%ectiv dosarele medicale a 3 %acien0i diagnostica0i cu *e%atocarcinom +n serviciul nostru +ntre 2445 i 2467ulterior, am anali-at ra%oartele anatomo8%atologice ale %acien0ilor ce au eneficiat de c*irurgia oe-ită0ii +n clinicanoastră, la care s8a %racticat io%sie *e%atică intrao%erator.Re-ultate1 59,62: dintre %acien0ii cu *e%atocarcinom de-voltat %e ciro-ă *e%atică %re-entau măcar unul din factorii derisc clasici %entru carcinom *e%atocelular. 'teato-ă *e%atică a fost descrisă la 3,69: din aceti %acien0i. To0i %acien0ii cu*e%atocarcinom i ciro-ă *e%atică clasificată dre%t cri%togenică %re-entau le-iuni im%ortante de steato-ă *e%atică.$acien0ii la care carcinomul *e%atic s8a de-voltat +n asen0a ciro-ei ;,


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surgical procedure for e1tremely obese children! "here are several methods of bariatric surgery for adults, but resection of

the stomach (3gastric sleeve3 resection) is the first choice for pediatric population all over the world!

"he result is weight loss, improved control of diabetes mellitus, reduction of cardiac ris+ factors and conse4uently theoverall mortality! "he most fre4uently cited criteria for surgery are unsuccessful conservative si10month treatment, the

value of the body mass inde1 over /-+g5m', and also associated pathologic conditions such as diabetes, hypertension,

3sleep apnea3 etc!

6n conclusion, laparoscopic gastric sleeve resection is a safe and appropriate method for obese children population! Also, it

is necessary to highlight the importance of collaboration with centeres of e1cellence for application of bariatric surgery!

, ani de chirurgie bariatric- la Spitalul .Sf( %onstantin/ Bra+o'

"hree )ears o& 'ariatric !ur(er in *!t. Constantin* Hospital 'ra+ov

. Moldovan, D. $ocreata, LuminiNa )+m%eanu, Andreea Moldovan'%italul "'f. )onstantinO, raov, Rom(nia

'co%1 Lucrarea +i %ro%une %re-entarea ex%erienNei noastre de %este > ani +n c*irurgia ariatrică.Materiale i metode1 $rogramul ariatric al '%italului "'f. )onstantin& din raov a +nce%ut +n anul 2466. $(nă la46.64.246 au fost efectuate un număr de 6 du%ă gastro%lastie verticală desc*isă, 6 du%ă alaNie de inel %e cale clasică i un ca- de eventraNiegigantă cu %ierderea dre%tului la domiciliu, ca %rim tim% +nainte de cura eventraNiei. MenNionăm i un ca- de gastric sleevela%arosco%ic du%ă Diversie ilio8$ancreatică 'co%inaro. $e l(ngă o%eraNiile amintite s8au efectuat i 2 intervenNii dealaNie %e cale la%arosco%ică de inel gastric ca %rim tim% al redo surger. MI8ul mediu %reo%erator este de 9, cu limite +ntre >> i ?>,?7 9 ca-uri de%ăind graniNa a 244 Bg. Reali-ăm un sleeve lung, +n formă de PQ, de la 28> cm de %ilor i +ngust, calirat %e uKie de >4 !r la MI %este 4 i > !r la MI su 4. 'tandardul actual %entru re-ecNia stomacului estere%re-entat de cartuele $ur%le aco%erite cu $eristri% sau Tac*osil a%licate alternativ %e o faNă, fără sutură de +nfundare.

$entru te*nica L@'' folosim de rutină uad%ort %lus de la /lm%us.Re-ultate1 '8a +nregistrat o singură fistulă la nivelul liniei de agrafare, re-olvată %rin drenaK la%arosco%ic i tratamentconservator. Sn rest s8au +nregistrat com%licaNii %osto%eratorii clasele )lavien8Dindo I i II, ne+nregistr(ndu8se decese. Dintotalul de ?4 ca-uri cu diaet ti% II %reo%erator 35 sunt sevrate +n %re-ent de tera%ia cu Anti Diaetice /rale sau Insulină.'căderea %onderală medie este de >6 Bg, iar durata medie de s%itali-are 2,> -ile.

