ORIGINAL ARTICLE   

Minerva Chirurgica 2017 August;72(4):279-88

DOI: 10.23736/S0026-4733.17.07374-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Outcome of laparoscopic gastric bypass in obese and diabetic patients: when surgery fails

Silvia PALMISANO ¹ ✉, Greta GIACOMEL ¹, Marta SILVESTRI ¹, Michela GIURICIN ¹, Annamaria KULLA ¹, Fabiola GIUDICI ¹, Edoardo BALDINI ², Simone ALBERTARIO ², Patrizio CAPELLI ², Bernardo MARZANO ³, Giovanni FANTI ³, Aron ZOMPICCHIATTI ³, Paolo MILLO ⁴, Riccardo BRACHET CONTUL ⁴, Elisa PONTE ⁴, Antonella USAI ⁴, Nicolò, de MANZINI ¹

¹ General Surgery Clinic, Department of Medical, Surgical and Health Sciences, Trieste University Hospital, Trieste, Italy; ² General, Thoracic, and Vascular Surgery Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy; ³ Department of Surgery, Santa Maria degli Angeli Hospital, Pordenone, Italy; ⁴ Bariatric and Metabolic Unit, Department of General Surgery, Umberto Parini Regional Hospital, Aosta, Italy

BACKGROUND: The beneficial effects of bariatric surgery on diabetes and obesity have been widely demonstrated in the literature. The aim of our study was to evaluate the rate of failure of laparoscopic gastric bypass both in terms of weight loss and metabolic remission after one follow-up year.
METHODS: A longitudinal, multicenter prospective study was carried out on 771 patients affected by pathological obesity. The following parameters were recorded for each patient before surgery: anthropometric, metabolic, social, smoking habits and previous failure of other bariatric procedures. After 1 follow-up year, final weight, final Body Mass Index (BMI), final percentage of lost excess body weight and percentage of lost BMI were evaluated.
RESULTS: Statistical analysis showed a correlation between BMI>50 kg/m2, presence of metabolic syndrome, presence of diabetes, gastric pouch volume greater than 60 mL and failure of weight loss outcome. Statistical analysis of metabolic failure has recognized a high preoperative glycated hemoglobin percentage (HbA1c%) value as a statistically significant negative predictive factor.
CONCLUSIONS: Bariatric Surgery is the most effective treatment for weight loss and metabolic improvement. However, in our study, surgery did not achieve the expected outcome in patients with specific metabolic, anthropometric and surgical characteristics (BMI>50 kg/m2, presence of metabolic syndrome, presence of T2DM with high preoperative HbA1c% level and gastric pouch volume greater than 60 mL).

KEY WORDS: Obesity - Bariatric surgery - Metabolic syndrome X - Type 2 diabetes mellitus