BACKGROUND AND AIMS: Gastric restriction techniques have recently emerged as minimally invasive bariatric procedures. Endoscopic sutured gastroplasty (ESG) with the Endomina (Endo Tools Therapeutics, Gosselies, Belgium) triangulation platform proved to be safe and effective for the treatment of class I and II obesity in prospective studies. In this registry, we aimed to further assess on a larger scale the safety and efficacy of the procedure in routine practice with a dedicated device. METHODS: This was a multicenter, observational, prospective post-market study including patients with obesity undergoing Endomina ESG. The primary safety outcome was the occurrence of serious adverse device effects (SADEs) at 12 months. The primary efficacy outcome was the technical success defined by completing the procedure without premature abortion owing to technical issues. The rates of procedure-related adverse events, weight loss outcomes, and quality of life changes were collected. RESULTS: A total of 142 patients underwent ESG in 3 centers from July 2020 to March 2023. Of these, 67 (mean body mass index, 38.5 ± 6.3 kg/m2) reached at least 12 months of follow-up up to October 2022. Technical success was 100%. No SADEs occurred. Seven mild procedure-related adverse events were reported overall. Mean percentage of excess weight loss and total body weight loss at 12 months' follow-up were 48.5% ± 38.6 and 15.3% ± 10.6, respectively (n = 67). Improved quality of life was observed following ESG. CONCLUSIONS: ESG is safe and effective, thus offering a satisfactory therapeutic option for a wide range of obese patients on a large scale.
- MeSH
- dospělí MeSH
- gastroplastika * metody škodlivé účinky MeSH
- gastroskopie metody MeSH
- hmotnostní úbytek MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidní obezita chirurgie MeSH
- obezita chirurgie komplikace MeSH
- pooperační komplikace MeSH
- postmarketingový dozor * MeSH
- prospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
Úvod: Adjustabilní gastrická bandáž (AGB) patřila k oblíbeným bariatrickým metodám. Z dlouhodobého hlediska u více než poloviny operovaných selhává, je neúčinná a je potřeba ji ve velké míře odstranit. Z tohoto důvodu je od používání této metody celosvětově ustupováno. Mezi nejčastěji používané revizní bariatrické operace po odstraněné AGB patří sleeve gastrektomie (SG) a Roux-Y gastrický bypass (RYGB). Kazuistika: V kazuistice prezentujeme případ nemocné, které byla odstraněna AGB a provedena tubulizace žaludku s nepříznivým průběhem ve smyslu rozvoje stenózy tubulizovaného žaludku. Proto jí byl proveden jako další revizní výkon RYGB s dobrým efektem. Závěr: Revizní operace jsou technicky náročnější než primární výkony a mají vyšší procento komplikací. Mezi nejčastější revizní operace patří SG a RYGB. Po SG se může vytvořit stenóza tubulizovaného žaludku, která má negativní vliv na nutriční stav nemocného a kvalitu jeho života. Toto lze řešit endoskopickou dilatací a při inefektivitě konverzí na RYGB
Introduction: Adjustable gastric banding (AGB) used to be a popular bariatric procedure. However, it fails in more than half of those operated on in the long term, becomes ineffective and must be removed. Therefore, the use of AGB has been in decline globally. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most used bariatric revision surgeries when AGB is removed. Case report: We present the case of a woman after AGB removal and conversion to SG who developed a stenosis of the sleeve. Therefore, a decision was made to convert to RYGB with a good effect. Conclusion: Revisional procedures are more technically challenging than primary procedures and have higher complication rates. The most performed revisional operations include SG and RYGB. Stenosis of the sleeve can occur after SG, with a negative impact on the patient’s nutritional status and quality of life. This can be managed by endoscopic dilatation, and where this solution proves ineffective, RYGB can be indicated.
- MeSH
- bariatrická chirurgie MeSH
- dospělí MeSH
- gastrektomie metody MeSH
- gastroplastika metody škodlivé účinky MeSH
- kvalita života MeSH
- lidé MeSH
- morbidní obezita chirurgie MeSH
- reoperace metody MeSH
- stenóza chirurgie MeSH
- žaludeční bypass * metody škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Obesity is the pandemic disease of this century. Surgery is the only effective treatment but cannot be offered to every patient. Endoscopic sutured gastroplasty is a minimally invasive technique that may potentially fill the gap between surgery and behavioral therapy. In this study, we prospectively investigated the efficacy and safety of a novel suturing device. METHODS: After a pre-bariatric multidisciplinary work-up, class 1 and 2 obese patients were included. Using a simple triangulation platform, transmural sutures with serosa-to-serosa apposition were performed in the gastric cavity. Patients were followed according to the same routines as those performed for bariatric procedures. RESULTS: Between November 2015 and December 2016, 51 patients were included across three European Centers. Mean body mass index at baseline was 35.1 kg/m2 (SD 3.0). Excess weight loss and total body weight loss at 1 year were 29 % (SD 28) and 7.4 % (SD 7), respectively, for the whole cohort (45 patients). At follow-up gastroscopy, 88 % of sutures were still in place (30 patients). No severe adverse events were observed. CONCLUSIONS: Endoscopic sutured gastroplasty using this novel device is safe and achieved weight loss results in line with criteria expected for these endoluminal techniques. Further prospective studies vs. placebo or nutritional support are needed.
