Draft Summary IFSO-EC MGB Presentations

 

Dr Cabaerllo pointed out the documentation in the literature showing that the RNY bypas is a particularly dangerous, complex and complicated procedure

 

Suter M, Giusti V, Heraief E, Zysset F, Calmes JM. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc 2003;17: 603-9.

 

-Complication (20.5%) Reoperation (8.4%): leak (4.6%) bowel obstruction (2.8%) subphrenic abscess (0.9%) Mortality (0.9%)

CONCLUSIONS: RNY is a very complex and dangerous operation. Long and steep learning curve (100-150pts) Weight loss and correction of comorbidities are similar to open surgery.

Even surgeons with extensive experience in advanced laparoscopic as well as bariatric surgery may sustain serios complications.

 

 

 

Papasavas PK, Caushaj PF, McCormick JT, Quinlin RF, Hayetian FD, Maurer J, Kelly JJ, Gagne DJ. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17:610-4.

 

Complications (25.2%)

Reinterventions (13.8%)

Gastrojejunostomy stricture (8.9%)

Intestinal obstruction (7.3%) adhesions (6), internal hernia in transverse mesocolon (3), jejuno jejunostomy stricture (3), cicatrix Roux limb at transverse mesocolon (3).

Gastrointestinal bleeding (4%)

Gastrojejunostomy leak (1.6%)

Symptomatic gallstone disease (2.8%)

Gastric remnant perforation (0.8%)

Negative laparoscopy to rule out anastomotic leak

3 deaths, 2 attributable to anastomotic leak.

 

 

 

 

Lee WJ, Yu PJ, Wang W, Chen TC, Wei PL, Huang MT. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg 2005;242:20-8.

 

METHODS Eighty patients randomized LRYGBP (n = 40) or LMGBP (n = 40); followed 2 years. Late complication, EWL, BMI, GIQLI, and comorbidities.

RESULTS

– One conversion (2.5%) in LRYGBP group

Operation time in LMGBP group (205 vs 148, p< 0.05)

– Operative morbidity LRYGBP group (20% vs 7.5%, p< 0.05)

  • Residual excess weight <50% at 2 years postoperatively was achieved in 75% LRYGBP and 95% of LMGBP (p< 0.05)

 

 

 

 

Lee WJ, Lee YC, Ser KH, Chen SC, Chen JC, Su YH. Revisional surgery for lap minigastric bypass. Surg Obes Relat Dis. 2011 Jul-Aug;7(4):486-91.

METHODS:

From January 2001 to December 2009, 1322 patients (996 women and 326 men, mean age 31.6 ± 9.1 years, mean body mass index 40.2 ± 7.4 kg/m(2)), who were enrolled in a surgically supervised weight loss program and had undergone LMGB were included. All the patients received regular yearly follow-up, and all the clinical data were prospectively collected and stored. The reasons and type of surgery for revision surgery were identified and analyzed.

RESULTS:

The excess weight loss and mean body mass index at 5 years after LMGB was 72.1% and 27.1 ± 4.6 kg/m(2). Of the 1322 patients, 23 (1.7%) had undergone revision surgery during a follow-up of 9 years. The estimated accumulated revision rate of 9 years was 2.69% for LMGB. The most common cause of revision was malnutrition in 9 (39.1%), followed by inadequate weight loss in 11 (34.7%), and intractable bile reflux and dissatisfaction each in 3 (13.0%). The type of revision surgery was LRYGB in 11 (47.8%), sleeve gastrectomy in 10 (43.5%), and conversion to a normal anatomic state in 2 (8.6%). All the revision procedures were performed using a laparoscopic approach, without major complications. Two patients underwent repeat second revision surgery to duodenal switch and biliopancreatic diversion each in 1 patient. All patients had satisfactory results after revision surgery. No patients had undergone revision surgery for internal hernia or ileus during the follow-up period.

CONCLUSION:

LMGB resulted in significant and sustained weight loss with an acceptably low revision rate at long-term follow-up. Revision surgery after LMGB can be performed using a laparoscopic approach with a low risk.