7aterials and 7ethods8 9:t! Constantin; Hospitals


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0astric Banding 1 %omplica*ii re&ultate eficien*-

,astric 'andin( - Complications Results $&&icienc

'. /lariuUniversitatea de Medicină i !armacie "Victor ae&, Timioara, Rom(nia

/iectiv1 'tudiul eficacităNii gastric anding8ului %rin %risma ex%erienNei %ersonale i a datelor din literatură.Material i metodă1 Am anali-at re-ultatele unei serii %ersonale de 6?4 gastric anding8uri i le8am com%arat cu datele dinliteratură. $acienNii au fost oe-i i su%eroe-i ;MI mediu de ?,9=. Am utili-at te*nica %ars flacida cu aordla%arosco%ic.Re-ultate, DiscuNii1 Rata conversiilor a fost de 9,>:, durata medie a intervenNiei de ?4 minute, accidente i incidenteintrao%eratorii 6,>:, com%licaNii %osto%eratorii 5,>:, eecul metodei 2,3:. )u c(t indicele de masă cor%oreală a fost maimare, cu at(t i re-ultatul %osto%erator a fost mai un.)onclu-ii1 6. #astric anding8ul răm(ne o o%eraNie eficientă +n cura oe-ităNii moride.2. Dei alte ti%uri de intervenNii au eficacitate mai mare, datorită ratei mici a com%licaNiilor o%eraNia +i %ăstrea-ă

actualitatea.>. @x%erienNa ec*i%ei c*irurgicale i codificarea te*nicii o%eratorii crete eficienNa metodei i scade rata com%licaNiilor.. Anali-a seriei %re-entate, ra%ortată la datele din literatură ne face să susNinem această intervenNie c*irurgicală.)uvinte c*eie1 oe-itate moridă, gastric anding, studiu clinic.

bective8 "he study of gastric banding effectiveness in the surgical treatment of the morbid obesity by personal

e1perience and literature data!

7atherials and 7ethods8 #e have analy$ed the results of a personal series of @ gastric bandings and we compared

them with the data reported in literature! 2atients were obese and superobese (average body mass inde1 %@,-)! 2ars

flacida techni4ue was used by laparoscopic approach!

Eesults, iscussions8 "he conversion rate was -!/., average duration of surgery was @ minutes, intraoperative accidents

and incidents ,/., postoperative complications ,/., method failures ',&.! "he weightloss was more obvious in the most

obese patients! Compared to literature data we believe the results are satisfactory!Conclusions8

! Gastric banding remains an effective therapeutic procedure in the surgical treatment of morbid obesity!

'! Although other processes are listed with superior results, the low complication rate and intra and postoperative ris+

maintain gastric banding still up to date!

/! "he team


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2urpose8 "he paper presents our e1perience in corrective surgery after bariatric procedures!

7aterial and 7ethods8 =etween April '' and ctober '%, a total of patients with a history of bariatric surgery in

other centers were reoperated in our surgical department8 ' laparoscopic ablations of gastric band (only the ablationtime), ' sleeves & months after the band ablation( by laparoscopy, one open after open band ablation), sleeve after

bilio0pancreatic diversion :copinaro failure and - combined operations8 band ablation plus sleeve (' open after open and

I=G and / laparoscopic procedures)! 7edian preoperative =76 was %',@ with a ma1imum of -/!& (a case of combined

band ablation and gastric sleeve)!

Eesults8 =oth surgical and bariatric results were very good, fistula, /0% Clavien complications, one case of gastric tube

edema, treated by parenteral nutrition and conservative support till the passage recovery! "he actual mean =76 after a

folllow0up between ' and / months is /,&! All the / cases of type 66 diabetes are in remission!

Conclusion8 Gastric sleeve is an effective method of redo surgery after gastric band, I=G and after :copinaro procedure!

epending on the condition of the stomach, it is often possible to perform both procedures at the same surgical time!

"he 1mportance o& ,astric 'arium "est in 'ariatric !ur(er

R. !. #alea, !lorinela )ăNoi #alea, @. $o%, A. Mironiuc, . )*iorescu, !. Mi*ăileanu, /. #rad, D. V. MircioiuUniversitatea de Medicină i !armacie "Iuliu JaNieganu&, )luK8Ga%oca, Rom(nia

uring @0'/, along @ years, /& surgical procedures have been performed in the =ariatric :urgery Center form the

:econd :urgical Clinic of Clu0Napoca consisiting of silastic ring vertical gastroplasty (GI:), &' cosmetic

interventions and ?? corrections! #e had e1cellent results in !-. cases, %@ patients had an e1cessive weight loss and in

% cases weight gain was noticed!

Gastric barium test was able to indicate the positive evolution of the patients, but also, when the case, the presence of

stoma stenosis, the rupture of the suture, or the enlargement of the gastric stoma!

=etween '/ and '% we performed %& surgical interventions of sleeve gastrectomy and % of gastric by0pass, as first

operation or as conversion from GI:! "he gastric barium test has given us the tips for the surgical indication as well as for

the postsurgical follow0up in order to improve the surgical techni4ue!

6n conclusion, we consider that, at the moment, sleeve gastrectomy is the best bariatric surgery procedure!

