Obes Surg. 2012 Sep 11. [Epub ahead of print]

Laparoscopic Roux-en-Y Vs. Mini-gastric Bypass for the Treatment of Morbid Obesity: a 10-Year Experience.  Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC.

Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China, wjlee_obessurg_tw@yahoo.com.tw.

BACKGROUND:

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for the treatment of morbid obesity but is technically challenging and results in significant perioperative complications. While laparoscopic mini-gastric bypass (LMGB) has been reported to be a simple and effective treatment for morbid obesity, controversy exists. Long-term follow-up data from a large number of patients comparing LMGB to LRYGB are lacking.

METHODS:

Between October 2001 and September 2010, 1,657 patients who received gastric bypass surgery (1,163 for LMGB and 494 for LRYGB) for their morbid obesity were recruited from our comprehensive obesity surgery center. Patients who received revision surgeries were excluded. Minimum follow-up was 1 year (mean 5.6 years, from 1 to 10 years). The operative time, estimated blood loss, length of hospital stay, and operative complications were assessed. Late complication, changes in body weight loss, BMI, quality of life, and comorbidities were determined at follow-up. Changes in quality of life were assessed using the Gastrointestinal Quality of Life Index.

RESULTS:

There was no difference in preoperative clinical parameters between the two groups.

Surgical time was significantly longer for LRYGB (159.2 vs. 115.3 min for LMGB, p < 0.001).

The major complication rate was borderline higher for LRYGB (3.2 vs. 1.8 %, p = 0.07).

At 5 years after surgery, the mean BMI was lower in LMGB than LRYGB (27.7 vs. 29.2, p < 0.05) and

LMGB also had a higher excess weight loss than LRYGB (72.9 vs. 60.1 %, p < 0.05).

Postoperative gastrointestinal quality of life increased significantly after operation in both groups without any significant difference at 5 years. Obesity-related clinical parameters improved in both groups without significant difference, but LMGB had a lower hemoglobin level than LRYGB.

Late revision rate was similar between LRYGB and LMGB (3.6 vs. 2.8 %, p = 0.385).

CONCLUSIONS:

This study demonstrates that LMGBP can be regarded as a simpler and safer alternative to LRYGB with similar efficacy at a 10-year experience.

 

23011462

 

 

2.

Obes Surg. 2012 Aug 26. [Epub ahead of print]

Ghrelin Level and Weight Loss After Laparoscopic Sleeve Gastrectomy and Gastric Mini-Bypass for Prader-Willi Syndrome in Chinese.

Fong AK, Wong SK, Lam CC, Ng EK.

Division of Upper GI Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.

Prader-Willi syndrome (PWS) is a chromosomal disorder characterized by the presence of hyperghrelinemia, hyperphagia, and obesity. The optimal treatment for PWS patient remains controversial. Here, we present our experience of treating PWS with laparoscopic mini-gastric bypass (LMGBP) and laparoscopic sleeve gastrectomy (LSG). Three patients with genetic diagnosis of PWS and body mass index (BMI) greater than 40 kg/m(2) were referred for bariatric surgery. All of them had completed 2-year postoperative follow-up. Body weight, BMI, and ghrelin levels were recorded before and after surgery. They were two females and one male. Their age ranged from 15 to 23 years old, and the mean BMI was 46.7 kg/m(2) (range 44-50). Two patients underwent LSG and one patient underwent LMGBP. After a median follow-up of 33 months (range 24-36 months), mean weight loss and percentage of excessive weight loss at 2 years were 32.5 kg (24.9-38.3 kg) and 63.2 % (range 50.5-86.2 %), respectively. The mean fasting active ghrelin level decreased from 1,134.2 pg/ml preoperatively to 519.8 pg/ml 1 year after surgery. No major complication was observed. Iron deficiency anemia was observed in the patient who underwent LMGBP. Significant reduction of body weight and level of serum ghrelin can be achieved with minimal morbidity by LSG or LMGBP in patients with PWS.

 

22923339

 

 

3.

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

One thousand consecutive mini-gastric bypass: short- and long-term outcome.

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

Department of Digestive Surgery, Hôtel-Dieu de France Hospital and University Saint Joseph Medical School, Bd Alfred Naccache, Achrafieh, BP 166830 Beirut, Lebanon. rnoun@wise.net.lb

There is growing evidence that mini-gastric bypass (MGB) is a safe and effective procedure. Operative outcome and long-term follow-up of a consecutive cohort of patients who underwent MGB are reported. The data on 1,000 patients who underwent MGB from November 2005 to January 2011 at an academic institution were reviewed. Mean age was 33.15 ± 10.17 years (range, 14-72), preoperative BMI was 42.5 ± 6.3 kg/m(2) (range, 26-75), mean preoperative weight was 121.6 ± 23.8 kg (range, 71-240), and 663 were women. Operative time and length of stay for primary vs. revisional MGB were 89 ± 12.8 min vs. 144 ± 15 min (p < 0.01) and l.85 ± 0.8 day vs. 2.35 ± 1.89 day (p < 0.01). No deaths occurred within 30 days of surgery. Short-term complications occurred in 2.7% for primary vs. 11.6% for revisionnal MGB (p < 0.01). Five (0.5%) patients presented with leakage from the gastric tube but none had anastomotic leakage. Four (0.4%) patients, all with revisional MGB, presented with severe bile reflux and were cured by stapling the afferent loop and by a latero-lateral jejunojejunostomy. Excessive weight loss occurred in four patients; two were reversed and two were converted to sleeve gastrectomy. Maximal percent excess weight loss (EWL) of 72.5% occurred at 18 months. Weight regain subsequently occurred with a mean variation of -3.9% EWL at 60 months. The 50% EWL was achieved for 95% of patients at 18 months and for 89.8% at 60 months. MGB is an effective, relatively low-risk, and low-failure bariatric procedure. In addition, it can be easily revised, converted, or reversed.

 

22411569

4.

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

Role of bariatric-metabolic surgery in the treatment of obese type 2 diabetes with body mass index <35 kg/m2: a literature review.

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

SchoolofHealthSciences,UniversityofBrasília,Brasília,Brazil. caioedureis@gmail.com

Bariatric surgery has been used to treat type 2 diabetes mellitus (T2DM); however, its efficacy is still debatable. This literature review analyzed articles that evaluated the effects of bariatric surgery in treatment of T2DM in obese patients with a body mass index (BMI) of <35 kg/m(2). A paired t test was applied for the analysis of pre- and postintervention mean BMI, fasting plasma glucose (FPG), and glycosylated hemoglobin (A1c) values. A significant (P<0.001) reduction in BMI (from 29.95±0.51 kg/m(2) to 24.83±0.44 kg/m(2)), FPG (from 207.86±8.51 mg/dL to 113.54±4.93 mg/dL), and A1c (from 8.89±0.15% to 6.35±0.18%) was observed in 29 articles (n=675). T2DM resolution (A1c <7% without antidiabetes medication) was achieved in 84.0% (n=567) of the subjects. T2DM remission, control, and improvement were observed in 55.41%, 28.59%, and 14.37%, respectively. Only 1.63% (n=11) of the subjects presented similar or worse glycemic control after the surgery. T2DM remission (A1c <6% without antidiabetes medication) was higher after mini-gastric bypass(72.22%) and laparoscopic/Roux-en-Y gastric bypass (70.43%). According to the Foregut and Hindgut Hypotheses, T2DM results from the imbalance between the incretins and diabetogenic signals. The procedures that remove the proximal intestine and do ileal transposition contribute to the increase of glucagon-like peptide-1 levels and improvement of insulin sensitivity. These findings provide preliminary evidence of the benefits of bariatric-metabolic surgery on glycemic control of T2DM obese subjects with a BMI of <35 kg/m(2). However, more clinical trials are needed to investigate the metabolic effects of bariatric surgery in T2DM remission on pre-obese and obese class I patients.

 

22176155

5.

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

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.

General and Emergency Surgery Department,GaribaldiHospital,Catania,Italy, lpiazza267@gmail.com.

