MALABSORPTIVE BARIATRIC SURGERY in Low BMI Korean Patients Ji
Yeon Park Soonchunhyang University Seoul Hospital, Korea
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Body weight / Height 2 The most practical measure of a persons
adiposity BMI (kg/m 2 )WHO classification of weight status 25 ~
29.9Overweight 30 ~ 34.9Mildly Obese (Class I obesity) 35 ~
39.9Moderately obese (Class II obesity) 40 ~ 49.9Severely or
extremely obese (Class III obesity) >50Super obese (Class IV
obesity)
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NIH Consensus statement 1991 risk/benefit ratio Decision based
on a prudent evaluation of the risk/benefit ratio Era of open
surgery A very few surgical options
Long-term, prospective, controlled trial 4047 obese subjects
surgery group (n=2010) vs. control group (n=2037) Recruitment : Sep
1987 ~ Jan 2001 BMI : Men 38, women 34 Gastric bypass (13%),
banding (19%) & vertical banded gastroplasty (68%) Follow-up:
12 ~ 25 years
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The SOS intervention study
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Adjusted hazard ratio 0.17 (0.13 - 0.21) Carlsson et al. N Engl
J Med 2012;367:695-704
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BARIATRIC SURGERY Lower the BMI & Body weight METABOLIC
SURGERY Reduce HbA1c & medications
Mingrone et al. N Engl J Med 2012;366:1577-85. Single-center,
nonblinded, randomized, controlled trial Medical therapy vs. BPD
vs. RYGB 60 pts Age : 30 ~ 60 years BMI 35 DM > 5 years HbA1c
7.0%
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Outcomes at 2 years Mingrone et al. N Engl J Med
2012;366:1577-85.
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Difference in the rate of T2DM remission At 2 years Medical
therapy RYGBBPDP-value Diabetes remission015 (75%)19 (95%)7.0% BMI
27 ~ 43
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At 12 months Schauer et al. N Engl J Med 2012;366:1567-76
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Changes in Diabetes Control Over 3 Years Schauer et al. N Engl
J Med 2014;370:2002-13 Predictors of HbA1c
Indication to bariatric surgery in class I obesity Comorbidity
burden >> BMI levels Obesity scoring system phenotypization
beyond BMI levels for guiding therapeutic choices Position
statement from IFSO, 2014
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Schauer et al. N Engl J Med 2014;370:2002-13
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Parikh et al. Ann Surg 2014;260:617624 Randomized pilot
trial
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Serrot et al. Surgery 2011;150:684-91
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66 patients BMI 30 35 kg/m2 DM duration 12.5 7.4 years HbA1c
9.7 1.5% Cohen et al. Diabetes Care 2012
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Estimated 10-year cardiovascular risk after RYGB in mild
obesity Cohen et al. Diabetes Care 2012
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Lee W-J et al. Arch Surg. 2011;146(2):143-148 Randomized
controlled trial 30 SAGB + 30 SG HbA1c>7.5 % BMI 25 - 35 Kg/m 2,
C-peptide 1.0 ng/mL Duration of T2DM > 6 months Baseline
characteristics Duration of DM : 6.4 years (4.28.5 ) BMI 30.6 kg/m2
(25.134.7) HbA1c 10.0% (7.515.0)
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Effect of duodenal exclusion at 12 months SAGB vs SG Lee W-J et
al. Arch Surg. 2011;146(2):143-148
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Lee W-J et al. OBES SURG (2014) 24:15521562
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At Soonchunhyang University Seoul Hospital
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RYGB RYGB : Low BMI vs. high BMI Low BMI (n=137)High BMI
(n=266)p-value Age (years) 40.1 10.636.2 11.10.001 Sex Male 17
(12.4)55 (20.7)0.040 chi Female 120 (87.6)211 (79.3) Body weight
(kg) 84.9 9.8111.2 17.2
Purpose Metabolic resolution >> weight loss RYGB or SAGB
RYGB or SAGB (malabsroptive procedures) Effective comorbidity
resolution and weight loss Malabsoptive vs. Restrictive procedures
Better diabetic resolution after BYPASS Different response of
diabetic resolution? Difference in preoperative diabetic
characteristics Patient selection : DM duration, preoperative
C-peptide Long-term follow-up is necessary......