Misfire n chirurgia bariatric- laparoscopic-( )roare de pilota7 sau defec8iune tehnic-9 cine este de

n'ino'-8it:

Mis&ire in Laparoscopic !tapled 'ariatric !ur(er. Pilot $rror or "echnical #ailure2 3ho4s to 'lame &or 1t5

). oru ;6=, D. I. Ulmeanu ;2=, V. )onstantinica ;6=, G. )o%ca ;6=, Adina Marinciu ;>=, R. $oenaru ;6=;6= '%ital )linic "'fanta Maria&, ucureti, Rom(nia;2= '%ital "Regina Maria& ăneasa, ucureti, Rom(nia;>= '%ital "Mon-a&, ucureti, Rom(nia

!olosirea suturii mecanice la%arosco%ice a crescut dramatic +n ultimii 24 de ani. !olosirea sta%lerelor +n c*irurgia ariatricăla%arosco%ică este oligatorie %entru a reali-a intervenNii minim8inva-ive, com%lexe i de rutină care includ ligaturi,

secNionări, re-ecNii, anastomo-e i +nc*iderea a%onevro-ei. !uncNionarea defectuoasă este definită ca falimentuldis%o-itivului +n reali-area %erformanNelor ate%tate. $rolemele care %ot a%ărea +n tim%ul sta%larii %ot fi determinate dea%licator, de cartu, de re+ncărcare sau de %ersonalul din sala o%eratorie. IncidenNa acestor evenimente este foarte mică,estimată la a%rox 4,44>:, dar im%licaNiile asu%ra decursului %osto%erator %ot varia de la nesemnificative %(nă la efectecatastrofice. @roarea utili-atorului %oate fi atriuită ex%erienNei %ersonale sau a%recierii defectuoase a mărimii, lungimiista%ler8ului sau grosimii Nesutului. !alimentul instrumentului +n formarea unei linii com%lete i se%arate de suturămecanică sau funcNionarea defectuoasă s%ecifică ;funcNionare %arNială sau im%osiilitatea de a desc*ide sta%ler8ul du%ătragere= sunt cele mai comune as%ecte. Ra%ortarea acestor evenimente este oligatorie %entru a %utea oNine +munătăNirea at(t a ex%erienNei o%eratorului, dar i a funcNionării dis%o-itivului.

>se of laparoscopic mechanical suture increased dramatically in the last ' years! >se of staplers in laparoscopic bariatric

surgery is mandatory in order to perform minimally0invasive, comple1 and routine procedures that include ligation,

division, resection, anastomosis and fascial closure! 7alfunction is defined as failure of the device to meet its performancee1pectations! 2roblems that one can encounter during stapling are related to stapler, cartridge, reload or operating room

personnel! "he incidence of these events is very low, estimated to !/. but the implications on postoperative evolution


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vary from little or no conse4uences to catastrophic events! >ser error can be attributable to personal e1perience or

misudge of staple si$e, length, tissue thic+ness! evice failure to form properly and suture line separation or device

specific malfunctions (staples partially firing or staples misfire and not releasing) are most common aspects! Eeport ofsuch events is mandatory in order to improve both user e1perience and device function as well!

;ncidente = Universitatea de Medicină i !armacie "#r. T. $o%a&, Iai, Rom(nia

;= '%italul )onsultmed, Iai, Rom(nia

/iectiv1 Recunoaterea imediată a incidentelor intrao%eratorii i a com%licaNiilor %osto%eratorii %entru a fi tratate c(tmai ra%id.Materiale i metode1 Sn %erioada iunie 2462 8 decemrie 246, ?4 de %acienNi au eneficiat de intervenNii c*irurgicaleariatrice la%arosco%ice1 > %licaturi ;L#$=, > extrageri de inel gastric, 3 re-ecNii gastrice longitudinale ;L'#=. La a ?8aintervenNie L'#, la a%licarea cartuului >, Kumătate din transă nu a fost sta%lată ;inter%unere dulă de mucoasă=,necesit(nd resta%lare7 %acientul 6, +n -iua 2 %re-intă *emo%eritoneu 8 reintervenNie la%arosco%ică1 *emosta-ă %e transăgastrică, lavaK, drenaK multi%lu. Un alt %acient %re-intă -iua 6 %osto%erator drenaK *ematic 8 tratament conservator. A 358a%acientă o%erată ;a%nee +n somn, JTA, L@', IR) grd I= %re-intă scaderea *emogramei +n %rima -i %osto%erator ;J ?,9gWL =fără exteriori-are de s(nge %e tuul de dren. Reec*ilirare volemică +n secNia ATI, evoluNie oscilantă cu s(ngerareintermitentă7 se decide reintervenNie la 2 ore1 *emosta-ă +n ligamentul gastrocolic, evacuare, drenaK multi%lu. @voluNie

favorailă, externare +n -iua ?7 revine +n oc *i%ovolemic du%ă -ile, reintervenNie la%arosco%ică1 evacure lic*id *ematicvec*i lavaK, drenaK multi%lu. @voluNia este lent favorailă.Re-ultate1 Sn lotul examinat de ?4 %acienNi au fost %re-ente > com%licaNii *emoragice din care 2 au im%us rentervenNiila%arosco%ice.)onclu-ii1 $acienNii oe-i %re-intă de regulă %atologie asociată, o %arte consecinNă directă a oe-ităNii, care8i %redis%une laa%ariNia com%licaNiilor. $osto%erator, necesarul do-elor mari de *e%arină fracNionată favori-ea-ă a%ariNia com%licaNiilor*emoragice c*iar i la nivelul vaselor de mici dimensiuni care eventual %rin caracterul lor intermitent creea-ă dificultăNi +nluarea deci-iilor de reintervenNie.

bectives8 arly recognition and immediate treatment of the intraoperative incidents and postoperative complications!