The elevated variety of procedures proposed for surgical treatment of obesity in the last few years suggests the necessity to find an ideal operation. Laparoscopic mini-gastric bypass (LMGB) was developed to obtain better results with lesser morbidity and mortality. LMGB was introduced by Rutledge, in 1997, and it consists of a long lesser-curvature tube with a terminolateral gastroenterostomy 180 cm distal to the Treitz ligament. From July 1995 to May 2011 we have performed 552 bariatric operations, among them we have operated 197 laparoscopic mini-gastric bypass (Fig. 1). There were 147 female (75%) and 50 male (25%) with the mean age of 37.9 years (range 20-55) and the mean BMI of 52.9 kg/m(2). All procedures were completed laparoscopically, without conversion and the mean operative time was 120 min (range from 90 to 170 min). The average postoperative stay was 5.0 days. We report one case of mortality for pulmonary septic complications. Major complications were two cases of pulmonary embolism (treated in ICU), six cases of melena on seventh postoperative day and three cases of anastomotic ulcers resolved with high doses of PPI. We registered a significant reduction of BMI and percentage of excess weight after surgery with a significant improvement in obesity-related comorbidities including blood pressure, hyperglycemia, blood lipid, uric acid, and liver function. An ideal weight loss operation should be effective, easy to perform and safe. Laparoscopic Roux-en-Y GastricBypass is actually the “gold-standard” technique but LMGB seems to be an attractive alternative: shorter operative time, with less morbidity and mortality, easier to teach and to perform. Another advantage could be the presence of a single anastomosis alone reducing the possibility of leaks.

 

22105765

6.

Obes Surg. 2012 Mar;22(3):502-6.

Bariatric surgery inAsiain 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.

Department of Surgery, Minimally Invasive Surgical Centre, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore, Singapore.

Erratum in

•              Obes Surg. 2012 Feb;22(2):345. Fah, Chin Kin [corrected to Chin, Kin-Fah].

Obesity is a major public health concern around the world, includingAsia. Bariatric surgery has grown in popularity to combat this rising trend. An e-mail questionnaire survey was sent to all the representative Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) members of 12 leading Asian countries to provide bariatric surgery data for the last 5 years (2005-2009). The data provided by representative members were discussed at the 6th International APMBSS Congress held atSingaporebetween 21st and 23rd October 2010. Eleven nations exceptChinaresponded. Between 2005 and 2009, a total of 6,598 bariatric procedures were performed on 2,445 men and 4,153 women with a mean age of 35.5 years (range, 18-69years) and mean BMI of 44.27 kg/m(2) (range, 31.4-73 kg/m(2)) by 155 practicing surgeons. Almost all of the operations were performed laparoscopically (99.8%). For combined years 2005-2009, the four most commonly performed procedures were laparoscopic adjustable gastric banding (LAGB, 35.9%), laparoscopic standard Roux-en-Y gastric bypass (LRYGB, 24.3%), laparoscopic sleeve gastrectomy (LSG, 19.5%), and laparoscopic mini gastric bypass (15.4%). Comparing the 5-year trend from 2004 to 2009, the absolute numbers of bariatric surgery procedures inAsiaincreased from 381 to 2,091, an increase of 5.5 times. LSG increased from 1% to 24.8% and LRYGB from 12% to 27.7%, a relative increase of 24.8 and 2.3 times, whereas LAGB and mini gastric bypass decreased from 44.6% to 35.6% and 41.7% to 6.7%, respectively. The absolute growth rate of bariatric surgery inAsiaover the last 5 years was 449%.

 

22033767

7.

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

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.

Department of Physical Medicine and Rehabilitation,ShuangHoHospital,TaipeiMedicalUniversity,Taipei,Taiwan.

Erratum in

•              Obes Surg. 2012 Jan;22(1):194.

BACKGROUND:

Significant variability in weight loss and glycemic control has been observed in obese patients receiving bariatric surgery. Genetic factors may play a role in the different outcomes.

METHODS:

Five hundred and twenty severely obese patients with body mass index (BMI) ≥35 were recruited. Among them, 149 and 371 subjects received laparoscopic adjustable gastric banding (LAGB) and laparoscopic mini-gastric bypass (LMGB), respectively. All individuals were genotyped for five obesity-related single nucleotide polymorphisms on ESR1, FTO, PPARγ, and UCP2 genes to explore how these genes affect weight loss and glycemic control after bariatric surgery at the 6th month.

RESULTS:

Obese patients with risk genotypes on rs660339-UCP2 had greater decrease in BMI after LAGB compared to patients with non-risk genotypes (-7.5 vs. -6 U, p = 0.02). In contrast, after LMGB, obese patients with risk genotypes on either rs712221-ESR1 or rs9939609-FTO had significant decreases in BMI (risk vs. non-risk genotype, -12.5 vs. -10.0 U on rs712221, p = 0.02 and -12.1 vs. -10.6 U on rs9939609, p = 0.04) and a significant amelioration in HbA1c levels (p = 0.038 for rs712221 and p < 0.0001 for rs9939609). The synergic effect of ESR1 and FTO genes on HbA1c amelioration was greater (-1.54%, p for trend <0.001) than any of these genes alone in obese patients receiving LMGB.

CONCLUSIONS:

The genetic variants in the ESR, FTO, and UCP2 genes may be considered as a screening tool prior to bariatric surgery to help clinicians predict weight loss or glycemic control outcomes for severely obese patients.

 

21720911

8.

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

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.

Department of Medicine,UniversityofAlberta,Edmonton,Alberta,Canada.

The clinical efficacy and safety of bariatric surgery trials were systematically reviewed. MEDLINE, EMBASE, CENTRAL were searched to February 2009. A basic PubCrawler alert was run until March 2010. Trial registries, HTA websites and systematic reviews were searched. Manufacturers were contacted. Randomized trials comparing bariatric surgeries and/or standard care were selected. Evidence-based items potentially indicating risk of bias were assessed. Network meta-analysis was performed using Bayesian techniques. Of 1838 citations, 31 RCTs involving 2619 patients (mean age 30-48 y; mean BMI levels 42-58 kg/m(2) ) met eligibility criteria. As compared with standard care, differences in BMI levels from baseline at year 1 (15 trials; 1103 participants) were as follows: jejunoileal bypass [MD: -11.4 kg/m(2) ], mini-gastric bypass [-11.3 kg/m(2) ], biliopancreatic diversion [-11.2 kg/m(2) ], sleeve gastrectomy [-10.1 kg/m(2) ], Roux-en-Y gastric bypass[-9.0 kg/m(2) ], horizontal gastroplasty [-5.0 kg/m(2) ], vertical banded gastroplasty [-6.4 kg/m(2) ], and adjustable gastric banding [-2.4 kg/m(2) ]. Bariatric surgery appears efficacious compared to standard care in reducing BMI. Weight losses are greatest with diversionary procedures, intermediate with diversionary/restrictive procedures, and lowest with those that are purely restrictive. Compared with Roux-en-Y gastric bypass, adjustable gastric banding has lower weight loss efficacy, but also leads to fewer serious adverse effects.

© 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

 

21438991

Grant Support

9.

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

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

[Article in Chinese]

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

Department of Minimally Invasive Surgery,ChanghaiHospital, TheSecondMilitaryMedicalUniversity,Shanghai200433,China.

OBJECTIVE:

To evaluate the outcomes after laparoscopic gastrointestinal surgery for patients with obesity and type 2 diabetes mellitus(T2DM).

METHODS:

From June 2003 to June 2010, 219 patients underwent laparoscopic gastrointestinal surgery for obesity and T2DM, including laparoscopic adjustable gastric banding(LAGB, n=201), laparoscopic mini gastricbypass(LMGB, n=13), and laparoscopic sleeve gastrectomy(LSG, n=5). Clinical data were analyzed retrospectively.

RESULTS:

The mean body mass index(BMI) of patients who received LAGB was 37.9 kg/m(2), and decreased to 32.4 kg/m(2) at 6 months and to 29.7 kg/m(2) at 12 months. In 43 patients who had concurrent T2DM, 11(25.6%) showed clinical partial remission(CPR) and 16(37.2%) clinical complete remission (CCR). Postoperative complications occurred in 26 patients(12.9%). The mean BMI of patients undergoing LMGB was 34.7 kg/m(2), and decreased to 31.6 kg/m(2) at 6 months and 26.9 kg/m(2) at 12 months after surgery. Ten patients had T2DM before operation, of whom 2(20.0%) had CPR and 7(70.0%) CCR postoperatively. Postoperative complications occurred in 2 patients(15.4%). The mean BMI of patients who underwent LSG was 43.8 kg/m(2), and was reduced to 38.1 kg/m(2) at 6 months and 34.3 kg/m(2) at 12 months after operation. Three patients were diagnosed with T2DM before operation. One patient (33.3%) had CPR and 1(33.3%) reached CCR after operation. There was 1(20.0%) patient who developed complication. No perioperative death occurred.