 

 

Dr Caballo concluded that

The one anastomosis gastric bypass (BAGUA) is a well standarized easily reproducible surgical procedure. That the “anti-reflux stitch” that fixes the intestine to the gastric pouch staple line, allow an easier anastomosis always in the same `position

The incorporation of the anti-reflux suture adds confort for the patient and reduced the complication related to biliary reflux. Finally Dr. Cabarello concluded that the One-Anastomosis Bypass offers a safe procedure such that it is possible to offer it for diabetes surgery in normal weight subjects.

 

 

 

 

 

 

 

 

 

The French Experience of Jean-Marc Chevallier.

Digestive Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75908 Paris cedex 15. E-mail: jean-marc.chevallier@egp.aphp.fr.

[MID-TERM EXPERIENCE WITH MINI-GASTRIC BYPASS IN FRANCE : REPORT OF THE FIRST 564 MGB CASES FOLLOWED UP TO 5 YEARS .

Jean-Marc Chevallier, Digestive Surgery, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75908 Paris cedex 15. E-mail: jean-marc.chevallier@egp.aphp.fr. Rutledge R, Trelles N, Arienzo R , Jamal W, Chakhtoura G, Zinzindohoué F, Berger A.]

 

Professor Chevallier presented a discussion of the Digestive Surgery, Hôpital Européen Georges Pompidou, in Paris France. He first noted that the The Roux-en-Y Gastrojejunal Bypass Procedure requirs Two steps: sub- and sus mesocolic, 2 anastomosis and it was felt that too many possible mistakes and Severeness of the complications Laparoscopically challenging : requiring a skilled manual suturing, long learning curve. Considered as the most difficult laparoscopic procedure , especially on obese patients. Having a large experience with Bands and notin
g in other studies that the band was associated with high failure rate Chevallier and colleagues undertook a stuy of MGB after noting the results of studies by Rutledge and by Lee.

 

 

 

 

RY Bypass
N = 40

Mini-Bypass
N = 40

Operative time (mns)

205

148 p < 0.05

Early complications

20.00%

7.5 % p < 0.05

Late complications

7.5 %

7.5 %

EWL at one year

58.7 %

64.9 %

EWL at two years

60.00%

64.4 %

[Prospective Randomized Trial Lee WJ, Yu P-J, Wang W, Chen TC, Wei PL, Huang MT. Laparoscopic Roux-en-Y versus Mini-Gastric Bypass for the treatment of Morbid Obesity. Ann Surg 2005 ; 242 : 20-28.]

 

 

Source

Thus Chevalier’s extensive bariatric experience with the Lap Band and the RNY led him to review the results of the MGB as reported by Lee and Rutledge. What he found was reports of a short simple operation that met or exceeded the outcomes of the “gold standard” RNY. Chevallier’s study of bands[Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years.Chevallier JMZinzindohoué FDouard RBlanche JPBerta JLAltman JJCugnenc PH. Departments of Digestive Surgery and Nutrition, Hopital Européen Georges Pompidou, 20-40 rue Leblanc, 75908 Paris cedex 15, France. jean-marc.chevallier@hop.egp.ap-hop-paris.fr] showed the cumulative rate of complications was 192 (19.2%) at 3-4 years. Chevallier’s group also had experience with RNY and internal hernia complications. Thus limitations of the RNY and Band along witht the potential advantage of MGB led to a trial MGB by Chevallier.

 

 

The results of Hôpital Européen Georges Pompidou’s study by Chevallier and his group were excellent. From October 2006 to July 2011 564 patients: ( 445 women : 79 %) underwent MGB, the mean age = 41 ± 11 yrs, range 17-62 ), the mean weight was = 133 ± 25 kg ( 75-221 ), the mean BMI = 47 Kg / m 2 ± 7,43 (range 32,8-80,2 ), 113 patients had already had a failed restrictive operation (36 %), 87 gastric bandings (45 removed simultaneously))

11 VBGs and 15 Sleeve Gastrectom resuces.

Early Complications occurred in 14 (4 %) 2 leakages, 1 on the gastrojejunal anastomosis ( reop)

1 colonic fistula( ( Day 26 : colectomy) 3 intestinal obstructions 2 on a trocar’s site ( reop)

1 on an umbilical hernia ( reop) 2 abdominal abscesses 1 reop at day 22 : no leakage 1 subphrenic : reop for drainage 1 cutaneous abscess , 1 abdominal bleeding : reop at Day 6 : splenectomy

2 endoluminal bleeding: anastomotic hemorrhage : endoscopic sclerosis, 1 rhabdomyolisis: increase of CPK level, no renal failure , 2 pulmonary embolisms.