7aterials and 7ethods8 :tarting from Bune '' until ecember '%, @ patients beneficiated for laparoscopic bariatric

operations8 / laparoscopic gastric placation (LG2), / gastric band removal and &% laparoscopic gastric sleeve (LG:)! At the

@ th

L:G, during the /rd

cartridge application half of it was misstappled because of double interposition of mucosa* the %th patient presented hemoperitoneum at %? hours 0 relaparoscopy, hemostasis, evacuation, lavage, drainage* another

hemoperitoneum at the 'th patient was treated conservatively* the &th

patient with L:G, at '% hrs has a lower Hb

(@,-g5L) 0 volemic repletion, relatively stable for '% hrs, intermittent bleeding 0 relaparoscopy, hemostasis, evacuation,

lavage, drainage* discharge in the @ th

p!o! day, readmitted in the th

p!o! day with hipovolemic shoc+8 relaparoscopy, old

blood evacuation, lavage, drainage with slow recovery but favorable!

Eesults8 From @ patients, / had hemorrhagic complications of which ' necessitated laparoscopic reintervention and one

misstappled incident!

Conclusions8 bese patients usually have got comorbidities direct related to obesity! "he need of obtaining an

anticoagulant status with high dose of fractionated heparins to avoid thromboembolic complications predispose to

hemorrhagic events even in small vessels, which due to intermittent bleeding can create difficulties in decision ma+ing!


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Plicatura gastric= laparoscopic= 1 )xperin8a Spitalului >ude8ean de ?rgen8= Baia Mare

Laparoscopic ,astric Plication - $%perience o& $mer(enc Count Hospital o& 'aia Mare

Mi*aela Lee ;6=, ). Mare ;2=, Monica Vardai ;>=, A. '-as- ;6=, $. Radu ;6=, Ioana Lee ;>=, Lavinia Murean ;6=, Adriana'toicovici ;6=;6= '%italul udeNean de UrgenNă, aia Mare, Rom(nia;2= MedJel%, aia Mare, Rom(nia;>= !ortis Diagnosis )enter, aia Mare, Rom(nia

Introducere1 /e-itatea, cea mai frecventX oalX metaolicX, are re%ercusiuni grave asu%ra duratei i calitXNii vieNii dincau-a olilor cu care se asocia-X, dar i din cau-a as%ectelor estetice i sociale %e care le im%licX. Tratamentul c*irurgical,singurul ca%ail sX %roducX efecte sigure i duraile, eneficia-X de multi%le o%Niuni. $licatura gastricX la%arosco%icX,datoritX multi%lelor sale avantaKe, este %referatX de tot mai mulNi %acienNi i %rofesioniti din sistemul de sXnXtate. 'co%ulstudiului nostru este de a evalua re-ultatele oNinute +n '%italul udeNean de UrgenNX din aia Mare cu aceastX te*nicXc*irurgicalX, com%licaNiile %osto%eratorii i costurile asociate.

Materiale i metode1 Sn cursul anului 246, %licatura gastricX la%arosco%icX a fost efectuatX la 62 %acienNi oe-i, cu indicede masX cor%oralX +ntre >9,? i 95,< i v(rsta +ntre 29 i 34 de ani.Re-ultate1 Gu s8a +nregistrat nicio com%licaNie %osto%eratorie, iar %ierderea medie +n greutate a fost de 6,? Bg +n %rimalunX de la o%eraNie.)onclu-ii1 $licatura gastricX la%arosco%icX este urmatX de re-ultate une, are cost redus i cele mai mici rate decom%licaNii i mortalitate %osto%eratorie din c*irurgia ariatricX, fiind o o%eraNie fe-ailX %entru maKoritatea s%italelor dinRom(nia.

=ac+ground8 besity, the most common metabolic illness, has serious repercussions on life span and life 4uality because of

the associated diseases, but also due to its involvement in the aesthetic and social aspects! =eing the only one able to

produce reliable and long0lasting effects, the surgical treatment has multiple options! "he laparoscopic gastric plication is

preferred by more and more patients and professionals of the health system due to its many advantages! "he aim of our

study is to assess the results obtained in the mergency County Hospital of =aia 7are with this surgical techni4ue, the postoperative complications and the associated costs!