 

CONCLUSION:

Laparoscopic gastrointestinal surgery may result in satisfactory weight loss and clinical remission of T2DM with few complications.

 

21365507

 

[PubMed – in process]

Publication Types

10.

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

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

Kim Z,HurKY.

Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Hannam-dong, Yongsan-gu, Seoul 140-743, Korea.

BACKGROUND:

Type 2 diabetes mellitus (T2DM) has become an epidemic health problem worldwide. Compared to Western countries, inAsia, T2DM occurs in patients with a lower body mass index (BMI) due to central obesity and decreased pancreatic β-cell function. The efficacy of laparoscopic mini-gastric bypass(LMGB) in obese patients with T2DM has been proven by numerous studies. Treatment outcomes of LMGB for non-obese T2DM patients are also estimated to be excellent. The aim of the present pilot study was to evaluate the efficacy and safety of LMBG in non-obese T2DM patients (BMI 25-30 kg/m(2)).

METHODS:

Ten consecutive patients underwent LMGB at our hospital from August 2009 to October 2009. Preoperative data including glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2 h postprandial glucose (2-h PPG) were compared with data collected at 1, 3, and 6 postoperative months.

RESULTS:

All procedures were completed laparoscopically. Mean age of the patients was 46.9 years, mean BMI was 27.2 kg/m(2), mean operative time was 150.5 min, and mean postoperative hospital stay was 5.3 days. Neither mortality nor major complications occurred. Mean preoperative glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-h PPG, and C-peptide level were 9.7%, 222 mg/dl, 343 mg/dl, and 2.78 ng/ml, respectively. At the sixth postoperative month, HbA1c, FPG, 2-h PPG, and C-peptide level measured 6.7%, 144 mg/dl, 203 mg/dl, and 2.18 ng/ml.

CONCLUSIONS:

This preliminary study demonstrated the resolution of hyperglycemia in 70% of non-obese T2DM patients (BMI 25-30 kg/m(2)). Although long-term follow-up data are required, early operative outcomes were satisfactory in terms of glycemic control and safety of the procedure.

 

21165621

11.

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

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

Patel S, Szomstein S, Rosenthal RJ.

Bariatric and Metabolic Institute,ClevelandClinicFlorida,Weston,FL33331,USA.

BACKGROUND:

The rise of bariatric surgery has lead to an increasing number of reoperations for failed bariatric procedures. The reasons and types of these operations are varied in nature and remain to be defined.

METHODS:

A retrospective review of a prospectively collected database was conducted to identify patients who underwent laparoscopic revisional surgery for non-gastric banding-related bariatric procedures between 2001 and 2008.

RESULTS:

Of 384 secondary bariatric operations, 151 reoperative procedures were performed. Twenty-six vertical banded gastroplasties (17.2%), 2 mini-gastric bypasses (1.3%), 2 non-divided bypasses (1.3%), 1 distal Roux-en-Y gastric bypass (RYGBP; 0.7%), and 2 sleeve gastrectomies (1.3%) were converted to RYGBP. Three RYGBP (2%) and four jejunoileal bypass procedures (2.6%) were reversed secondary to malnutrition. One jejunoileal bypass (0.7%) and one biliopancreatic diversion (0.7%) underwent sleeve gastrectomies. Three pre-anastomotic rings were removed due to erosion (2%). Eleven pouch trimmings (7.3%), 16 redo gastrojejunostomies (10.6%), 5 redo jejunojejunostomies (3.3%), 36 remnant gastrectomies (23.8%), and 2 gastrogastric fistula takedowns (1.3%) were performed for pouch enlargements, strictures, and gastrogastric fistulas. Thirty-six patients (23.8%) underwent a combination of these procedures. The major morbidity (13.2%) was related to leaks. Other complications included wound infection, intra-abdominal abscess formation, and trocar site hernias. The mortality rate was 2%.

CONCLUSIONS:

Reoperative bariatric surgery is a complex and growing field in bariatric surgery. The indications for surgical reoperation can vary depending on the procedure and reason for intervention. Laparoscopy appears to be a feasible approach. Though safe, morbidity and mortality are significantly higher than in primary bariatric procedures.

 

20676940

12.

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

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.

Department of International Business,Ching-YunUniversity,Zhongli City,Taiwan. lyc6115@ms61.hinet.net

BACKGROUND/AIMS:

Bariatric surgery is the only long-lasting effective treatment to reduce body weight in morbid obesity. Previous literature in using data mining techniques to predict weight loss in obese patients who have undergone bariatric surgery is limited. This study used initial evaluations before bariatric surgery and data mining techniques to predict weight outcomes in morbidly obese patients seeking surgical treatment.

METHODOLOGY:

251 morbidly obese patients undergoing laparoscopic mini-gastric bypass (LMGB) or adjustable gastric banding (LAGB) with complete clinical data at baseline and at two years were enrolled for analysis. Decision Tree, Logistic Regression and Discriminant analysis technologies were used to predict weight loss. Overall classification capability of the designed diagnostic models was evaluated by the misclassification costs.

RESULTS:

Two hundred fifty-one patients consisting of 68 men and 183 women was studied; with mean age 33 years. Mean +/- SD weight loss at 2 year was 74.5 +/- 16.4 kg. During two years of follow up, two-hundred and five (81.7%) patients had successful weight reduction while 46 (18.3%) were failed to reduce body weight. Operation methods, alanine transaminase (ALT), aspartate transaminase (AST), white blood cell counts (WBC), insulin and hemoglobin A1c (HbA1c) levels were the predictive factors for successful weight reduction.

CONCLUSION:

Decision tree model was a better classification models than traditional logistic regression and discriminant analysis in view of predictive accuracies.

 

20214230

 

13.

J Chir (Paris). 2009 Feb;146(1):60-4.

[Laparoscopic mini-gastric bypass].

[Article in French]

Chevallier JM, Chakhtoura G, Zinzindohoué F.

Service de chirurgie digestive, hôpital Européen Georges-Pompidou,Paris. jean-marc.chevallier@egp.aphp.fr

 

19446695

14.

Surg Obes Relat Dis. 2009 May-Jun;5(3):383-6. Epub 2009 Jan 18.

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.

Bariatric and Metabolic Institute, Section of Minimally Invasive and Endoscopic Surgery,ClevelandClinicFlorida,Weston,Florida,USA.

 

19356992

15.

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

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

Peraglie C.

The Centers of Laparoscopic Obesity Surgery-Florida, Heart ofFloridaRegionalMedicalCenter, 40124 Highway 27,Davenport,FL,USA. drp@clos.net

BACKGROUND:

The ideal management of the super-super obese patient (SSO) is unclear and controversy exists as to the choice of procedure as well as the risk for increased morbidity and mortality. I present my experience of laparoscopic mini-gastric bypass (LMGB) in 16 SSO patients with early follow-up results.

METHODS:

Review of a prospectively maintained database was performed. All the patients underwent LMGB by a single surgeon (CP). Data collected included demographics, operative time, length of stay, complications, and weight loss. Follow-up data was obtained at office visits in addition to periodic telephone interviews and e-mails. All office follow-up and review of correspondence from Primary Care Physicians (PCP) was managed by the operating surgeon.

RESULTS:

Sixteen patients were identified as being SSO and comprise the study group. There were 14 women and two men. Average age was 40 years (27-61). Average weight and BMI were 166 (150-193) and 62.4 (60-73), respectively. All procedures were performed laparoscopically by a single surgeon with no conversion to open. Average operative time was 78 min (41-147 min) and hospital stay was 1.2 days. Intraoperative complications included a liver laceration in one patient and an enterotomy in another. Both were managed laparoscopically. No patients required readmission to the hospital, and there were no major complications or deaths. Weight loss showed a consistent increase over the follow-up period with 2 year results of 72 KG lost or 65% EWL.