 

LATE COMPLICATIONS

N = 10 (1.7 %) / 3 abdominal reoperations, 1 Peritonitis : perforated excluded gastric remnant following intestinal occlusion of the biliary limb secondary to anastomotic stricture on an anastomotic ulcer ( 3 years after ), 6 marginal ulcers treated by PPI , 1 anastomotic stricture endoscopically dilated , 2 symptomatic cholelithiasis , 16 complained of diarrhea ( resolved after 6 months except for 2, 7 complained of Biliary reflux ( 2 conversions in RYGBP)

 

Weight Loss After MGB-Excellent

 

The weight loss results were excellent even in this patient populationwith a large number of revisions.

 

 

Pre-op

1 year

2 years

3 years

4 years

Patients (n)

564

382

266

168

67

Lost to follow up > 18 mths

   

41

38

43

Weight (Kg)

133

94

87

81

80

BMI (Kg/m2)

47

33

31

30

30

EWL %

 

53

64

76

77

 

ENDOSCOPIC FINDINGS after MGB

Endoscopoc finding were of particular note as bariatric surgeons have raised concerns about the risk of bile reflux. Of 82 symptomatic patients endoscoped at 2 years there were 4 ulcers and No evidence of any form of metaplasia. At 4 years 8 symptomatic patients were found to have ulcers and none had any metaplasia.

 

Chevallier and his group tehn concluded the efficacy and safety of MGB/Omega GBP have been demonstrated in a randomized trial and confirmed in their 5 year results. Many technical complications of RYGBP are due to problems on the Enteroenterostomy ( ileus, leakage, kinking) and the omplication rate s lower in MGB because there is only one gastrojejunal anastomosis.

The very powerful weight loss efficiency of the MGB is maintained at 1,2,3 and 4 years post op. The group found that the MGB was reproductible and has a role in training in bariatric surgery. They felt that in the even that the MGB failed for whatever reason it was easily revised.. Marginal ulcer is very important problem in the MGB as it is in the RNY bypass. It is critical that surgeons and patient be aware of this longterm risk and at accordingly, ie Rx H. Pylori aggressively, avoid ulcerogenic medications, cigarettes, alcohol and others. It is also recommended that healthy diet high in fresh fruits and vegetables be cousumened including a high amount of probiotic yogurt. Agressive use of PPIs and anti ulcer therapy is indicated. Other than marginal ulcer there was no evidence of metaplasia following the MGB. They also suggested that the MGB might be a candidate for a tool for lower weight diabetics with modification (Metabolic surgery)

 

Dr. Jacques Himpens www.lap-surgery.com Department of Gastrointestinal Surgery at Saint Pierre University Hospital, Université Libre de Bruxelles, The European School of Laparoscopic Surgery, Brussels, Belgium.

 

Dr. Himpens et al publised the important work “Long-term Outcomes of Laparoscopic Adjustable Gastric Banding” concluded that “Based on a follow-up of 54.3% of patients, LAGB appears to result in a mean excess weight loss of 42.8% after 12 years or longer. Of 78 patients, 47 (60.3%) were satisfied, and the quality-of-life index was neutral. However, because nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%), LAGB appears to result in relatively poor long-term outcomes.” [Long-term Outcomes of Laparoscopic Adjustable Gastric Banding, Jacques Himpens, MD; Guy-Bernard Cadière, MD, PhD; Michel Bazi, MD; Michael Vouche, MD; Benjamin Cadière, MD; Giovanni Dapri, MD , Arch Surg. 2011;146(7):802-807. doi:10.1001/archsurg.2011.45]

 

From 23/10/2007  20/10/2011Himpens and his group in Brussels operated upon 375 pts, 334 WOMEN, 41 MEN, Age at surgery was 34 yrs (18-67), Preop BMI 40.6 kg/m² (30-57). The hospital length of stay was median 3 days. Early complications: LEAK 7 (1.9%), BLEEDING 8 (2.1%) INCISION.Hernia. 2 (0.5%).