7aterials and 7ethods8 6n '%, the laparoscopic gastric plication was performed on ' obese patients with body mass

inde1 between /-,@ and -,? and age between '- and & years!

Eesults8 "here was no postoperative complication, and the average weight loss was %!@ +g in the first month after the

operation!

Conclusions8 "he Laparoscopic gastric plication is followed by good results, has reduced costs and the lowest rates of

complications and postoperative mortality in bariatric surgery, being a feasible operation for most hospitals in Eomania!

Sc-dere ponderal- semnificati'- f-r- caren8- de 'itamina D


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9>5.Y>>< %molWl ;toNi %acienNii au avut indicaNie de su%limentare cu vitaminele D i 62=. )onclu-ii1 $acienNii urmăriNi auavut o scădere +n greutate adecvată, iar 62 luni %ost8o%erator valorile vitaminei D i 62 au fost mai mari dec(t

%reo%erator.

bective8 Anthropometric and nutritional assessment (vitamin and =') before and after gastric sleeve!

7atherials and 7ethods8 bese patients, with indication for metabolic surgery, undergo a comple1 preoperative

assessment, and are followed after surgery at , /, &, and ' months clinically and nutritionally! 2resently, we evaluated

weight (#), body mass inde1 (=76), vitamin and =' before and after surgery!

Eesults8 #e analysed /' patients ('/ women), average age %!J' years! 2reoperative, #K''J%!@ +g, and after surgery,

# decreased statistically significant, to ?!@J'!' +g at month (p!), @!?J'!% at / months (p!), /!&J@!

+g at & months (p!) and to -J%! +g at ' months (pK!/)! =76 preoperative was %/J&!& +g5m', whereas post0

operative decreased statistically significant8 /?!%J@!& +g5m' at month (p!), /%!-J?!' +g5m' at / months (p!),

/-!/J?!- +g5m' at & months (p!) and /'!&J@!% +g5m' at ' months (pK!&)! Iitamin preoperative was @!?J!'

ng5dl, at & months post0operative increased to ''!J/!' ng5dl, and to '&!J-! ng5dl at ' months after surgery! Iitamin

= ' preoperative was /J pmol5l, at & months post0operative8 'J@ pmol5l, and at ' montths post0operative was-/!%J//? pmol5l (all patients were recommended to ta+e suppliments with vitamin and =')!

Conclusions8 "he patients we followed had an ade4uate weight loss and improved the level af vitamin and vitamin ='

at ' months after surgery!

'ile Acids "pe < Diabetes and Obesit - 1s Metabolic !ur(er the =e5

!lorinela )ăNoi #alea ;6=, R. !. #alea ;6=, A. Mironiuc ;6=, ). )o%ăescu ;2=;6= Universitatea de Medicină i !armacie "Iuliu JaNieganu&, )luK8Ga%oca, Rom(nia;2= '%italul "$onderas&, ucureti, Rom(nia

=ile acids are recogni$ed as +ey regulators of systemic metabolism modulating glucose homeostasis! 6n humans, the levels

of bile acids correlate with insulin sensitivity! "heir metabolism is altered in type ' diabetes and the levels seem to be

increased after metabolic surgery leading to improved insulin sensitivity and restoration of glycaemic control! :urgical procedures that involve rerouting of the food induce an increase of bile acids, but new data have showed that substantial

changes in circulating total bile acids are +nown to occur after sleeve gastrectomy as well! 6t seems that total serum bile

acids are inversely correlated with '0hour postprandial glucose levels and positively correlated with glucagon0li+e peptide0

(GL20) levels! "he mechanism by which bile acids increase in the enterohepatic circulation is not fully understood, but it

might be a result of an increased upta+e in the intestines or an increased synthesis in the liver!

Teoria incretin- n chirurgia diabetului

"he 1ncretin "heor in the !ur(er o& Diabetes

'. ălan, '. Revencu, #. )on0u, /. )on0u, D. RevencuUniversitatea de 'tat de Medicină i !armacie "Gicolae Testemi0anu&, )*iinău, Re%ulica Moldova