CONCLUSION:

Laparoscopic mini-gastric bypass (MGB) is a technically simple and safe procedure in SSO patients. LMGB has the advantages of being a single stage procedure, being easily reversible and revisable in a laparoscopic procedure and does not sacrifice portions of the stomach or implant foreign materials. Weight loss appears favorable in the short term; however, information regarding long-term weight loss, durability, and safety profile in this population will require a greater number of patients and longer follow up.

 

18575943

16.

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

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.

Assistance Publique-Hôpitaux de Paris, University Paris 5,Paris,France.

BACKGROUND:

Since 2002, we have performed 350 laparoscopic Roux-en-Y gastric bypasses (LRYGB). We decided to evaluate the laparoscopic mini-gastric bypass (LMGB), an operation reported as effective, yet simpler than LRYGB. It consisted of a long lesser curvature tube with a terminolateral gastroenterostomy, 200 cm distal to the Treitz ligament.

METHODS:

From October 2006 to November 2007, 100 patients (23 men and 77 women) underwent LMGB. The mean age was 40.9 +/- 11.5 years (17.5-62.4), the preoperative mean body weight was 131 +/- 23.1 kg (82-203) and the mean BMI was 46.9 +/- 7.4 kg/m(2) (32.8-72.4). Twenty-four patients had prior restrictive procedure: 20 LAGB of which nine were already removed and four VBG (two laparoscopic and two by open surgery). In preoperative gastric endoscopy Helicobacter pylorii was present in 26 patients and eradicated.

RESULTS:

All procedures were completed laparoscopically by six different surgeons. Mean operative time was 129 +/- 37 min. There was no death. Seven patients (7%) presented major early complications: three reoperations for incarcerated herniation of small bowel in the trocar wound, one peritonitis due to a traumatic injury of the biliary limb, one perianastomotic abscess, one intraabdominal bleeding requiring splenectomy, and one endoscopic haemostasis for anastomotic bleeding. One patient presented anastomotic stenosis that required endoscopic dilatation 2 months postoperatively. Mean BMI at 3 months was 38.7 kg/m(2) (31.2-60.9) and at 6 months 35.1 (23.6-53.0). Nine patients complained of diarrhea that resolved 3 months postoperatively and, significantly, only two patients complained of biliary reflux.

CONCLUSION:

Pending long-term evaluation, LMBG seems a good alternative to LRYGB, giving the same results with a more simple and reproductible technique.

 

18566866

17.

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

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.

Department of Digestive Surgery, Hôtel-Dieu de France Hospital,Beirut,Lebanon. rnoun@wise.net.lb

BACKGROUND:

Laparoscopic mini-gastric bypass (MGB) is being increasingly performed worldwide. Results of MGB by mini-laparotomy (minilap MGB) are hereby reported.

METHODS:

126 patients undergoing minilap MGB from October 2004 to October 2006, were reviewed at an academic institution.

RESULTS:

Mean age was 35 +/- 11.4 years (range 15-72), preoperative BMI was 44 +/- 6.9 kg/m2 (range 35-61.8) and 80 (63.4%) were women. Co-morbidities were present in 42 (33.3%). Operative time was 144 +/- 15.8 minutes (range 120-160) and length of hospital stay was 3.32 +/- 0.62 days (range 2-18). There was no hospital mortality, and the in-hospital complication rate was 4.7%. No anastomotic leakage occurred, and the incidence of wound sepsis was 2.3%. The mean total cost of the procedure was 3408 +/- 547 USD (range 2967-6876). Five patients (3.9%) developed incisional hernias and 3 (2.3%) marginal ulcers. BMI at 6 months was 33.0 +/- 3.1 kg/m2 (range 26.8-43.5, P < 0.001) compared with preoperative value. At 1 year, mean excess weight loss was 68.4% and comorbidities resolved in 85%.

CONCLUSION:

Minilap MGB is a simple, safe, effective and low-cost gastric bypass. It represents an attractive cost-effective alternative to laparoscopic MGB.

 

18219775

 

18.

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

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.

Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taipei, Taiwan, Republic of China. wjlee_obessurg_tw@yahoo.com.tw

BACKGROUND:

Gastric bypass surgery is an effective and long-lasting treatment of morbidly obese patients. However, the bypass limb may need to be tailored in morbidly obese patients with a wide range of obesity. The aim of the present study was to report clinical result of tailored bypass limb in a group of patients receiving laparoscopic mini-gastric bypass surgery.

METHODS:

From Jan 2002 to Dec 2006, laparoscopic mini-gastric bypass was performed in 644 patients [469 women, 175 men: mean age 30.5 +/- 8.1 years; mean body mass index (BMI) 43.1 +/- 6.0] in our department. The gastric bypass limb was tailored according to the preoperative BMI. The clinical data and outcomes were analyzed. All the clinical data were prospectively collected and stored.

RESULTS:

Two hundred eighty-six patients belonged to lower BMI (BMI < 40; mean 36.0), 286 patients moderate BMI (BMI 40-50; mean 43.2), and 72 patients higher BMI (BMI > 50; mean 55.4). All procedures were completed laparoscopically. Mean operative time was 130 min, and mean hospital stay was 5.0 days. Twenty-three minor early complications (4.3%) and 13 major complications (2.0%) were encountered, with one death occurred (0.016%). There was no significant difference in operation time and complication rate between the groups. The mean bypass limb was 150 cm for the lower BMI group, 250 cm for moderate BMI group, and 350 cm for the higher BMI group. The mean BMI reduction 2 years after surgery was 10.7, 15.5, and 23.3 for the lower, moderate, and higher BMI group. The weight loss curves and resolution of obesity related comorbidities were compatible with the tailored bypass limbs between the groups. However, the lower BMI patients had more severe anemia than the other two groups.

CONCLUSION:

Morbidly obese patients receiving gastric bypass surgery may need to tailor the bypass limb according to BMI. The application of gastric bypass in lower BMI patients should be more carefully.

 

18193178

19.

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

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.

Graduate Institute of Business Administration,Fu-JenCatholicUniversity,TaipeiHsien,Taiwan.

BACKGROUND:

Surgery is the only long-lasting effective treatment for morbid obesity. Prediction on successful weight loss after surgery by data mining technologies is lacking. We analyze the available information during the initial evaluation of patients referred to bariatric surgery by data mining methods for predictors of successful weight loss.

METHODS:

249 patients undergoing laparoscopic mini-gastric bypass (LMGB) or adjustable gastric banding (LAGB) were enrolled. Logistic Regression and Artificial Neural Network (ANN) technologies were used to predict weight loss. Overall classification capability of the designed diagnostic models was evaluated by the misclassification costs.

RESULTS:

We studied 249 patients consisting of 72 men and 177 women over 2 years. Mean age was 33 +/- 9 years. 208 (83.5%) patients had successful weight reduction while 41 (16.5%) did not. Logistic Regression revealed that the type of operation had a significant prediction effect (P = 0.000). Patients receiving LMGB had a better weight loss than those receiving LAGB (78.54% +/- 26.87 vs 43.65% +/- 26.08). ANN provided the same predicted factor on the type of operation but it further proposed that HbAlc and triglyceride were associated with success. HbAlc is lower in the successful than failed group (5.81 +/- 1.06 vs 6.05 +/- 1.49; P = NS), and triglyceride in the successful group is higher than in the failed group (171.29 +/- 112.62 vs 144.07 +/- 89.90; P = NS).

CONCLUSION:

Artificial neural network is a better modeling technique and the overall predictive accuracy is higher on the basis of multiple variables related to laboratory tests. LMGB, high preoperative triglyceride level, and low HbAlc level can predict successful weight reduction at 2 years.

 

18074500

 

20.

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

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.

Department of Surgery, Min-Sheng General Hospital, and Department of International Business, Ching Yun University, Taoyuan, Taiwan, Republic of China. wjlee_obessurg_tw@yahoo.com.tw

BACKGROUND:

Laparoscopic gastric bypass resulted in significant weight loss and resolution of type 2 diabetes mellitus (T2DM). The current indication for bariatric surgery is mainly applied for patients with body mass index (BMI)>35 kg/m2 with comorbidity status. However, little is known concerning T2DM patients with BMI<35 kg/m2. Recent studies have suggested that T2DM patients with BMI<35 kg/m2 might benefit from gastric bypass surgery.

