Leonardo E Silva, MD, PhD, FACS1, Ruy Jorge C Junior, MD, PhD, FACS2, Paula Cristina P Ribeiro, RD, LDN1, Maxley M Alves, MD1, Tanous K El Ajouz, MD1, Rodrigo A Silva, MD, Prof3. 1ICAD Goiania, 2Department of Surgery – University of Pittsburgh, PA, USA, 3Department of Surgery – Santa Casa School of Medicine – Sao Paulo, Brazil
The aim of this study was to assess retrospectively the incidence of reflux and endoscopic changes in MGBN post-operative time after 5 years post-op; from 5 to 10 years post-op; from 10 to 15 years post-op.
Method: The inclusion pre-operative criteria for MGBN was: (1) erosive reflux disease; and/or (2) significant sliding hiatal hernia (>3cm); and/or (3) hipotonia of lower esophageal sphincter (LES).
The data of morbidly obese patients who underwent to MGBN by the same team in two different Hospitals from 1999 to 2016 were retrospectively collected. During this period 2135 patients were submitted to MGBN. We called all 2135 patients by means of email; mobile phone and social networks. However only 1452 patients (68%) answered the call. We divided these 1452 patients in three groups. Group 1: Patients submitted to MGBN until 5 years postoperative time; Group 2 from 5 to 10 years postoperative time and Group 3 from 10 to 15 years postoperative time. We evaluated mortality; morbidity; GERD symptoms; upper endoscopy findings; histological findings after endoscopic biopsies; weight loss and T2DM resolution.
Results: Mean age was 42. BMI was 44±4.5. No conversion to open surgery. 30day mortality was 0. Overall mortality was 0,2%. Perioperative morbidity was 0,8%. The mean operative time was 92±4 minutes. No leak was observed. %EWL was 88±4,4% at 5 years; 81+ 2,1% and 79±1,2% at 15years. Barret’s was 0,8%. No cancer or dysplasia were found. Non-erosive reflux disease was 12% and erosive reflux disease was 5%.
Incident T2DM (46,8%) was cured in 81,2% (blood glucose < 6mmol/l and HbA1c<5.5) with a mean of 6% relapse rate after 15 years with no new case.
There are some limitations in this study. First no functional evaluation of gastroesophageal reflux by 24-h pH monitoring and/or changes of the lower esophageal sphincter pressure were assessed pre and/or postoperatively. Secondly, clinical response was determined by the use of PPIs after LSCNG, and no other prospectively clinical evaluation/scale was used.
Conclusion: This long-term study demonstrated that MGBN is a safe, simple and effective procedure to treat severe obese patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80577
Program Number: P539
Presentation Session: Poster (Non CME)
Presentation Type: Poster
