Efficacy of the BAGUA technique against the Roux-en-Y Gastric Bypass as a treatment for Obesity and Type 2 Diabetes Mellitus, at the “Abel Gilbert Pontón” Hospital, period 2015 to 2019.
Keywords:
Obesity, Type 2 Diabetes mellitus, Gastric Bypass, BAGUA, Y de Roux (BGYR)Abstract
Background: Obesity associated with diabetes is a life-threatening condition. Currently, surgery represents an effective and long-lasting therapeutic option to treat it, with gastric bypass being the standard procedure, demonstrating a significant effect on weight loss and resolution of diabetes.
Objective: To compare results that demonstrate the efficacy of each gastric bypass technique in the ¨Abel Gílbert Pontón¨ hospital, focusing on the benefits, complications, and evolution of each group.
Methodology: Observational study, retrospective, analytical, comparative, and longitudinal, carried out at the Abel Gílbert Pontón Hospital, during the period 2015-2019. The population consisted of patients diagnosed with obesity and type 2 diabetes mellitus who underwent gastric bypass.
Results: 76 patients were analyzed, of which 46 underwent BAGUA and 30 under RYGB. When comparing weight loss, no significant difference was noted in any of the follow-up times (3, 6, and 12 months), but significant differences were observed regarding surgical time, hospital stay, and ICU admission, in favor of BAGUA. Greater remission of diabetes mellitus was evidenced for BAGUA. RYGB was more related to complications (bleeding, anastomotic leak and reoperation). There was no difference in the presence of gastroesophageal bile reflux. One patient died (1.32%), who had undergone RYGB.
Conclusions: BAGUA is an effective procedure for weight loss, with equal or better benefits than RYGB, and has greater effectiveness in remission of diabetes mellitus; Furthermore, it is safer, with less morbidity and less reoperation.
References
Organización Mundial de la Salud. Obesidad y Diabetes [Internet]. 2016. Available from: www.paho.org/es/temas/diabetes
Hermosillo-Cornejo DG, Arreola-Ramírez DA, Girón-Gidi AD, Álvarez-hernández DA, López-caballero C. Cirugía bariátrica y metabólica , una perspectiva histórica desde sus inicios. MEDIGRAPHIC - EL Resid. 2016;11(2):88–95.
Ramos A, Kow L, Brown W, Welbourn R, Dixon J, Kinsman R, et al. The IFSO Global Registry: 5th IFSO Global Registry Report 2019 [Internet]. United Kingdom; 2019. 6–8 p. Available from: https://www.ifso.com/pdf/5th-ifso-global-registry-report-september-2019.pdf
Sociedad Americana de Cirugía Bariatrica y Metabólica. Cirugía para la diabetes [Internet]. 2020. Available from: https://asmbs.org/patients/surgery-for-diabetes
Mahawar K. Bariatric Surgery : The Past , the Present , and the Future Bariatric Surgery : The Past , the Present , and the Future. Webmedcentral. 2012;3:1–7.
Scopinaro N. Thirty-Five Years of Biliopancreatic Diversion : Notes on Gastrointestinal Physiology to Complete the Published Information Useful for a Better Understanding and Clinical Use of the Operation. OBES SURG. 2012;22:427–32.
Rutledge R, Kular K, Manchanda N. The Mini-Gastric Bypass original technique. Int J Surg [Internet]. 2019;61:38–41. Available from: https://doi.org/10.1016/j.ijsu.2018.10.042
De Luca M, Tie T, Ooi G, Higa K, Himpens J, Carbajo M, et al. Mini Gastric Bypass-One Anastomosis Gastric Bypass (MGB-OAGB)-IFSO Position Statement. Obes Surg. 2018;28(5):1188–206.
Cohen R, Le Roux C, Junqueira S, Ribeiro R, Luque A. Roux-En-Y Gastric Bypass in Type 2 Diabetes Patients with Mild Obesity: a Systematic Review and Meta-analysis. Obes Surg. 2017;27(10):2733–9.
Organización Mundial de la Salud. Informe mundial sobre la diabetes: 8 de junio de 2020 [Internet]. 2020. Available from: www.who.int/es/news-room/fact-sheets/detail/diabetes
Rowley WR, Bezold C, Arikan Y. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Popul Health Manag. 2016;20:1–7.