METHODS:

From Jan 2002 to Dec 2006, 820 patients who underwent laparoscopic mini-gastric bypass were enrolled in a surgically supervised weight loss program. We identified 201 (24.5%) patients who had impaired fasting glucose or T2DM. All the clinical data were prospectively collected and stored. Patients with BMI<35 kg/m2 were compared with those of BMI>35 kg/m2. Successful treatment of T2DM was defined by HbA1C<7.0%, LDL<100 mg/dl, and triglyceride<150 mg/dl.

RESULTS:

Among the 201 patients, 44 (21.9%) had BMI<35 kg/m2, and 114 (56.7%) had BMI between 35 and 45, 43 (21.4%) had BMI>45 kg/m2. Patients with BMI<35 kg/m2 are significantly older, female predominant, had lower liver enzyme and C-peptide levels than those with BMI>35 kg/m2. The mean total weight loss for the population was 32.1, 33.4, 31.9, and 32.8% (at 1, 2, 3, 5 years after surgery), and percentage to change in BMI was 31.9, 34.2, 32.2, and 29.5% at 1, 2, 3, and 5 years. One year after surgery, fasting plasma glucose returned to normal in 89.5% of BMI<35 kg/m2 T2DM and 98.5% of BMI>35 kg/m2 patients (p=0.087). The treatment goal of T2DM (HbA1C<7.0%, LDL<150 mg/dl and triglyceride<150 mg/dl) was met in 76.5% of BMI<35 kg/m2 and 92.4% of BMI>350 kg/m2 (p=0.059).

CONCLUSION:

Laparoscopic gastric bypass resulted in significant and sustained weight loss with successful treatment of T2DM up to 87.1%. Despite a slightly lower response rate of T2DM treatment, patients with BMI <35 still had an acceptable DM resolution, and this treatment option can be offered to this group of patients.

 

17940829

21.

J Chir (Paris). 2007 Jul-Aug;144(4):305-6.

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

[Article in French]

Chevallier JM.

Service de Chirurgie digestive, Hôpital Européen Georges Pompidou (HEGP), APHP -Paris. jean-marc.chevallier@egp.aphp.fr

Erratum in

•              J Chir (Paris). 2007 Nov-Dec;144(6):566.

Comment on

•              [Laparoscopic mini-gastric bypass: an effective option for the treatment of morbid obesity]. [J Chir (Paris). 2007]

 

17925735

22.

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

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

[Article in French]

Noun R, Zeidan S.

Département de Chirurgie Digestive, Hôtel Dieu de France, UniversitéSaint Joseph- Beyrouth, Liban. rnoun@wise.net.lb

OBJECTIVE:

To evaluate laparoscopic Mini-Gastric Bypass in the treatment of morbid obesity.

PATIENTS AND METHODS:

Thirty patients with a mean BMI of 41.84.5 Kg/M2 underwent a laparoscopicMini-Gastric Bypass between March 2005 and February 2006. A laparoscopic approach with five trocar incisions was used to create a long narrow gastric tube; this was then anastomosed ante-colically to a loop of jejunum 200 cm. distal to the ligament of Treitz Peri-operative and short-term follow-up results up to May 2006 are reported.

RESULTS:

Conversion to open mini-gastric bypass was necessary in one case (3.3%). Mean operative time was 135 45 minutes. There were no deaths. There were no anastomotic leakages. Two patients developed obstruction at the gastrojejunostomy requiring laparoscopic correction in one case and accounting for an overall morbidity of 6.6%. Mean hospital stay was 3 0.25 days. One patient developed marginal ulcer which resolved with medical treatment; no patients developed symptoms of reflux esophagitis. Mean loss of excess weight was 67.6% at one year and was accompanied by resolution of obesity-associated medical illness in 85% of patients.

CONCLUSION:

Laparoscopic Mini-Gastric Bypass is a technically simple, safe, and effective procedure in the treatment of morbid obesity and its associated medical illnesses. Moreover, the procedure is easily reversible laparoscopically when post-operative complication occurs.

Comment in

•              [Commentary. Invited comment on the article by Noun et al. about Laparoscopic mini-gastric bypass…]. [J Chir (Paris). 2007]

 

17925734

23.

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

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.

Institute of Microbiology and Biochemistry,CollegeofLife Science,NationalTaiwanUniversity, ROC.

BACKGROUND:

Variability in weight loss has been observed from morbidly obese patients receiving bariatric operations. Genetic effects may play a crucial role in this variability.

METHODS:

304 morbidly obese patients (BMI > or =39) were recruited, 77 receiving laparoscopic adjustable gastric banding (LAGB) and 227 laparoscopic mini-gastric bypass (LMGB), and 304 matched non-obese controls (BMI < or =24). Initially, all subjects were genotyped for 4 SNPs (single nucleotide polymorphisms) on UCP2 gene in a case-control study. The SNPs significantly associated with morbid obesity (P < 0.05) were considered as candidate markers affecting weight change. Subsequently, effects on predicting weight loss of those candidate markers were explored in LAGB and LMGB, respectively. The peri-operative parameters were also compared between LAGB and LMGB.

RESULTS:

The rs660339 (Ala55Val), on exon 4, was associated with morbid obesity (P = 0.049). Morbidly obese patients with either TT or CT genotypes on rs660339 experienced greater weight loss compared to patients with CC after LAGB at 12 months (BMI loss 12.2 units vs 8.1 units) and 24 months (BMI loss 13.1 units vs 9.3 units). However, this phenomenon was not observed in patients after LMGB. Although greater weight loss was observed in patients receiving LMGB, this procedure had a higher operative complication rate than LAGB (7.5% vs. 2.8%; P < 0.05).

CONCLUSION:

Ala55Val may play a crucial role in obesity development and weight loss after LAGB. It may be considered as clinicians incorporate genetic susceptibility testing into weight loss prediction prior to bariatric operations.

 

17894153

 

24.

Obes Surg. 2007 May;17(5):684-8.

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.

Department of Digestive Surgery , Hôtel-Dieu de France Hospital,Beirut,Lebanon. rnoun@wise.net.lb

Erratum in

•              Obes Surg. 2007 Jul;17(7):996.

BACKGROUND:

Despite the initial success of primary gastric restrictive operations, many patients require revision for weight regain, mechanical complications or intolerance to restriction. The mini-gastric bypass(MGB) for revision of failed primary restrictive procedures was evaluated.

METHODS:

33 patients undergoing revisional surgery to a MGB for a failed silastic ring vertical banded gastroplasty (VBG) or a gastric banding (GB) from June 2005 to September 2006, were reviewed at an academic institution. The patients had had a minilaparotomy. Revision of the VBGs was further compared with revision of the GBs.

RESULTS:

The MGB was completed in all except 2 patients who required Roux-en-Y gastric bypass(RYGBP) because of gastric tube damage. Mean age was 41 years (range 20-64), preoperative BMI was 39.5 kg/m2 (range 28-58), and 20 (65%) were women. The revision was performed after an average of 36.3 months (range 12-84), and was more time-consuming in patients with prior VBG than GB (184 vs 155 min, P=0.007). Postoperative complications occurred in 2 (6.4%) with prior VBG, and length of hospital stay was 4.65 days (range 3-17). Mean BMI at 6 months was 30.6 (range 24.8-50.0, P<0.001) compared with the preoperative BMI. Reflux disease was cured, and all patients noted major improvement in the eating dimension.

CONCLUSION:

Open MGB through a previous mini-incision is a safe and effective operation for revision of failed gastric restrictive operations. The revision procedure was technically more difficult in patients with prior VBG and hazardous in patients with prior redo VBG.

 

17658031

 

25.

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

Hospitalization before and after mini-gastric bypass surgery.

Rutledge R.