 

LEAKs : n=7 1 post VBG, 1 post LAGB (+erosion), 1 male heavy smoker, 3 learning curve, 1 bezoar  blow-out. Late complications: Internal hernia: n= 6 (1.6%) Cholecystitis: n=20 (/354) = 5.6% Recurrent anastomotic ulcer: n=5 (1.3%).

 

Bile reflux / acid reflux in 16 converted to RNY.

 

Dr Himpens concluded that bile reflux is a real issue after MGB but easily treated with conversion to RNY. Dr Himpens reported that he no longer performs RNY and only performs the MGB because if its marked superiority.

 

 

Mario Musella, MD – Associate Professor of Surgery, “Federico II” University – Naples – Italy spoke on the staus of the MGB in Italy. Dr Musella reviewed someof the publications on the MGB including:

 

One Thousand Consecutive Mini-Gastric Bypass: Short- and Long-term Outcome.

Noun R, Skaff J, Riachi E, Daher R, Antoun NA, Nasr M.

Obes Surg. 2012 May;22(5):697-703.

 

Role of Bariatric-Metabolic Surgery in the Treatment of Obese Type 2 Diabetes with Body Mass Index <35 kg/m(2): A Literature Review.

Reis CE, Alvarez-Leite JI, Bressan J, Alfenas RC.

Diabetes Technol Ther. 2012 Apr;14(4):365-72. Epub 2011 Dec 16.

 

Bariatric surgery in Asia in the last 5 years (2005-2009).

Lomanto D, Lee WJ, Goel R, Lee JJ, Shabbir A, So JB, Huang CK, Chowbey P, Lakdawala M, Sutedja B, Wong SK, Kitano S, Chin KF, Dineros HC, Wong A, Cheng A, Pasupathy S, Lee SK, Pongchairerks P, Giang TB.

Obes Surg. 2012 Mar;22(3):502-6. Erratum in: Obes Surg. 2012 Feb;22(2):345. Fah, Chin Kin

 

Laparoscopic mini-gastric bypass: short-term single-institute experience.

Piazza L, Ferrara F, Leanza S, Coco D, Sarvà S, Bellia A, Di Stefano C, Basile F, Biondi A.

Updates Surg. 2011 Dec;63(4):239-42. Epub 2011 Nov 22.

 

ESR1, FTO, and UCP2 genes interact with baria
tric surgery affecting weight loss and glycemic control in severely obese patients.

Liou TH, Chen HH, Wang W, Wu SF, Lee YC, Yang WS, Lee WJ.

Obes Surg. 2011 Nov;21(11):1758-65. Erratum in: Obes Surg. 2012 Jan;22(1):194.

 

Bariatric surgery: a systematic review and network meta-analysis of randomized trials.

Padwal R, Klarenbach S, Wiebe N, Birch D, Karmali S, Manns B, Hazel M, Sharma AM, Tonelli M.

Obes Rev. 2011 Aug;12(8):602-21. doi: 10.1111/j.1467-789X.2011.00866.x. Epub 2011 Mar 28. Review.

 

Reasons and outcomes of reoperative bariatric surgery for failed and complicated procedures (excluding adjustable gastric banding).

Patel S, Szomstein S, Rosenthal RJ.

Obes Surg. 2011 Aug;21(8):1209-19.

 

Improvement of insulin resistance after obesity surgery: a comparison of gastric banding and bypass procedures.

Lee WJ, Lee YC, Ser KH, Chen JC, Chen SC.

Obes Surg. 2008 Sep;18(9):1119-25. Epub 2008 Mar 4.

