Role of Laparoscopic Mini-Gastric Bypass in Management of Morbid Obesity

Abstract

Summary A s the number of morbid obese patients is increasing, bariatric surgery is considered the only effective treatment for long-term sustainable weight loss. Different operations have been developed to achieve sustainable, significant weight loss with minimal invasion and complications, but until now there is no ideal choice, each operation still have reported complication and disadvantages. However, most of the patients accept the risk because of their miserable and limited life secondary to morbid obesity. The risk of weight regain is the problem of all kinds of bariatric surgeries, to reach the best method one should tailor the choice according to the patient’s life style, comorbidities, eating habits, BMI with the least risk of complication. Bariatric surgical techniques include Malabsorptive procedures, Restrictive procedures and combined procedures which depend on both malabsorption and decrease size of the stomach, as, roux-en-y and minigastric bypass surgeries. Roux-en-Y gastric bypass is the most frequent performed bariatric procedure. It has both restrictive and malabsorptive aspects. But it has also some complications e.g., infection, venous thromboembolism, hemorrhage, hernia, bowel obstruction and complication of gastric bypass e.g., anastomotic leakage, stricture, ulcer and nutritional deficiencies. In 1997, Rutledge with the purpose to carry out an ideal weight loss operation which should be effective, easy to perform and safe, introduced laparoscopic minigastric bypass (LMGB). The procedure consists of a long lesser-curvature gastric tube with a side-to-side gastrojejunostomy performed 180–220 cm distal to the Treitz’ ligament. In 2001, Rutledge presented his result on 1,274 cases with new technique; laparoscopic Mini-Gastric Bypass (LMGB), with EWL 51% after 6 months, 68% after 12 months, 77% after 24 months. Since that time, LMGB started to be practiced by many surgeons from different countries with short & mid term results that are promising when the right patient is selected with good postoperative follow-up. Mini-gastric bypass surgery is now an effective alternative to Roux-en-Y procedure for treatment of morbid obesity. As it carries many advantages as the cost of mini-gastric bypass is less than other procedures, the time of mini-gastric bypass is decreased from 2 hours to 45- 60 minutes and it gives the excellent results on the long run. However minigastric bypass as any loop anastomosis carries the risks of bile reflux gastritis and reflux oesphagitis which is not evident in the studies. So it is confirmed that mini-gastric bypass surgery is easy, simple, less expensive, and less time-consuming and gives better results than Roux-en-Y gastric bypass surgery, however we need more studies to detect the possible complications specific to the mini-gastric bypass mainly biliary reflux gastritis. Our study was conducted at Ain Shams university hospitals and included 20 patients. Laparoscopic Mini-Gastric Bypass (LMGB) was done for all patients. The patients had regular postoperative follow up at the out patients clinic in Eldemerdash hospital at 1, 3, 6, 12 months postoperatively. Our results revealed that: all cases were done laparoscopically with no need for conversion except 1 case was converted to open surgery due to presence of ventral hernia and large left lobe of the liver.