Center for Excellence in Laparoscopic Obesity Surgery,Henderson,NV89052,USA. drr@clos.net <drr@clos.net>

The mini-gastric bypass (MGB) was developed to address some of the limitations of the Roux-en-Y gastricbypass (“RNY”). The RNY has recently been reported to increase the need for hospitalization for complications after RNY surgery. To determine the rates and indications for inpatient hospital use before and after MGB in comparison to similar rates in RNY. The study is a self reported retrospective study of patients from across theUnited Statesreceiving MGB in Centers for Excellence in Laparoscopic Obesity Surgery (“CELOS”) hospitals from 2000 to 2005. Complications and hospitalization in the year before and in the 1 to 5 years after MGB. 1069 patients who underwent MGB were selected for study. The rate of hospitalization in the year following MGB was 67% of the rate in the year preceding MGB (11% vs. 17%, P<0.001). The most common reasons for admission prior to MGB were general medical problems (38%) obstetric and Gynecological issues (36%), orthopedic problems (16%), gallbladder surgery (9%) and renal stones in 2%. The most common reasons for hospital admission after MGB were complications from surgery (29%), gallbladder surgery (20%), renal stones (14%), plastic surgery procedures (11%), appendectomy (9%), Gynecologic issues (9%) and orthopedic problems (6%). Thus while MGB complications made up a third of hospital readmissions following MGB surgery the over all hospitalization rates declined significantly. Previous studies have demonstrated that hospitalization after RNY gastric bypass increases remarkably (20% per year). The present study shows that hospitalization following MGB instead of rising, as reported with RNY, decreases by a third. The MGB has been shown to be a short, safe successful weight loss surgery in previous work. The present study supports the MGB as a low risk procedure that decreases the need for hospitalization.

 

17386913

 

26.

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

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

Peraglie C.

The Centers of Excellence for Laparoscopic Obesity Surgery,Houston,TX77380,USA. drp@clos.net

A 42-year-old morbidly obese female, homozygous for Factor V Leiden, underwent mini-gastric bypass without complications. The recommendations for prophylaxis in this high-risk population are unclear and most likely involve a combination of pharmacologic and non-pharmacologic measures.

 

17355777

27.

Surg Obes Relat Dis. 2007 Jan-Feb;3(1):37-41. Epub 2006 Dec 27.

Surgical revision of loop (“mini”) gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass.

Johnson WH,FernanadezAZ, Farrell TM, Macdonald KG, Grant JP, McMahon RL, Pryor AD, Wolfe LG, DeMaria EJ.

Department of Surgery,DukeUniversityMedicalCenter,Durham,North Carolina,USA.

BACKGROUND:

The claim that the “mini”-gastric bypass (MGB) procedure with its loop gastrojejunostomy is safer and equally effective to the Roux-en-Y gastric bypass (RYGB) procedure has been promoted before validation. Rumors of unreported complications and the accuracy of follow-up are additional concerns. This study was undertaken to identify MGB patients who require or required revisional surgery at 5 hospitals within the region of theUnited Stateswhere the MGB procedure originated to assess the claim that revision to RYGB is rarely needed.

METHODS:

The databases of 5 medical centers were retrospectively searched to identify patients undergoing surgical revision after a MGB procedure, all of which had been done elsewhere.

RESULTS:

A total of 32 patients were identified who presented with complications after undergoing an MGB procedure and required or require revisional surgery. The complications included gastrojejunostomy leak in 3, bile reflux in 20, intractable marginal ulcer in 5, malabsorption/malnutrition in 8, and weight gain in 2. Of the 32 patients, 21 required conversion to RYGB and an additional 5 have planned revisions in the future. Also, 2 patients were treated with Braun enteroenterostomies and 4 required 1 or more abdominal explorations.

CONCLUSIONS:

The results of this preliminary review have confirmed that MGB does require revision in some patients and that conversion to RYGB is a common form of revision. A national registry to record the complications and number of revisions is proposed to gain insight into the need for revision after MGB and other nontraditional bariatric procedures.

 

17196443

29.

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

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

Noun R, Zeidan S, Safa N.

Department of Digestive Surgery, Hôtel-Dieu de France Hospital,Beirut,Lebanon. rnoun@wise.net.lb

Acute obstruction of jejunal limbs after gastric bypass surgery is rare but can result in a catastrophic scenario if the diagnosis is delayed. We report a 31-year-old female who developed acute efferent limb obstruction after a laparoscopic mini-gastric bypass (MGB), manifested as recurrent episodes of epigastric discomfort and bile-stained vomiting. The diagnosis was evident on oral contrast studies. She was successfully treated by a salvage laparoscopic side-to-side anastomosis between the efferent limb and the afferent limb 4 cm distal to the gastro-jejunostomy. Acute obstruction of the efferent limb after a MGB operation can be easily diagnosed and effectively treated by laparoscopic latero-lateral jejuno-jejunostomy.

 

17132422

30.

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

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

Rutledge R, Dorghazi P, Peralgie C.

The Centers for Excellence in Laparoscopic Obesity Surgery,Henderson,NV,USA. DrR@clos.net

BACKGROUND:

Obesity is associated with elevated levels of estrogen. Gastric bypass causes rapid weight loss and decreased levels of estrogen. Patients after gastric bypass can suffer from anxiety and depression out of proportion to the surgical outcome. This study reports the efficacy of a short-term empiric trial of topical estradiol for the treatment of mild to moderate depression and anxiety following mini-gastric bypass (MGB) in women.

METHODS:

Postoperative MGB women were surveyed for the presence of depressive symptoms before and after MGB. The results of an empiric trial of transdermal patches of estradiol-17beta were assessed. Outcome measures were the self-reported efficacy of the patch.

RESULTS:

711 women who had undergone MGB and had functioning e-mail addresses made up the study. 62% of patients reported depression prior to surgery. 156 patients (22%) reported depression after the operation. 130 women were treated empirically with the patch, and remission of depression was observed in 92 (71%). In response to the question “Did the estrogen patch help?”, subjects reported responses of 1) Yes, fantastic, 2) Yes, somewhat, 3) Hard to say, 4) No, in 36%, 31%, 20%, 13% of respondents respectively. Patients treated with estradiol sustained antidepressant benefit of treatment after the patch was discontinued. Treatment lasted <1 month, 1-3 months, and >3 months, in 48%, 32% and 20% respectively. Treatment was well-tolerated and adverse events were rare.

 

CONCLUSION:

Depression is common in obese patients and remains a problem in a subset following the MGB operation. Transdermal estradiol replacement appears to be an effective treatment of symptoms of depression in women following MGB.

 

16989708

31.

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

Prevention of trocar-wound hernia in laparoscopic bariatric operations.

Chiu CC, Lee WJ, Wang W,Wei PL,HuangMT.

Department of Surgery,Chi-MeiHospital- LiouYing Campus,Taiwan.

BACKGROUND:

Morbid obesity is a risk for fascial wound dehiscence and incisional hernia after abdominal surgery. The development of minimally invasive surgical techniques has led to a dramatic decrease in these complications. However, laparoscopic surgery may still be followed by trocar-wound herniation. Various methods have been advocated for its prevention.

METHODS:

The records of 752 patients who underwent laparoscopic bariatric operations (610 mini-gastricbypass and 142 gastric banding) as treatment for morbid obesity between October 2001 and June 2005, with regular follow-up, were retrospectively reviewed. In all patients, the fascial layer of trocar wounds was not closed. Instead, a Surgicel plug was inserted into the muscle layer of trocar wounds of 10- and 12-mm diameter.

RESULTS:

2 male patients in the mini-gastric bypass group developed a trocar wound hernia, for an overall prevalence of 0.33% (2/610). The intervals between surgery and diagnosis were 3 and 5 months respectively. In these 2 patients, the hernia occurred at the 12-mm trocar wound of the left midclavicular line, 2-3 cm below the costal margin, outside the left rectus muscle. These 2 patients have not developed intestinal obstruction as a consequence of the hernia, and have not undergone hernia repair. No patient in the gastric banding group has been found to develop a hernia.

CONCLUSION:

With our technique, the prevalence of trocar-wound hernia after laparoscopic bariatric surgery has been very rare.

 

16839493

32.

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

Revision of failed gastric banding to mini-gastric bypass.

Rutledge R.

The Centers for Excellence in Laparoscopic Obesity Surgery (CELOS),Las Vegas,NV89144,USA. DrR@clos.net

BACKGROUND:

Although laparoscopic adjustable gastric banding (LAGB) has been found to be a generally successful weight loss operation, there are reports of occasional LAGB failure. The results of rescue procedures for these patients are important. The mini-gastric bypass (MGB) is a safe and effective alternative to other bariatric surgical procedures. We report the results of conversion of 3 failed LAGB procedures to MGB.

METHODS:

In a series of 2,595 patients who underwent MGB, 3 had previously undergone an LAGB that failed to sustain weight loss.

