EVALUATION OF LONG LOOP OMEGA VERTICAL GASTRIC BYPASS (LLOV GBP) AS A SURGICAL TREATMENT OF MORBID OBESITY

Abstract

SUMMARY AND CONCLUSION C hronic diseases are well established as the predominant death cause, and obesity, being one of the factors strongly contributive to chronic diseases, has been consistently threatening the global health. As of June 2013, The American Medical Association (AMA) has officially recognized obesity as a disease based on the belief that “recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately 1 in 3 Americans”. Obesity affects many health issues and is associated with a range of cardio-metabolic health issues, which exacerbate costs. Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer (e.g. endometrial, colon, and breast cancers). Bariatric surgery has long been introduced for weight control if conservative treatment failed and was widely accepted in the past decades. Compared with nonsurgical strategies, bariatric surgery proves more effectiveness for moderately to severely obese people to lose weight. Besides, bariatric surgery was demonstrated to induce significant and long-term remission of obesity related comorbidities. Bariatric surgical techniques include Malabsorptive, Restrictive and combined procedures which depend on both malabsorption and decrease in size of the stomach, as, Roux en-Y and Mini-Gastric Bypass surgeries. Laparoscopic gastric bypass is the preferred surgical procedure for Morbid Obesity based on its reported efficacy and complications profile. Current estimates indicate that a mean percentage excess weight loss (EWL%) of 61.6–62.2% is achieved. Mini-Gastric Bypass (MGB), pioneered by Rutledge is a procedure employing a long, narrow sleeve gastric tube in conjunction with an ante-colic loop gastro-jejunal anastomosis. This variety of gastric bypass has the technical advantages of using a tension-free, gastro-jejunal anastomosis and of avoiding a R-Y limb construction and its potential complications. We modified the technique of Omega-Loop Single Anastomosis Gastric Bypass with the objective of reducing the complications of both Roux en-Y Gastric Bypass and Mini Gastric Bypass. We perform Long Loop Omega Vertical Gastric Bypass (LLOV GBP). This procedure is composed of a small 30 ml gastric pouch similar to Roux en-Y Gastric Bypass, a loop gastro-jejunostomy at 200 – 250 cm from ligament of Trietz, similar to that of Mini Gastric Bypass, a gastro-jejunal anastomosis constructed in a vertical fashion to minimize reflux with a wide stoma (30-45 mm) for better drainage. According to our results, Long Loop Omega Vertical Gastric Bypass (LLOV GBP) is an effective and safe procedure that results in weight loss comparable to that of Roux en-Y Gastric Bypass and Mini Gastric Bypass. The technical modifications performed with the objective of minimizing the complications of jejuno-jejunostomy in Roux en-Y Gastric Bypass, minimizing the incidence of bile reflux gastritis associated with Mini Gastric Bypass and improving weight loss. LLOV GPB seems to be a promising bariatric procedure which is technically feasible, safe with low rate of complications even in patients with high BMI, and effective in achieving and maintaining significant weight loss and resolution of obesity related co-morbidities.