/e-itatea i diaetul -a*arat ti% 2 %ot deveni cele mai mari %roleme ale sănătă0ii %ulice +n viitoarele decenii.Modificarea stilului de via0ă, tratamentul medicamentos răm(n ineficiente.)*irurgia ariatrică +n tratamentul oe-ită0ii moride com%ortă o rată +naltă de re-olu0ie com%letă i a diaetului -a*aratti% 2. Mecanismul re-olu0iei diaetului -a*arat ti% 2 du%ă interven0iile ariatrice răm(ne neelucidat. )D i )D< Koacă unrol distinct i %atogenic +nalt +n instalarea diaetului -a*arat ti% 6./iectivul1 @valuarea eficacităNii 8%ass8ului gastric ;#= +n tratamentul diaetului -a*arat ti% 2 ;D\ 2= la %acienNii cuoe-itate, %recum i a mecanismelor ce stau la a-a controlului glicemic.Materiale i metode1 'tudiul %ros%ectiv include 2? %acien0i cu D\ 2 su%ui # %e %erioada 2445 8 246. Durata diaetuluia fost de >Y4,9 ani, IM) %reo%erator fiind de 2,Y6, BgWm]. Valorile medii ale glicemiei a-ale i *emogloinei glicoli-ateau constituit 5,9 Y 4,? mmolWl i res%ectiv ?,2 Y 4,2 :. Sn toate ca-urile s8a %relevat segment de intestin su0ire %entruexamenul *istoc*imic.Re-ultate1 'unt relatate re-ultatele %osto%eratorii %e o %erioadă de 63,5Y>, luni. IM) a constituit 25, Y4,5 BgWm],glicemia a-ală i *emogloina glicoli-ată au constituit 9,9 Y 4,2 mmolWl i res%ectiv 9,9 Y 4,6 :. @xamenul *istoc*imic aeviden0iat un infiltrat inflamator cronic constituit din limfocite T, %re%onderent )D i )D


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)onclu-ii1 Diaetul -a*arat ti% 2 %are a fi ini0iat de acelai lan0 %atogenetic ca i diaetul ti% 6. 'tudiul %reliminar relevăeficacitatea 8%ass8ului gastric, fiind o o%0iune %romi0ătoare +n tratamentul diaetului -a*arat ti% 2.

besity and type ' are li+ely to be the two greatest public health problems of the coming decades! Lifestyle changes and

drug therapy remain ineffective! =ariatric surgery, an effective treatment for morbid obesity, commonly leads to near

complete resolution of type ' diabetes ("'7)! "he underlying mechanisms, however, remain unclear! "he C% and C?

cells play distinct and highly pathogenic roles mediating type diabetes!

bective8 "o assess the potential and mechanisms of the gastric bypass (EMG=2) in affecting glycemic control in obesity

subects with "'7!

7aterials and 7ethods8 "his prospective clinical trial includes '@ patients with "'7 who underwent EMG=2 from '

through '%! uration of diabetes was /J,- years, and preoperative =76 of %',%J,% +g5m! "he blood glucose and

glycosylated haemoglobin were ,- J ,@ mmol5l and @,' J ,' ., respectively! A part of the small bowel was ta+en for the

histochemical e1amination!

Eesults8 #e report the preliminary postoperative follow0up data of &,J/,% months! =76 decreased to ',% J, +g5m,

blood glucose and glycosylated haemoglobin were -,- J ,' mmol5l and -,- J , ., respectively! "he histochemical e1amemphasi$ed the presence of a chronic inflammatory infiltrate in the lamina propria mostly constituted of C% and C? "

lymphocites!

Conclusions8 =oth type ' diabetes and type diabetes can have a common pathogenic mechanism! ur preliminary

observations demonstrated the efficacy of Eou10en0M gastric bypass as a promising option in "'7!

0astric slee'e9 dificult-8i


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Plicatura gastric- 1 O promisiune neonorat-

,astric Plication - an 7n&ul&illed Promise

I. ). $uia ;6=, $. #. )ristea ;6=, Aida $uia ;2=;6= Institutul Regional de #astroenterologie i Je%atologie "/ctavian !odor&, )luK8Ga%oca, Rom(nia;2= )ainet Medicină de !amilie, )luK8Ga%oca, Rom(nia

/iectiv1 'tudiul %re-intă re-ultatele oNinute la 69 %acienNi cărora li s8a %racticat o%eraNia de %licatură gastrică.Materiale i metode1 $acienNii au fost o%eraNi %entru oe-itate +ntre 2464 i 2466. De oicei aordul a fost la%arosco%ic idoar +ntr8un singur ca- %licatura a fost o o%eraNie secundară asociată. ToNi s8au +ncadrat +n cerinNele c*irurgiei ariatrice,cu indice de masă cor%orală ;IM)= %este 4 sau %este >9, com%licat cu comoridităNi ;*i%ertensiune arterială,disli%idemie, a%nee +n somn=. Diaetul a %re-entat un criteriu a%arte, IM) minim fiind de >6. $arametrii urmăriNi au fostv(rsta, sexul, variaNia IM) i a greutăNii, evoluNia comoridităNilor legate de oe-itate.Re-ultate1 Intervalul mediu de urmărire a fost de >4 luni. Du%ă o slăire iniNială extrem de variailă ;minim ? Bg 8 maxim>9= toNi %acienNii au +nregistrat o cretere +n greutate de minim 9 Bg i maxim 4 Bg, de%ăind +n 9 situaNii greutatea