RESULTS:

Average operative time was 54 minutes in LAGB conversions to MGB (compared to 37.5 minutes in primary MGB), and length of stay was 1 day. There were no complications in the patients converted MGB. The weight loss in converted MGB patients was similar to the weight loss in primary MGB patients, with a mean weight loss at 1 year of 60 kg (79% of excess weight)

CONCLUSION:

Conversion of failed LAGB to MGB was a safe procedure that added approximately 20 minutes to the short MGB operating time. Patient satisfaction was high, recovery was rapid, and weight loss was very good.

 

16608620

33.

Nat Clin Pract Gastroenterol Hepatol. 2006 Jan;3(1):16-7.

Is laparoscopic Roux-en-Y gastric bypass superior to mini-gastric bypassfor the treatment of morbid obesity?

LivingstonEH.

UniversityofTexasSouthwesternSchoolofMedicine,Dallas,TX75390-9156,USA. edward.livingston@utsouthwestern.edu

Comment on

•              Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. [Ann Surg. 2005]

 

16397605

 

[PubMed]

 

Publication Types

34.

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

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

Rutledge R, Walsh TR.

The Centers of Excellence for Laparoscopic Obesity Surgery (CELOS),Las Vegas,NV89144,USA. dr_rrutledge@hotmail.com

BACKGROUND:

There is a growing body of evidence showing that the Mini-Gastric Bypass (MGB) is a safe and effective alternative to other bariatric surgical operations. This study reports on the results of a consecutive cohort of patients undergoing the MGB.

METHODS:

A prospective database was used to continuously assess the results in 2,410 MGB patients treated from September 1997 to February 2004.

RESULTS:

The average operative time was 37.5 minutes, and the median length of stay was 1 day. The 30-day mortality and complication rates were 0.08% and 5.9% respectively. The leak rate was 1.08%. Average weight loss at 1 year was 59 kg (80% of excess body weight). The most frequent long-term complications were dyspepsia and ulcers (5.6%) and iron deficiency anemia (4.9%.) Excessive weight loss with malnutrition occurred in 1.1%. Weight loss was well maintained over 5 years, with <5% patients regaining more than 10 kg.

CONCLUSIONS:

Overall, the MGB is very safe initially and in the long-term. It has reliable weight loss and complications similar to other forms of gastric bypass.

 

16259892

35.

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

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.

Department of Surgery,En-ChuKongHospitalandSchool of Nursing,Taiwan. wjlee@km.eck.org.tw

OBJECTIVES:

This prospective, randomized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic mini-gastric bypass (LMGBP) in the treatment of morbid obesity.

SUMMARY BACKGROUND DATA:

LRYGBP has been the gold standard for the treatment of morbid obesity. While LMGBP has been reported to be a simple and effective treatment, data from a randomized trial are lacking.

METHODS:

Eighty patients who met the NIH criteria were recruited and randomized to receive either LRYGBP (n = 40) or LMGBP (n = 40). The minimum postoperative follow-up was 2 years (mean, 31.3 months). Perioperative data were assessed. Late complication, excess weight loss, BMI, quality of life, and comorbidities were determined. Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI).

RESULTS:

There was one conversion (2.5%) in the LRYGBP group. Operation time was shorter in LMGBP group (205 versus 148, P < 0.05). There was no mortality in each group. The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05). The late complications rate was the same in the 2 groups (7.5%) with no reoperation. The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05). A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted. Both gastrointestinal quality of life increased significantly without any significant difference between the groups.

CONCLUSION:

Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.

Comment in

•              Is laparoscopic Roux-en-Y gastric bypass superior to mini-gastric bypass for the treatment of morbid obesity?[Nat Clin Pract Gastroenterol Hepatol. 2006]

 

15973097

 

[

PMCID:

 

PMC1357700

Free PMC Article

36.

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

Short-term results of laparoscopic mini-gastric bypass.

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

Department of Surgery,En-Chu-KongHospital,Taipei,Taiwan.

BACKGROUND:

The laparoscopic mini-gastric bypass (MGB) is a modification of Mason’s loop gastricbypass, but with a long lesser curvature tube. With weight loss results similar to laparoscopic Roux-en-Y gastric bypass (LRYGBP), the MGB is a simpler operation with a low complication rate. Controversy exists concerning the efficacy and side-effects of this procedure. This report presents the technique of laparoscopic MGB and its results in 423 patients.

METHODS:

From October 2001 to October 2004, 423 consecutive patients (87 males and 336 females) underwent laparoscopic MGB (LMGB) for morbid obesity. Mean age was 30.8 years, preoperative mean weight 120.3 kg and mean BMI 44.2 kg/m2.

RESULTS:

All procedures were completed laparoscopically. Mean operative time was 130.8 minutes, and mean hospital stay was 5.0 days. 18 minor early complications (4.3%) were encountered, and 7 major complications (1.7%) occurred. Marginal ulcers were noted in 34 patients (8.0%) during follow-up, and anemia was found in 41 patients (9.7%). Mean BMI decreased to 29.2 and 28.4 kg/m2 at 1-year and 2-year follow-up, with mean excess weight loss 69.3% and 72.2%. The Gastrointestinal Quality of Life Index improved significantly 1 year after the operation.

CONCLUSIONS:

LMGB has a low complication and mortality rate. The learning curve is less steep than for LRYGBP, whereas the efficacy is similar.

 

15946455

37.

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

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

[Article in Romanian]

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

Clinica de Chirurgie Generală, Spitalul Clinic Sfântul Ioan, Bucureşti. catcop63@yahoo.com

The mini-invasive treatment of morbid obesity represents a priority of our surgical team. The majority of the patients have been operated on restrictive bariatric procedures. The technique we are presenting is indicated for the extreme and super obese patients (BMI >50 kg/m2) for whom the restrictive procedures are less efficient. In these situations we have performed a mixed procedure, combining two principles restriction and malabsorption by creating a low capacity gastric tube connected to the jejunum through a linear stapled anastomosis. The name of these procedure is mini gastric bypass and our experience is consisting of 7 patients, with BMI between 52.7 and 71.69 kg/m2, with very important comorbidities. In this paper we are describing the specifics of the laparoscopic approach and the postoperative results at 3-18 months. We have recorded one conversion to the open surgery, two hemorrhagic postoperative complications and one marginal ulcer (3 month post-operatively); all complications were treated conservatively. All the patients lost weight, the EWL at 12 months was between 45.26% and 77.65%, while the co-morbidities had a significant good evolution. The procedure was efficient, well accepted and tolerated by the patients.

 

15739671

 

38.

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

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

García-Caballero M, Carbajo M.

Department of Surgery. UniversityMalaga.Campo GrandeHospital.Valladolid. España. gcaballe@uma.es

The One Anastomosis Gastric Bypass has been developed from the Mini Gastric Bypass procedure as originally described by Robert Rutledge. The modification of the original procedure consists of making a latero-lateral gastro-jejunal anastomosis instead of a termino-lateral anastomosis, as is carried out as described in the original procedure. The rationale for these changes is to try to reduce exposure of the gastric mucosa to biliopancreatic secretions because of their potentially carcinogenic effects with longer term exposure, which is the major criticism of the original technique. If we fix the jejunal loop to the gastric pouch some centimetres up to the gastro-jejunal anastomosis the biliopancreatic secretions have less possibility of coming into the gastric cavity (gravity force). Furthermore, if the anastomosis is latero-lateral this possibility is reduced even more. In addition, the intestinal loop reinforces the staple line against disruption, and also the gastric pouch against dilatation.

 

15672654

 

39.

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

Laparoscopic mini-gastric bypass for failed vertical banded gastroplasty.

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

Department of Surgery,En-Chu-KongHospital,Taipei,Taiwan.

BACKGROUND:

Bariatric surgery is the only method for sustained weight loss in morbid obesity. However, 10-25% of patients will require re-operation for unsatisfactory weight loss or weight regain after restrictive surgery. Re-operation is associated with higher morbidity and mortality. This study is to evaluate the s a fety and efficacy of laparoscopic mini-gastric bypass (LMGB) for failed vertical banded gastroplasty (VBG).