 

Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Lee WJ, Chong K, Ser KH, Lee YC, Chen SC, Chen JC, Tsai MH, Chuang LM.

Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taiwan, Republic of China.

Arch Surg. 2011 Feb;146(2):143-8.

 

Laparoscopic mini-gastric bypass for type 2 diabetes: the preliminary report.

Kim Z, Hur KY.

World J Surg. 2011 Mar;35(3):631-6.

 

ESR1, FTO, and UCP2 genes interact with bariatric surgery affecting weight loss and glycemic control in severely obese patients.

Liou TH, Chen HH, Wang W, Wu SF, Lee YC, Yang WS, Lee WJ.

Obes Surg. 2011 Nov;21(11):1758-65.

Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.

 

[Outcomes after laparoscopic surgery for 219 patients with obesity].

Ding D, Chen DL, Hu XG, Ke CW, Yin K, Zheng CZ.

Zhonghua Wei Chang Wai Ke Za Zhi. 2011 Feb;14(2):128-31. Chinese.

 

Obesity and the decision tree: predictors of sustained weight loss after bariatric surgery.

Lee YC, Lee WJ, Lin YC, Liew PL, Lee CK, Lin SC, Lee TS.

Hepatogastroenterology. 2009 Nov-Dec;56(96):1745-9.

 

Laparoscopic conversion of distal mini-gastric bypass to proximal Roux-en-Y gastric bypass for malnutrition: case report and review of the literature.

Dang H, Arias E, Szomstein S, Rosenthal R.

Surg Obes Relat Dis. 2009 May-Jun;5(3):383-6. Epub 2009 Jan 18. Review. No abstract available.

 

[Laparoscopic mini-gastric bypass].

Chevallier JM, Chakhtoura G, Zinzindohoué F.

J Chir (Paris). 2009 Feb;146(1):60-4. French. No abstract available.

 

Laparoscopic mini-gastric bypass (LMGB) in the super-super obese: outcomes in 16 patients.

Peraglie C.

Obes Surg. 2008 Sep;18(9):1126-9. Epub 2008 Jun 25.

 

Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital.

Chakhtoura G, Zinzindohoué F, Ghanem Y, Ruseykin I, Dutranoy JC, Chevallier JM.

Obes Surg. 2008 Sep;18(9):1130-3. Epub 2008 Jun 20.

 

The serial changes of ghrelin and leptin levels and their relations to weight loss after laparoscopic minigastric bypass surgery.

Liou JM, Lin JT, Lee WJ, Wang HP, Lee YC, Chiu HM, Wu MS.

Department of Internal Medicine, College of Medicine, National Taiwan University, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, Taiwan.

Obes Surg. 2008 Jan;18(1):84-9. Epub 2007 Dec 15.

 

Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI>35 and <35 kg/m2.

Lee WJ, Wang W, Lee YC, Huang MT, Ser KH, Chen JC.

J Gastrointest Surg. 2008 May;12(5):945-52. Epub 2007 Oct 16.

 

Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight.

Lee WJ, Wang W, Lee YC, Huang MT, Ser KH, Chen JC.

Obes Surg. 2008 Mar;18(3):294-9. Epub 2008 Jan 12.

 

Mini-gastric bypass by mini-laparotomy: a cost-effective alternative in the laparoscopic era.

Noun R, Riachi E, Zeidan S, Abboud B, Chalhoub V, Yazigi A.

Obes Surg. 2007 Nov;17(11):1482-6.

 

Prediction of successful weight reduction after bariatric surgery by data mining technologies.

Lee YC, Lee WJ, Lee TS, Lin YC, Wang W, Liew PL, Huang MT, Chien CW.

Obes Surg. 2007 Sep;17(9):1235-41.

[Commentary. Invited comment on the article by Noun et al. about Laparoscopic mini-gastric bypass…].

Chevallier JM.

J Chir (Paris). 2007 Jul-Aug;144(4):305-6. French. No abstract available. Erratum in: J Chir (Paris). 2007 Nov-Dec;144(6):566.

 

[Laparoscopic mini-gastric bypass: an effective option for the treatment of morbid obesity].

Noun R, Zeidan S.