- MeSH
- dospělí MeSH
- gastroplastika škodlivé účinky přístrojové vybavení MeSH
- gastroskopie MeSH
- hmotnostní úbytek MeSH
- index tělesné hmotnosti MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- obezita chirurgie MeSH
- prospektivní studie MeSH
- šicí techniky škodlivé účinky přístrojové vybavení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- audiovizuální média MeSH
- časopisecké články MeSH
- klinické zkoušky MeSH
- multicentrická studie MeSH
BACKGROUND: Laparoscopic greater curvature plication (LGCP) is a new metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report LGCP outcomes in 244 morbidly obese patients. METHODS: Between 2010 and 2011, patients underwent LGCP. Body mass index (BMI, kilogram per square meter) evolution, excess BMI loss (%EBMIL), excess weight loss (%EWL), complications, and type 2 diabetes mellitus (T2DM) changes were recorded. Repeated-measures analysis of variance (ANOVA) was used to assess weight change at 6, 12, and 18 months. Subgroup analyses were conducted to provide benchmark outcomes at 6 months. Logistic regression was used to identify characteristics predictive of suboptimal weight loss. RESULTS: Mean baseline BMI (±SD) was 41.4 ± 5.5 (80.7 % women, mean age 46.1 ± 11.0 years, 68 [27.9 %] patients had T2DM). Mean operative time was 70.6 min; mean hospitalization, 36 h (24-72). Sixty-eight patients (27.9 %) experienced postoperative nausea and/or vomiting that was controlled within 36 h. There was no mortality. Major complication rate was 1.2 % (n = 3). Repeated-measures ANOVA indicated significant weight loss across time points (p < 0.001). At 6 months (n = 105), BMI, %EBMIL, and %EWL were 36.1 ± 4.7, 34.8 ± 17.3, and 31.8 ± 15.9. Preoperative BMI was the only predictor of weight loss. Patients with BMI <40 lost more weight than those ≥40, although by 9 months, differences were no longer significant. In patients with preoperative BMI <40, 18-month %EWL approached 50 % and %EBMIL exceeded 50 %. At 6 months, 96.9 % of patients' T2DM was significantly improved/resolved. CONCLUSIONS: Over the short term, LGCP results in effective weight loss and significant T2DM reduction with a very low rate of complications.
- MeSH
- analýza rozptylu MeSH
- diabetes mellitus 2. typu krev komplikace patofyziologie MeSH
- gastroplastika škodlivé účinky metody MeSH
- hmotnostní úbytek MeSH
- index tělesné hmotnosti MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- logistické modely MeSH
- morbidní obezita krev komplikace patofyziologie chirurgie MeSH
- následné studie MeSH
- prospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Bariatrická chirurgie je v současné době jedinou efektivní terapií morbidní obesity. Hlavní výhodou laparoskopické adjustabilní bandáže žaludku (LAGB) je její minimální invazivita pro žaludek a možnost adjustace podle potřeb pacienta. Cíl: Dosud byl publikován nevelký počet dlouhodobých studií, týkajících se výsledků LAGB.Uvádíme naše dvanáctileté zkušenosti s touto metodou. Materiál a metodika: Na sestavě 100 pacientů (76 % žen, 24 % mužů), operovaných od února 1998 do prosince 2006 prezentujeme výsledky a komplikace, reoperace. Výsledky: Průměrná doba sledování byla 5,2 roku (0,5–11,8). Z dispenzarizace bylo ztraceno 22 % pacientů po 5 letech, 33 % po 8 letech. Komplikace se vyskytly u 38 % pacientů. U 18 % pacientů bylo nutno provést reoperaci. Nedošlo k žádnému úmrtí v souvislosti s LAGB. Závěr: Na základě naší 12leté zkušenosti můžeme konstatovat, že LAGB je efektivní bariatrická metoda k redukci hmotnosti. Vzhledem k vysokému počtu komplikací a reoperací je nezbytný výběr pacientů podle specifických kritérií a pracoviště s velkými zkušenostmi s bariatrickou chirurgií.
Bariatric surgery is currently the only effective treatment for morbid obesity. The main advantage of laparoscopic adjustable gastric banding (LAGB) is that this operation is minimally invazive to the stomach and adjustable to the patient's needs. AIM: Few long-term studies regarding the outcome of LAGB for morbid obesity have so far been publised. We report our 12-year experience with this method. PATIENTS AND METHODS: On list of 100 patients (76% women, 24% men) operated since February 1998 until December 2006 we present results and complications, reoperations. Mean follow up was 5.2 years (0.5-11.8). Patients lost to follow up was 22% at 5 years and 33% at 8 years. Complications occurred in 38% patients. 12% of the patients needed reoperation. There was no mortality. CONCLUSION: From our 12-year experience, we can state that LAGB is an effective bariatric procedure for achieving weight loss. Because of the high complication and reoperation rate, it is necessary to select patients according specific criteria and choose experienced bariatric surgery.