METHODS:

From May 2001 to March 2003, 29 consecutive patients underwent LMGB for failed VBG. Average age was 39.7 years (range 22 to 56), and average BMI before re-operation was 41.7 kg/m(2) (range 35.0-70.8). 8 patients had previous open VBG, and 21 had laparoscopic VBG. The re-operation was for regain of weight in 16 patients, inadequate weight loss in 10 patients, and severe reflux esophagitis in 3 patients. Re-operation was performed after an average of 58.5 months (range 14 to 180).

RESULTS:

All the re-operations were completed laparoscopically. Average operative time was 171.4 minutes (range 130 to 290). There was 1 mortality, due to leakage (3.4%). 1 re-operation was necessary, for incarceration of small bowel in a trocar wound 10 days after the LMGB (3.4%). 1 anastomotic site bleeding and 1 wound infection occurred. Average BMI 12 months after the LMGB was 32.1 kg/m(2) (range 26.4 to 42.7). The quality of life study was significantly improved. The revision operation had much more technical difficulty for those with previous open VBG than laparoscopic VBG.

CONCLUSION:

LMGB is an effective and safe revision operation for patients with failed VBG. A large series and long-term follow up is needed for confirmation.

 

15318981

40.

Obes Surg. 2003 Apr;13(2):318.

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

Rutledge R.

Comment on

•              The Magenstrasse and Mill operation for morbid obesity. [Obes Surg. 2003]

 

12740148

 

41.

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

Mini-gastric bypass controversy.

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

 

11775581

 

42.

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

More on mini-gastric bypass.

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

Comment on

•              The mini-gastric bypass: experience with the first 1,274 cases. [Obes Surg. 2001]

 

11501371

 

43.

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

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

Rutledge R.

Center for Laparoscopic Obesity Surgery,4301 Ben Franklin Blvd.,Durham,NC27704,USA. DrR@clos.net

BACKGROUND:

Results of the laparoscopic Mini-Gastric Bypass (MGB) are reported.

METHODS:

1,274 MGB patients are continuously monitored as part of an online computer tracking data-base system.

RESULTS:

Mean preoperative weight (+/- Standard Deviation) was 132 +/- 21 kg, BMI 47 +/- 7. Mean excess weight loss was 51% at 6 months, 68% at 12 months and 77% at 2 years. The mean operating-time was 36.9 +/- 33.5 minutes. The shortest time was 19 minutes. Hospital stay was 1.5 +/- 1.6 days. The overall complication rate has been 5.2%. The overall rate of deep vein thrombosis and pulmonary embolism was 0.08% and 0.16% respectively. The leak rate was 1.6%. There was one hospital death, 0.08%. Associated medical illnesses were either completely reversed or markedly improved.

CONCLUSIONS:

The MGB is safe, results in major weight loss, has a short operating-time, and has a short hospital stay. The MGB appears to meet many of the criteria of an “ideal” weight loss operation.

Comment in

•              More on mini-gastric bypass. [Obes Surg. 2001]

 

11433900

 

Nutr Hosp. 2012 Mar-Apr;27(2):623-31.

Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with One Anastomosis Gastric Bypass.

García-Caballero M, Valle M, Martínez-Moreno JM, Miralles F, Toval JA, Mata JM, Osorio D, Mínguez A.

Departamento de Cirugía, Facultad de Medicina, Universidad de Málaga,Málaga,Spain. gcaballe@uma.es

INTRODUCTION:

Diabetes mellitus type 2 (DMT2) is a major cause of death in the world. The medical therapy for this disease has had enormous progress, but it still leaves many patients exposed to the complications developed from the disease. It is well known the beneficial effects of bariatric surgery in obese diabetic patients, however it is important to investigate if the same principles of bariatric surgery that improve diabetes in obese patients, could be applied to non obese normal weight diabetics.

MATERIAL AND METHODS:

Thirteen diabetic patients operated by One Anastomosis Gastric Bypass (BAGUA), were evaluated in the preoperative period and 1,3 and 6 months after surgery. Body weight and composition, Fasting Plasma Glucose, HbA1c levels, blood pressure and serum lipids levels were analyzed, as well as the monitoring of the immediate postoperative treatment necessities for Diabetes and other metabolic syndrome comorbidities.

RESULTS:

After the surgery the 77% of the patients resolves its T2DM, 46% from surgery, and rest noted an significant improvement of the disease in spite of having a C peptide level near to zero some of the patients. The comorbidities, mainly hypertension and lipid abnormalities experience improvement early. All patients reduce their weight and the amount of fat mass until values consistent with their age and height.

CONCLUSIONS:

The One Anastomosis Gastric Bypass leads to resolution or improvement of T2DM in non obese normal weight patients. The best results are obtained in patients with few years of diabetes, without or short term use of insulin treatment and high C-peptide levels. 22732993 [PubMed – in process] Free full text

 

4.

Obes Surg. 2005 May;15(5):719-22.

Drain erosion and gastro-jejunal fistula after one-anastomosis gastric bypass: endoscopic occlusion by fibrin sealant.

Garcia-Caballero M, Carbajo M, Martinez-Moreno JM, Sarria M, Osorio D, Carmona JA.

Department of Surgery, UniversityMalaga,Spain. gcaballe@uma.es

Leakage and fistula are feared complications after gastro-intestinal anastomosis. A 36-year-old female underwent an one-anastomosis gastric bypass. The 24-h routine radiological study before oral intake showed a tiny leak, which was treated by NPO and I.V. fluids. After 5 days, despite output reduction, total parenteral nutrition was commenced. After 8 days, the leak remained with reduced output. It was then occluded endoscopically by fibrin glue. To our surprise, we found the drain that we had left behind the anastomosis, inside the gastric pouch. We began withdrawing the drain and occluded the defect with 4 ml Tissucol. After 48-h of no output, a repeat radiological study showed persistence of the leak. 6 days later, a radiological study demonstrated total closure of the leak. 15946469 [

 

 

5.

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

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.

Department of Surgery, HospitalCampo Grande,Valladolid,Spain.

BACKGROUND:

One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divided 25-ml (estimated) gastric pouch between the esophago-gastric junction and the crow’s foot level, parallel to the lesser curvature, which is anastomosed latero-laterally to a jejunal loop 200 cm distal to the ligament of Treitz.

METHODS:

The results of our first 209 OAGB patients operated from July 2002 to June 2004 are reported. Mean age was 41 years (14-66), BMI 48 (39-86) and mean excess body weight 66 kg (35-220). In 144 patients, OAGB was the only operation performed, and in 61 patients it was accompanied by other surgery (18 cholecystectomies, 5 incisional hernia repairs, and 38 adhesiolysis), and in 4 patients a restrictive bariatric operation had been performed previously.

RESULTS:

2 patients (0.9%) were converted to open surgery due to uncontrollable bleeding. 3 patients (1.4%) needed re-operation in the immediate postoperative period. 5 patients (2.3%) needed prolonged hospital stay due to acute pancreatitis in 1 and anastomotic leakage in 4, all resolving with conservative treatment. 2 patients died (0.9%), 1 from fulminant pulmonary thromboembolism and 1 from nosocomial pneumonia. Long-term complications have occurred in only 2 patients who developed clinically significant iron-deficiency anemia. Mean excess weight loss was 75% after 1 year and >80% at 2 years.

CONCLUSION:

OAGB is a simple, safe and effective operation with less perioperative risk than conventional gastric bypass, quicker return to normal activities, and better quality of life. 15826476 [

 

 

6.

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

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

García-Caballero M, Carbajo M.

Department of Surgery. UniversityMalaga.Campo GrandeHospital.Valladolid. España. gcaballe@uma.es

The One Anastomosis Gastric Bypass has been developed from the Mini Gastric Bypass procedure as originally described by Robert Rutledge. The modification of the original procedure consists of making a latero-lateral gastro-jejunal anastomosis instead of a termino-lateral anastomosis, as is carried out as described in the original procedure. The rationale for these changes is to try to reduce exposure of the gastric mucosa to biliopancreatic secretions because of their potentially carcinogenic effects with longer term exposure, which is the major criticism of the original technique. If we fix the jejunal loop to the gastric pouch some centimetres up to the gastro-jejunal anastomosis the biliopancreatic secretions have less possibility of coming into the gastric cavity (gravity force). Furthermore, if the anastomosis is latero-lateral this possibility is reduced even more. In addition, the intestinal loop reinforces the staple line against disruption, and also the gastric pouch against dilatation.

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