J Chir (Paris). 2007 Jul-Aug;144(4):301-4. French.

 

Ala55Val polymorphism on UCP2 gene predicts greater weight loss in morbidly obese patients undergoing gastric banding.

Chen HH, Lee WJ, Wang W, Huang MT, Lee YC, Pan WH.

Obes Surg. 2007 Jul;17(7):926-33.

 

Mini-gastric bypass for revision of failed primary restrictive procedures: a valuable option.

Noun R, Zeidan S, Riachi E, Abboud B, Chalhoub V, Yazigi A.

Obes Surg. 2007 May;17(5):684-8. Erratum in: Obes Surg. 2007 Jul;17(7):996.

 

Hospitalization before and after mini-gastric bypass surgery.

Rutledge R.

Int J Surg. 2007 Feb;5(1):35-40. Epub 2006 Aug 10.

 

Mini-gastric bypass in a patient homozygous for Factor V Leiden.

Peraglie C.

Obes Surg. 2007 Jan;17(1):104-7.

 

Laparoscopic latero-lateral jejuno-jejunostomy as a rescue procedure after complicated mini-gastric bypass.

Noun R, Zeidan S, Safa N.

Obes Surg. 2006 Nov;16(11):1539-41.

 

Efficacy of estradiol topical patch in the treatment of symptoms of depression following mini-gastric bypass in women.

Rutledge R, Dorghazi P, Peralgie C.

Obes Surg. 2006 Sep;16(9):1221-6.

 

Prevention of trocar-wound hernia in laparoscopic bariatric operations.

Chiu CC, Lee WJ, Wang W, Wei PL, Huang MT.

Obes Surg. 2006 Jul;16(7):913-8.

 

Revision of failed gastric banding to mini-gastric bypass.

Rutledge R.

Obes Surg. 2006 Apr;16(4):521-3.

 

One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients.

Carbajo M, García-Caballero M, Toledano M, Osorio D, García-Lanza C, Carmona JA.

Obes Surg. 2005 Mar;15(3):398-404.

 

Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients.

Rutledge R, Walsh TR.

Obes Surg. 2005 Oct;15(9):1304-8.

 

Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial.

Lee WJ, Yu PJ, Wang W, Chen TC, Wei PL, Huang MT.

Ann Surg. 2005 Jul;242(1):20-8.

 

Short-term results of laparoscopic mini-gastric bypass.

Wang W, Wei PL, Lee YC, Huang MT, Chiu CC, Lee WJ.

Obes Surg. 2005 May;15(5):648-54.

 

[Laparoscopic mini gastric bypass for the treatment of morbid obesity. Initial experience].

Copăescu C, Munteanu R, Prala N, Turcu FM, Dragomirescu C.

Chirurgia (Bucur). 2004 Nov-Dec;99(6):529-39. Romanian.

 

One anastomosis gastric bypass: a simple, safe and efficient surgical procedure for treating morbid obesity.

García-Caballero M, Carbajo M.

Nutr Hosp. 2004 Nov-Dec;19(6):372-5.

 

Laparoscopic mini-gastric bypass for failed vertical banded gastroplasty.

Wang W, Huang MT, Wei PL, Chiu CC, Lee WJ.

Obes Surg. 2004 Jun-Jul;14(6):777-82.

 

Similarity of Magenstrasse-and-Mill and Mini-Gastric bypass.

Rutledge R.

Obes Surg. 2003 Apr;13(2):318. No abstract available.

 

Mini-gastric bypass controversy.

Fisher BL, Buchwald H, Clark W, Champion JK, Fox SR, MacDonald KG, Mason EE, Terry BE, Schauer PR, Sugerman HJ.

Obes Surg. 2001 Dec;11(6):773-7.

 

More on mini-gastric bypass.

Olchowski S, Timms MR, O’Brien P, Bauman R, Quattlebaum JK.

Obes Surg. 2001 Aug;11(4):532.

 

The mini-gastric bypass: experience with the first 1,274 cases.

Rutledge R.Obes Surg. 2001 Jun;11(3):276-80.

 

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