Efectos metabólicos del by pass gástrico
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Efectos metabólicos del by pass gástrico
- 2. Restriction- transient and initial decreased food intake Ghrelin- Anorexigenic effect Duoenal Exclusion Inctetin effect + PROXIMAL Mechanism Faster food delivery DISTAL Mechanism Mild Malabsorption Why RYGB works?
- 5. Fed at the 5th week postop X Mechanistic aspects of RYGB x
- 7. Incretins: Early & Late postop Increased GLP1 secretion and insulin sensitivity
- 11. DECREASED GLUCOSE TRANSPORT FUNCTION & REDUCTION OF GLUCOSE ABSORPTIVE CAPACITY
- 17. Efficacy Buchwald H. JAMA, 2004 Buchwald,2004 Procedure % EWL T2DM (Controled) Gastric Banding 47% (n=1848) 48% Gastroplasty 68% (n=506) 68% Gastric Bypass 62% (n=4204) 84% BPD 70% (n=2480) 98%
- 18. Effect on Long-term Mortality Compared to Non-Operated Controls Study Procedure F/U Mortality Reduction MacDonald,1997 RYGB 9 yrs 88% Flum, 2004 RYGB 4.4yrs 33% Christou, 2004 RYGB 5 yrs 89% Sowemimo, 2007 RYGB 4.4 yrs 50% Adams, 2007 RYGB 8.4 yrs 40% Sjostrom, 2007 VBG/RYGB 14 yrs 31% Perry, 2008 (Medicare) RYGB, VBG, LAGB 2 yrs 48 % age < 65 34% age > 65
- 21. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis 1990-2006; 19 studies, 4, 070 diabetic patients The American Journal of Medicine (2009) 122, 248-256
- 23. Mortality Rates Following Common Operations in U.S. Hospitals ] Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator of hospital quality. JAMA 2004,292, 847-851 SRC: Bariatric Surgery Mortality 0.28% (55,567 patients) Aortic Aneur CABG Craniot Esophag Resect Hip Replac Panc Ped. Heart Surgery Number of Hospitals performing operation 2485 1036 1600 1717 3445 1302 458 National Average Mortality rate( %) 3.9 3.5 10.7 9.1 0.3 8.3 5.4 Average Hospital caseloads Median 30 491 12 5 24 8 4
- 26. Reproducibility RYGB & EWL &T2DM Control Author Procedure EWL T2DM Control Pories,1995 RYGB 77% 89% Schauer,2003 RYGB 73.7% 82% Sugerman,2003 RYGB 79% 86% Torquati,2005 RYGB 74% 81% Cohen,2006 RYGB 77% 97%
- 30. Diabetes & BMI at least 50 % of DM in the world have BMI<35 Int J Clin Practice, 2007(NHANEMCS and SHIELD) Dtsch Int Arztebl. 2010 SOARD, 2010
- 33. 70 60 50 40 30 20 10 0 Number Of Patients Cohen RV….. Cummings DE 6-Year Study of RYGB for Type 2 DM in Patients With BMI 30–35 kg/m 2 1% No Change 11% T2DM Improvement 88% T2DM Remission
- 34. A 5 6 7 8 9 10 11 0 6 12 24 48 60 72 Months After Surgery Hemoglobin A1c (%) Rapid & Durable Improvement in HbA1c Cohen RV….. Cummings DE
- 35. LRYGB, BMI 30-35 Cohen at al. Cohen at al. Significant decrease-p<0.05
- 36. UKPDS Risk Engine 10-Year Cardiovascular Risk Predictions (%) COHEN&CUMMINGS Pre-Op Post-Op Coronary Heart Disease * Fatal Coronary Heart Disease * Stroke * Fatal Stroke *
- 38. Laferrere,2008 RYGB Mechanisms of action