SHORT AND LONG TERM COMPLICATIONS FOLLOWING THE MINI-GASTRIC BYPASS

1. SHORT AND LONG TERM
COMPLICATIONS
FOLLOWING THE
MINI-GASTRIC BYPASS
Robert Rutledge, MD
Centers for Laparoscopic Obesity Surgery
98 E Lake Mead Parkway Suite 302
Henderson NV 89015
Web: www.clos.net, Email: DrR@clos.net

2. NEED FOR A BETTER FORM OF BARIATRIC SURGERY:
PROBLEMS WITH THE RNY
 A consecutive series of RNY
with a mean follow-up of 11.9 yrs.
 “clinical failure in 36%
Roux stasis syndrome in 27%.”
 One of the longest follow-up to date
 … the RNY appears to be limited by
 …substantial rate of clinical dissatisfaction.
Surgeons should be cautious in using RNY to
treat gastrointestinal disease.
McAlhany JC Jr et al, Long-term follow-up of patients with Roux-en-Y
gastrojejunostomy for gastric disease. Ann Surg. 1994 May;219(5):451-5

3. MINI-GASTRIC BYPASS
 Studies have demonstrated that MGB is
 Short
 Simple
 Effective
 Reversible and Revisable operation
 With very high levels of patient
satisfaction

4. MINI-GASTRIC BYPASS REFERENCES
Reference Reference
 Rutledge R. Hospitalization before and
after mini-gastric bypass surgery. Int J
Surg. 2007 Feb;5(1):35-40. Epub 2006
Aug 10.
 Peraglie C. Mini-gastric bypass in a
patient homozygous for Factor V
Leiden. Obes Surg. 2007 Jan;17(1):104-
7.
 Johnson WH, et al. Surgical revision of
loop ("mini") gastric bypass
procedure: multicenter review of
complications and conversions to
Roux-en-Y gastric bypass. Surg Obes
Relat Dis. 2007 Jan-Feb;3(1):37-41.
Epub 2006 Dec 27.
 Noun R, Zeidan S, Safa N. Laparoscopic
latero-lateral jejuno-jejunostomy as a
rescue procedure after complicated
mini-gastric bypass. Obes Surg. 2006
Nov;16(11):1539-41.
 Rutledge R, Dorghazi P, Peralgie C.
Efficacy of estradiol topical patch in
the treatment of symptoms of
depression following mini-gastric
bypass in women. Obes Surg. 2006
Sep;16(9):1221-6.
 Chiu CC, Lee WJ, Wang W, Wei PL,
Huang MT. Prevention of trocar-wound
hernia in laparoscopic bariatric
operations. Obes Surg. 2006
Jul;16(7):913-8.

5. MINI-GASTRIC BYPASS REFERENCES
References References
 Rutledge R, Walsh TR. Continued
excellent results with the mini-gastric
bypass: six-year study in 2,410
patients. Obes Surg. 2005
Oct;15(9):1304-8.
 Lee WJ, et al. Laparoscopic RNY
versus mini-gastric bypass for the
treatment of morbid obesity: a
prospective randomized controlled
clinical trial. Ann Surg. 2005
Jul;242(1):20-8.
 Garcia-Caballero M, Carbajo M. One
anastomosis gastric bypass: a simple,
safe and efficient surgical procedure
for treating morbid obesity. Nutr
Hosp. 2004 Nov-Dec;19(6):372-5.
 Wang W, Wei PL, Lee YC, Huang MT,
Chiu CC, Lee WJ. Short-term results of
laparoscopic mini-gastric bypass.
Obes Surg. 2005 May;15(5):648-54.
 Copaescu C, Munteanu R, Prala N,
Turcu FM, Dragomirescu C.
[Laparoscopic mini gastric bypass for
the treatment of morbid obesity.
Initial experience] Chirurgia 2004 Nov-
Dec;99(6):529-39.
 Wang W, et al. Laparoscopic mini-
gastric bypass for failed vertical
banded gastroplasty. Obes Surg. 2004
Jun-Jul;14(6):777-82.