- MeSH
- bariatrická chirurgie MeSH
- dospělí MeSH
- gastroplastika přístrojové vybavení škodlivé účinky MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- morbidní obezita chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
Je známým faktem, že uzávěr mezenterických vén může komplikovat mnoho jiných onemocnění, ale může se objevit jako život ohrožující komplikace po chirurgických výkonech v břišní dutině. Pacientka, 54 let, s Leidenskou mutací po bariatrickém výkonu s měsíčním odstupem hospitalizována a operována pro trombózu horní mezenterické žíly s nutností resekce tenkého střeva. Po operaci a agresivní hematologické terapii se stav zlepšuje. Opakované CT angiografie prokazují zlepšování průchodnosti mezenterických vén oproti předoperačnímu nálezu. Pacientka nyní dlouhodobě na antikoagulační terapii.
It is now recognized that occlusion of the mesenteric veins not only may complicate a number of disease processes but may occur as a life-threatening complication after abdominal surgery. 54-year old female patient with Leiden mutation that undergone bariatric operation after one month from the surgery rehospitalized and operated with the diagnosis of superior mesenteric vein thrombosis with unavoidable resection of the intestine. Patient’s state after surgery with following aggressive hematologic treatment becomes better. Mesenteric and portal vein flow is more fluent as showed by repeated CT angiography scans in comparison with pre-operative status. Patient currently on oral anticoagulant therapy.
- MeSH
- bodová mutace MeSH
- faktor V genetika MeSH
- gastroplastika škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mezenteriální cévní okluze etiologie MeSH
- pooperační komplikace MeSH
- robotika MeSH
- trombofilie genetika komplikace MeSH
- vena mesenterica MeSH
- žilní trombóza etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- MeSH
- adherence pacienta MeSH
- gastroplastika metody škodlivé účinky MeSH
- lidé MeSH
- poruchy příjmu potravy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a safe and effective bariatric operation for the treatment of morbid obesity. Optimized long-term weight loss and reduced complications may be facilitated by development of a standardized, accurate, band-fill measurement methodology for use in postoperative LAGB adjustments. METHODS: A summary of the primary in vitro, theoretical, and in vivo studies of pressure-volume theory relative to gastric banding was undertaken. RESULTS: LAGBs range in mechanisms of action from low-pressure/high-volume to high-pressure/low-volume. Use of both basic and dynamic pressure data obtained experimentally and clinically with a low-pressure/high-volume (LP/HV) band as a research tool revealed that intra-band pressures remained very low even when the band balloon was filled to its maximum fill volume; in contrast, when a high-pressure/low-volume (HP/LV) band was filled, it exhibited a pressure curve markedly steeper and of greater amplitude than that of the LP/HV band. Theoretical calculations of the differences between the bands in terms of the pressures they exerted on a bolus of food passing through a stoma found that the pressure created by the HP/LV band against the gastric wall was >100% higher than that applied by the LP/HV band; these mathematical results were verified by using invasive manometry in 35 patients undergoing band adjustment. In clinical testing, basic band pressure, band volume, and dynamic pressure data (that demonstrated esophageal motility patterns at the stoma during bolus passage) were gathered and correlated. As identified by intra-band pressure readings, a zone of disruptive peristaltic activity that obstructed bolus passage through the stoma was observed; slightly beneath this zone, it was hypothesized that successful patient adjustments might be carried out. The manometrically delineated measure of mean band pressure sufficient to exert a significant yet not disruptive restriction (i.e., 20 mm Hg; mean volume of 5.4 mL) was tested in 25 patients in follow-up. No patient required readjustment due to obstruction. Intra-band pressure, as opposed to band-fill-volume measurement, per se, was shown to produce a more accurate measurement of actual band (stoma) restriction in individual patients, and to identify a pressure "green zone" for effective restriction at adjustments. DISCUSSION: Ongoing scientific studies are needed to refine pressure-volume theory by using laboratory, theoretical, and clinical manometry to establish a reliable pressure-based algorithm for gastric band adjustment. Such an algorithm may lead to more consistent weight loss, fewer complications, and more compliant patients.
- MeSH
- endoskopie metody MeSH
- gastroplastika škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- morbidní obezita chirurgie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- diabetes mellitus terapie MeSH
- gastroplastika kontraindikace metody škodlivé účinky MeSH
- komplikace diabetu MeSH
- lidé MeSH
- morbidní obezita chirurgie MeSH
- pooperační péče MeSH
- předoperační péče MeSH
- výsledek terapie MeSH
- žaludeční balónek využití MeSH
- žaludeční bypass metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