Instituto Nacional de Estadística y Censos (INEC). Registro Estadístico de Defunciones Generales. Informe 2019. [Internet]. 2019. Available from: www.ecuadorencifras.gob.ec/documentos/web-inec/Poblacion_y_ Demografia/Nacimientos_Defunciones/2020/Boletin_ tecnico_ EDG 2019 prov.pdfle
Organización Panamericana de la Salud. La diabetes, un problema prioritario de salud pública en el Ecuador y la región de las Américas. Encuesta Nacional de Salud y Nutrición (ENSANUT) [Internet]. 2018. Available from: www.paho.org/ecu/index.php?option=com_content& view=article&id=1400:la-diabetes-un-problema-prioritario-de-salud-publica-en-el-ecuador-y-la-region-de-las americas&Itemid=360#:~:text= En Ecuador%2C diabetes están afectando,diez ecuatorianos ya tiene diabetes
Organización Mundial de la Salud. Obesidad y Sobrepeso [Internet]. 2020. Available from: www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight
Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis. Am J Med [Internet]. 2009;122(3):248–56. Available from: http://dx.doi.org/10.1016/j.amjmed.2008.09.041
Magouliotis DE, Tasiopoulou VS, Tzovaras G. One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Morbid Obesity: an Updated Meta-Analysis. Obes Surg. 2019;29(9):2721–30.
Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, et al. Effect of Laparoscopic Roux-en-Y Gastric Bypass on Type 2 Diabetes Mellitus. Univ Otago Libr. 2014;60–1.
Schirmer B, Hallowell P. Obesidad Mórbida y su tratamiento quirúrgico; Bypass Gástrico en Y de Roux Laparoscópico. In: Zinner MJ, Ashley SW, editors. Cirugías Abdominales de Maingot. 12va ed. 2018. p. 558–64.
Cummings DE. Endocrine mechanisms mediating remission of diabetes after gastric bypass surgery. Int J Obes [Internet]. 2009;33(S1):33–40. Available from: http://dx.doi.org/10.1038/ijo.2009.15
Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, et al. Efficacy of Laparoscopic Mini Gastric Bypass for Obesity and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract. 2015;2015.
Parikh M, Eisenberg D, Johnson J, El-chaar M, Kothari SN. American Society for Metabolic and Bariatric Surgery Review of the Literature on One-Anastomosis Gastric Bypass Manish. Surg Obes Relat Dis [Internet]. 2018;14:502–21. Available from: https://doi.org/10.1016/j.soard.2018.04.017
Garcia caballero M, Reyes Ortíz A, García M, Matínez Moreno A. Changes of Body Composition in Patients with BMI 23 – 50 After Tailored One Anastomosis Gastric Bypass ( BAGUA ): Influence of Diabetes and Metabolic Syndrome. 2014;2040–7.
Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ. Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients. Obes Surg [Internet]. 2017;27(5):1153–67. Available from: http://dx.doi.org/10.1007/s11695-016-2428-1
Musella M, Apers J, Rheinwalt K, Ribeiro R, Manno E, Greco F, et al. Efficacy of Bariatric Surgery in Type 2 Diabetes Mellitus Remission: the Role of Mini Gastric Bypass/One Anastomosis Gastric Bypass and Sleeve Gastrectomy at 1 Year of Follow-up. A European survey. Obes Surg. 2016;26(5):933–40.
Ros Pérez M, Medina Gómez G. Obesidad , adipogénesis y resistencia a la insulina. Endocrinol Y Nutr. 2011;58(7):360–9.
Pacheco Sánchez D, Pinto Fuentes P, Enrique Asensio D. Actualización en cirugía bariátrica / metabólica. Nutr Clínica en Med [Internet]. 2019;XIII:113–27. Available from: https://www.ifso.com/pdf/5th-ifso-global-registry-report-september-2019.pdf
Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, et al. Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery. Obes Surg. 2014;24:42–55.
Díez I, Martínez C, Ruiz J, De La Cruz F, Torres A. Recomendaciones de la SECO para la práctica de la cirugía bariátrica y metabólica ( Declaración de Vitoria-Gasteiz , 2015 ). Bariatrica Metabólica Iberoam. 2015;3:842–5.
García García M, Martím Lorenzo J, Lirón Ruiz R, Torralba Martínez J. COMPLICACIONES POSTOPERATORIAS TRAS CIRUGÍA BARIÁTRICA. CLASIFICACIÓN Y VALIDACIÓN SEGÚN CLAVIEN-DINDO. EXPERIENCIA EN NUESTRO CENTRO Y REVISIÓN DE LA LITERATURA. Cirugía Española. 2019;97:2–8.
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