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6,385 Consecutive Mini-Gastric Bypasses: 15 Years Later
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6,385 Consecutive Mini-Gastric Bypasses: 15 Years Later

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6,385 Consecutive Mini-Gastric Bypasses: 15 Years Later

6,385 Consecutive Mini-Gastric Bypasses: 15 Years Later

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  • 1. 6,385 Consecutive Mini-GastricBypasses: 15 Years LaterDr. Rutledge, DrR@clos.net
  • 2. First International ConsensusConference on the Mini-Bypass / OneAnastomosis BypassParis 2012 October 18-19Email DrR@CLOS.Net
  • 3. The Mini-Gastric Bypass • In spite of initial skepticism; there is growing evidence that mini-gastric bypass (MGB) is a safe and effective procedure with many of the features of an ideal bariatric surgery.
  • 4. Methods: • Outcome and long-term follow-up of a consecutive cohort of patients who underwent MGB are reported.
  • 5. Results • The data on 6,385 patients who underwent MGB from September 1997 to June 2011 were reviewed. • Mean preoperative weight (+/- Standard Deviation) was 143 +/- 31 kg, BMI 47 +/- 7. & 83% were female. • Mean operative time 41 minutes and median length of stay 1 day. Three deaths occurred within 30 days of surgery, (0.05%). The most recent death was 8 years ago
  • 6. Results • Early complications occurred in 4.9%. • 44 (0.7%) patients had anastomotic leaks. • Three (0.05%) patients presented with dypepsia/bile reflux not responsive to medical therapy and were successfully treated by Braun side-to-side jejuno- jejunostomy. • Gastritis/dyspepsia/marginal ulcer was the most serious long term complication; routinely treated medically.
  • 7. Results • Excessive weight loss occurred in 1% of patients; treated by take down of the bypass. • Mean % excess weight loss (EWL) of 78%. 10 year weight regain 4.9%. • >50% EWL was achieved for 95% of patients at 18 months and for 92% at 60 months. • 6% of patient had inadequate weight loss or significant weight regain were treated by revision, (addition of ~2 meters to the bypass).
  • 8. Results Mirror Dr Noun’s • One thousand consecutive mini-gastric bypass: Noun R, et al. Journal Obes Surg. 2012 May;22(5):697-703 • Short-term complications occurred in 2.7% for primary vs. 11.6% for revisionnal MGB (p < 0.01). Five (0.5%) patients presented with leak • 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. • Percent excess weight loss (EWL) of 72.5%
  • 9. IFSO Varianational Committee Survey Over 100 Surgeons from Around the World:
  • 10. IFSO Varianational Committee Survey • Results (Preliminary) • Experience with 39,000 cases in the prior year • Lap Band is a "Poor" Surgery • RNY & Sleeve Surgeons have "lots" of leaks • MGB Surgeons Answered More Correct than Non-MGB Surgeons
  • 11. MGB: Major Weight Loss, Best?
  • 12. MGB: Least Weight Regain
  • 13. MGB: Low Risk of Reflux Sx
  • 14. MGB: Revision is Easy
  • 15. Conclusion • MGB is an • effective, • relatively low-risk, and • low-failure bariatric procedure. • In addition, • it can be easily revised, converted, or reversed.