6. MINI-GASTRIC BYPASS REFERENCES
References References
 Rutledge R. The mini-gastric bypass:
experience with the first 1,274 cases.
Obes Surg. 2001 Jun;11(3):276-80.
 Rutledge R. Revision of failed gastric
banding to mini-gastric bypass. Obes
Surg. 2006 Apr;16(4):521-3.
 Rutledge R. Similarity of
Magenstrasse-and-Mill and Mini-
Gastric bypass. Obes Surg. 2003
Apr;13(2):318.
 Fisher BL, Buchwald H, Clark W,
Champion JK, Fox SR, MacDonald KG,
Mason EE, Terry BE, Schauer PR,
Sugerman HJ. Mini-gastric bypass
controversy. Obes Surg. 2001
Dec;11(6):773-7.

7. OLD ANTRECTOMY AND BILLROTH II
The Billroth II is a gastrojejunostomy favored by m any surgeons. In
selected cases a Braun entero-enterostomy may be added.

8. MINI-GASTRIC BYPASS
I. Restrictive Component:
• Gastric pouch based upon the
lesser curve, similar to Collis
Gastroplasty/Sleeve
Gastrectomy
• Vagotomy
II. Malabsorptive Component
• Ante-colic Billroth II Loop
Gastrojejunostomy
(6 foot + bypass)
• Bypass length varied with
weight of patient

9. RNY VS. THE MINI-GASTRIC BYPASS

10. MINI-GASTRIC BYPASS THOUSANDS OF
PATIENTS COME FROM ALL ACROSS THE NATION
Patients have come from all 50 states and around the world to have the MGB

11. RESULTS
 From 9/97 to 3/2011, 6,526 patients underwent
MGB at the Centers for Excellence in
Laparoscopic Obesity Surgery hospitals
 Follow-up information was achieved in 98% of
patients at 30 days and in 4,046 patients (62%)
overall,
 The mean follow-up was 21 months (range, 6-96
months).

12. RESULTS
 There were 85% females with a mean
preoperative age of 39 years (range, 12-81 years).
 After surgery, weight and body mass index
decreased from
 295 lbs and 49.1 kg/m2 to
 171 lbs and 28.5 kg/m2 for a
 Mean weight loss of 124 lbs,
 Ideal body weight of 140 lbs
 Mean excess weight loss of 81%.

13. 80% EXCESS WEIGHT LOSS
Weight loss follows a logarithmic curve for the first year
The combination of Restriction, Vagotomy and Bypass
Malabsorption leads to excellent weight loss

14. 5 YEAR WEIGHT LOSS
5 year weight loss is very durable

15. OPERATIVE OUTCOMES
 MGB was performed in 6,526 patients.
 Mean Operative time: 38 minutes
 The median length of hospital stay was 1 day.

16. COMPLICATIONS
 The most common early complications were
minor and included pain, nausea and other
nonspecific complaints.
 There were three deaths within 30 days of
surgery
 Perforate Transverse Colon (9 years ago)
 Post Operative MI (6 years ago, at 3 weeks post op
following otherwise uncomplicated surgery.)
 Leak (1 year ago death from Respiratory failure)

17. SHORT TERM COMPLICATIONS (< 30 DAYS)
 The overall rate of complications was low at 4.36%.
 Leaks (1.02%)
 Bleeding (0.56%)
 Dyspepsia/Gastritis (0.28%)
 Pneumonia (0.28%)
 Pulmonary Embolus (0.19%)
 Thrush (0.19%)
 DVT (0.19%)
 Pain (0.09%)
 Bad Taste (0.09%)
 Port Site Infection (0.09%)
 Port Site Bleeding (0.09%)
 Other (0.09%)