%reo%eratorie. La aceste as%ecte negative s8au adăugat vărsăturile %osto%eratorii frecvente i %ersistente ca durată la33: din %acienNi, care au necesitat elierarea celui de8al doilea strat la două %aciente. La una dintre ele a a%ărut o fistulăgastrică imediat du%ă reintervenNie. Tomografia com%uteri-ată efectuată cu stomacul %lin cu a%ă la una din %acientelecare +nregistrase un c(tig im%ortant +n greutate a evidenNiat o dilataNie cu as%ect sacciform segmentar.)onclu-ii1 $e a-a re-ultatelor de-amăgitoare la distanNă, a disconfortului %osto%erator, a com%licaNiilor i a graduluicrescut de dificultate te*nică, nu credem că %licatura gastrică are calităNile necesare %entru a intra +n arsenalul curent alte*nicilor de c*irurgie ariatrică modernă.

bective8 "his study presents the results for - patients with gastric plication!

7aterial and 7ethods8 - patients were operated for obesity in our clinic between ' and '! >sually the approach

was laparoscopic and in one case only the gastric plication was a secondary associated operation! All were within the

re4uirements of bariatric surgery, with a body mass inde1 (=76) over %, or with one over /- complicated with

comorbidities (hypertension, dyslipidemia, sleep apnea)! iabetes presented a special criterion, the minimum =76 of /!"he monitored parameters were age, se1, =76 and weight variation, evolution of comorbidities related to obesity!

Eesults8 "he mean follow0up was / months! After an initial e1tremely variable weight loss (minimum @ +g 0 ma1imum /-)

all patients e1perienced a weight gain of at least - +g and % +g ma1imum, e1ceeding the initial preoperative weight in -

situations! "o these negative aspects we add fre4uent and persistent postoperative vomiting in &&. patients which

necessitated the release of the second layer in two patients! For one of them a gastric fistula developed immediately after

reoperation! C" scan performed on another patient with weight gain, with a stomach filled with water, showed a

segmental sacciform dilatation!

Conclusions8 =ased on the disappointing long term results, postoperative discomfort, complications and the increased

degree of technical difficulty we do not believe that gastric plication has the necessary 4ualities to enter the current

arsenal of bariatric surgical techni4ues!

0astroplicatura laparoscopic-9 indica*ii re&ultate perspecti'e( )xperien*a dup- ," de ca&uri operateLaparoscopic ,reater Curvature Plication2 1ndications Results Perpectives. Our $%perience a&ter 6> cases

/. ). or- ;6=, T. ara ;6=, T. ara r. ;6=, A. 'uciu ;6=, M. Denes ;6=, /. imorean ;6=, A. ToroB ;6=, T. _antor ;6=, . or- ;2=;6= '%ital )linic udeNean de UrgenNă, T(rgu8Mure, Rom(nia;2= Universitatea de Medicină i !armacie, T(rgu8Mure, Rom(nia

#astro%licatura la%arosco%ică este o %rocedură ariatrică recentă, folosită +n tratamentul oe-ită0ii moride. $re-entămindica0iile i re-ultatele o0inute du%ă >4 de ca-uri o%erate. Sntre 246> i 246 am o%erat >4 de %acienNi cu oe-itatemoridă, av(nd MI mediu de 2,39. Am efectuat gastro%licatură la%arosco%ică la to0i olnavii. $osto%erator, %rocentulexcesului de greutate %ierdut a fost de 96: la 3 luni i 39: la 62 luni. )om%lica0ii care au necesitat reinterven0ie am avutla 2 ca-uri ;o %erfora0ie gastrică i o steno-ă antrală=, acestea a%ăr(nd la %rimii 3 olnavi ;cura de +nvă0are=. Sn restulca-urilor am +nregistrat doar com%lica0ii minore1 gre0uri, vărsături. )onsiderăm gastro%licatura la%arosco%ică o metodă

%romi0ătoare +n tratamentul oe-ită0ii moride, dar la care nu avem re-ultate la distan0ă, necesit(nd studii ulterioare.


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Laparoscopic Greater Curvature 2lication is an emerging bariatric procedure in the treatment of morbid obesity! =etween

'/ and '% we operated / patients with a mean =76 of %',&-! #e present the indications and the results after this

series! "he percentage of e1cess weight loss was -. at & months and &-. at ' months! Complications that neededreoperations were encountered only in the first & cases (one gastric perforation and one antral stenosis) probably due to

the learning curve! 6n the rest of the cases appeared minor complications (nausea and vomiting)! #e consider

Laparoscopic Greater Curvature 2lication a promising procedure, but we need long term results and future studies!


