Abstract
Background: The considerable increase in Obesity and especially the increase in super obese patients (Body Mass Index—BMI ≥ 50 Kg/m2) who require surgery lead doctors to search for surgery techniques which give good results in terms of a consistent and stable weight loss associated with low morbidity and good quality of life. The Long Magenstrasse (LM) intervention, born from combining two properly modified surgical procedures (Selective Vagotomy with pyloric divulsion and Mangestrasse & Mill by Johnston) seems to have these characteristics according to our experience after operating on 660 patients. Methods: From October 2003 to October 2008 we treated 186 patients with LM. One hundred and sixty-two patients were regularly present to the annual follow-up, but 24 patients didn’t turn up, therefore, they were contacted by phone. On average, surgery lasted approximately 80 minutes (range: 50 - 90 minutes). Thirty patients were super obese with an average BMI of 57.4 Kg/m2; 156 patients were grade II and III obese with an average BMI of 40.7 Kg/m2. Results: The average BMI of the 30 super obese patients decreased from 57.4 Kg/m2 to 35.9 Kg/m2 one year after surgery, to 35.6, 5 years after surgery and it has remained stable until now. In the 156 patients suffering from II and III grade obesity, the average BMI decreased from 40.7 Kg/m2 to 27.8 Kg/m2 one year after surgery and it has remained stable until now. Out of all super obese diabetic patients, only one has partially maintained his/her therapy. Patients have reported a decreased appetite since the very first days of post-operative period with an early sense of satiety which is unchanged until today. Conclusions: A consistent and stable weight loss over 5 years after surgery even in Super Obese patients, a decrease in appetite with an early sense of satiety, a re-equilibrium of the metabolic syndrome in particular of Diabetes Mellitus, allow to classify LM among those surgical treatments with a mixed mechanism of action: both restrictive and functional, in particular, entero-hormonal and gastric neurosecretory.
Highlights
When performing Sleeve Gastrectomy (SG), each surgeon chooses the measures that he/she considers the most suitable ones: from 3 to 8 cm distant from the pylorus with conservation or non-conservation of the antrum, a calibration bougie ranging between 32 and 50 Fr. resulting in great variability in results especially over time [1, 2].Whereas, in the Long Magenstrasse (LM) the surgical technique is very precise and its results are absolutely reproducible [3,4].The suture-section stretches from the angle of His up to 2 - 3 cm from the pylorus on a calibration bougie of 36 Fr., in this way the stomach appears uniformly tubular at the level of the small curvature
The considerable increase in Obesity and especially the increase in super obese patients (Body Mass Index—BMI ≥ 50 Kg/m2) who require surgery lead doctors to search for surgery techniques which give good results in terms of a consistent and stable weight loss associated with low morbidity and good quality of life
Out of these 30 super obese patients, 21 were women and 9 were men with an average age of 39; 16% suffered from Pickwick syndrome, 36% from dyslipidemia 16% was affected by hyperuricemia and 34% by arterial hypertension
Summary
When performing Sleeve Gastrectomy (SG), each surgeon chooses the measures that he/she considers the most suitable ones: from 3 to 8 cm distant from the pylorus with conservation or non-conservation of the antrum, a calibration bougie ranging between 32 and 50 Fr. resulting in great variability in results especially over time [1, 2].Whereas, in the LM the surgical technique is very precise and its results are absolutely reproducible [3,4].The suture-section stretches from the angle of His up to 2 - 3 cm from the pylorus on a calibration bougie of 36 Fr., in this way the stomach appears uniformly tubular at the level of the small curvature (food tract). Results: The average BMI of the 30 super obese patients decreased from 57.4 Kg/m2 to 35.9 Kg/m2 one year after surgery, to 35.6, 5 years after surgery and it has remained stable until now. In the 156 patients suffering from II and III grade obesity, the average BMI decreased from 40.7 Kg/m2 to 27.8 Kg/m2 one year after surgery and it has remained stable until now. Conclusions: A consistent and stable weight loss over 5 years after surgery even in Super Obese patients, a decrease in appetite with an early sense of satiety, a re-equilibrium of the metabolic syndrome in particular of Diabetes Mellitus, allow to classify LM among those surgical treatments with a mixed mechanism of action: both restrictive and functional, in particular, entero-hormonal and gastric neurosecretory
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