18. SHORT TERM COMPLICATIONS (< 30 DAYS)
 Port Site Abscess
 Negative Re-exploration
 Infection (other)
 Major Port Leakage
 Hemorrhoids
 Fever
 Failed Intubation
 Drug reaction
 Profound Dehydration
 C. Diff Infection
 Bowel Injury
 Early Ulcer
 Prolonged Ileus
3 (0.09%)
3 (0.09%)
3 (0.09%)
2 (0.07%)
2 (0.07%)
2 (0.07%)
2 (0.07%)
1 (0.04%)
1 (0.04%)
1 (0.04%)
1 (0.04%)
1 (0.04%)
1 (0.04%)

19. LONG TERM COMPLICATIONS (15%)
 Fifteen percent of patients had some form of
complication.
 Dyspepsia/Gastritis
 Anemia
 Ulcer
 Diarrhea
 Fainting
 Malnutrition w Revision
 Hypo/Hyper-vitaminosis
 Kidney stones
 Gallbladder
(5.2%),
(3.1%)
(2.4%)
(1.2%)
(1.1%)
(1.1%)
(1.0%)
(1.0%)
(0.9%)

20. LONG TERM COMPLICATIONS (15%)
 Major Hair Loss (0.8%)
 Persistent Dumping (0.7%)
 Unmanageable Gas (0.6%)
 Malnutrition w/o Revision (0.5%)
 Hernia, Gout, Weight Regain (>20 lbs.), Severe
Hypoglycemia (0.3%)
 Severe Osteoporosis, Drug Withdrawal, Yeast
infection, Lactose Intolerant, Low Estrogen, Bowel
Obstruction (0.2%)
 Constipation, Revision for Bile Reflux, Pain, Drug
Allergy, Heavy Menstruation, Neuropathy,
Hyper/Hypoglycemia, Allergic Reaction and Low
Potassium (0.1%)

21. BILE REFLUX
 Bariatric Surgeons have raised concerns about
Bile Reflux complications after Mini-Gastric
Bypass
 Recent studies have reported revisions to RNY
for “bile reflux”
 While Dyspepsia and Ulcers were common only 3
required revision for bile reflux
 In this series symptoms of dyspepsia and
marginal ulcers were treated successfully with
Antacid (Prilosec, etc.) therapy

22. CONCLUSIONS
 Mini-Gastric Bypass
 Short
 Simple
 Low Risk
 Effective
 Reversible and Revisable
 Durable

23. CONCLUSIONS
 The present series reconfirms that the
Mini-Gastric Bypass:
 Short safe and effective weight loss
therapy.
 This study delineates the spectrum and
frequency of complications after early and
late after the MGB.

24. CONCLUSIONS
 The most frequent complications late after MGB
are Dyspepsia/Gastritis, Iron Deficiency Anemia
and Marginal Ulcer.
 In most cases these complications responded to
medical therapy.
 This study shows the range of late complications
following the MGB.

25. FEARS ABOUT “BILE REFLUX”
 Early days of gastric bypass
loop placed adjacent to the
esophagus led to …
 “…bilious vomiting was particularly annoying
and persistent in the first (loop) patients and
resulted in a change of technique to the Roux-en-
Y reconstruction”. (Griffen et al)
 Others reported the need for RNY surgery for
MGB associated “Bile Reflux” (Johnson et al)

26. CONCLUSIONS: BILE REFLUX REDUX
 The present series demonstrates that,
while the symptoms of dyspepsia and ulcers were
relatively common,
they were routinely treated successfully with
antacids medications (i.e. PPI etc.)
 Surgery was necessary in only 3 patients for
symptomatic “Bile Reflux” symptoms
unresponsive to medical therapy

27. GIL GERARD "BUCK ROGERS", TV STAR
UNDERWENT MINI-GASTRIC BYPASS SURGERY.
Gil Gil Gil
Gerard Gerard Gerard
“Buck In London Post
Rogers” MGB
(1979- 2005 2006
1981)
180 lbs. 340 lbs. 205 lbs.
http://www.youtube.com/view_play_list?p=7BF29152EEF52939

28. Steps in Performance of MGB
Gil Gil Gil
Gerard Gerard Gerard