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)1poster


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0astric Slee'e @ess experien8a spitalului .Sf( %onstantin/ Bra+o'

"he *!&. Constantin* Hospital4s $%perience with ,astric !leeve Less

. Moldovan, D. $ocreata, LuminiNa )+m%eanu, Andreea Moldovan'%italul "'f. )onstantinO, raov, Rom(nia

'co%1 $re-entarea ex%erienNei noastre cu %rivire la c*irurgia ariatrică %rin aord unic L@''.Materiale i metode1 $rogramul ariatric L@'' al '%italului "'f. )onstantin& din raov a +nce%ut +n Iunie 2462. Din totalulcelor 6?9 de gastric sleevuri +n s%italul nostru, 9 ;23:= au fost reali-ate %rin aord unic L@''8'IL'. $ro%unem de rutinăaceastă te*nică %acienNilor cu MI +ntre >9 i 4, +nsă am a%licat8o cu succes %(nă la un MI de 94,2 cu o conformaNiefavorailă. !olosim de rutină uad%ort %lus de la /lm%us, am%lasat omilical la 4 de ca-uri sau su%raomilical +n 9ca-uri de %acienNi longilini.!olosim instrumentar de 9 mm;cameră, %ense 'tor- cure, Ligasure= %entru a reduce"conflictele& la nivelul %ortului de lucru. 'onda de calirare este de > de !r %entru %acienNii cu MI su 4 i de >4 de !r%entru cei de %este 4. 'tandardul actual %entru re-ecNia stomacului este re%re-entat de cartuele $ur%le aco%erite cu$eristri% sau Tac*osil a%licate alternativ %e o faNă, fără sutură de +nfundare.

Re-ultate1 Gu s8au +nregistrat com%licaNii clasele >8 )lavien, 6 *ematom %erigastric resorit s%ontan, 2 eventraNii%osto%eratorii dintre care 6 la o %acientă aflată su tratament in*iitor al cicatri-ării %entru o maladie autoimună.'căderea %onderală medie este de 2< Bg, iar durata medie de s%itali-are 2,> -ile. #astric sleeve L@'' este o %rocedurăsigură, re%roductiilă i cu re-ultate similare din %unct de vedere al eficienNei ariatrice cu varianta standard, av(nd ca%rinci%al eneficiu as%ectul estetic, ceea ce o face să fie %referată de %acienNii tineri.

2urpose8 "o present our e1perience on single site approach bariatric surgery(L:: :leeve Gastrectomy)!

7ethod8 "he 3:t! Constantin3 Hospital


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Aideo Presentation


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How )ou Can Remove "he Minimi?er 'and5

A. GeimarB, G. AleBsandr

'aint8$etersurg $avlov 'tate Medical Universit, 'aint8$etersurg, Russia

Gastric banding is one of the most popular bariatric surgical operation today! However, the last few years have seen a

sharp decline in the percentage of gastric banding, from %'. in '? to . in '/! "his has to do with the accumulated

negative e1perience, and with the emergence of longitudinal gastrectomy, which is increasingly gaining popularity the

world over, having reached, in '/, the /?. mar+ in the overall bariatric surgery spectrum (Angrisani)!

ne of the most serious postoperative complications is gastric band erosion (migration)! According to the literature, the

incidence of this complication is ranging from !'/. to /'!&. (Q=rien)! As a rule, band erosion is clinically shown in the

port site suppuration and in the absence of obstruction to food ingestion!

"odayQs world mar+et offers a large variety of gastric band models, of which the most fre4uently used are Lap0band and

:AG=! Nevertheless, every surgeon may be faced with a case of migrating band made by some other manufacturer!

#e are presenting a related clinical case here! A female patient, %' years old, underwent gastric banding / years ago!

Eesulting weight loss8 '' +g! "he patient sought assistance at the clinic complaining of the festering port site infection!ndoscopic e1amination thereof revealed a partial band migration into the gastric lumen! "he band model identified was

7inimi$er! "a+ing into account its design features (special loops for fi1ing, hard silicone, with rough proections in the loc+

area), the option of endoscopic removal seemed doubtful! Analysis of the relevant literature resulted in finding only one

article describing this type of gastric band removal! Attention was drawn to complications accompanying endoscopic

removal, to the impossibility of removing the band from the channel, to the amming of the band in the gastric lumen, with

rupture of the esophagus at band traction!

"he underta+en endoscopic procedure involved the forming of a nitinol wire loop around the band, followed by the cutting

of the band by means of a lithotripter! "raction into the gastric lumen was unsuccessful! A laparoscopy was carried out!

"he band loc+ was isolated from the scar adhesions, and thereupon e1tracted from its bed! "he perforation hole was

stitched!

Conclusion8 6n the diagnostics of migrated gastric bands, it is important to determine the band model!

6n removing the band it would always be desirable to cut the band endoscopically, as this will reduce the scope of bandisolation at laparoscopy and thereby lessen the operation trauma!

Gastric band cutting does not re4uire the use of special tools, which reduces the cost of endoscopic removal procedure!


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Scientific Abstracts. 2014.National Symposium of Bariatric and Metabolic Surgery

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Transcript of Scientific Abstracts. 2014.National Symposium of Bariatric and Metabolic Surgery