Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India Dr K S Kular Kular Medical Education & Research Society Kular Group of Institutes drkskular@gmail.com www.kularhospital.com Sleeve MGB Kular Hospital Sleeve v MGB (Hint: MGB Better) 　　Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux Conclusions

1. Five Year Outcome
Sleeve Gastrectomy &
Mini-Gastric Bypass:
From a Community Hospital in
Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com

2. Sleeve Vs MGB
• Sleeve
• MGB
• Kular Hospital
• Sleeve v MGB (Hint: MGB Better)
• Weight Loss Raw Data, Weight Loss
Excluding SG Revisions v Age Wt matched
MGBs, Resolution of Co-Morbidities, Patient
Satisfaction, Dyspepsia/Bile Reflux
• Conclusions

3. Sleeve Gastrectomy
• Popular
• Reported Very Good Results
• Primarily Gastric Procedure
• Problems Weight Regain
• Problems New Onset GERD
• Chosen by Kular Hospital

4. Mini-Gastric Bypass
• Very Safe/Very Good Results
• Gastric + Bypass
• Min Weight Regain
• Min GERD
• High Patient Satisfaction

5. Kular Hospital
• Community Hospital
• Rural Small City
• Indian Healthcare and Bariatric
Surgery
• Implications for Selection of
Operation
• Safety and Effectiveness

6. Kular Hospital
• 5 year follow up
• Prospectively collected bariatric
database of 104 MGB and 118 LSG
• Five year follow-up was achieved in
72 MGB and 76 LSG

7. Revisions
• 2 (2.7%) of MGB patients
1 for bile reflux
1 for weight regain
• 16 (21%) LSG patients
13 for weight regain
3 for Gastro-Esophageal Acid Reflux ).
• There was no mortality or leak

8. LSG v MGB
Revisions
LSG MGB
Revision 21% 2.7%
No
Revision
79% 97.3%

9. Total Weight Loss (kg)
LSG v MGB
LSG MGB
Year 1 27 43
Year 2 25 48
Year 5 20 46

10. Raw Weight Loss (kg)
46
43
48
20
27 25
0
10
20
30
40
50
60
0 2 4 6
Years Post Op
Kg
MGB
SG

11. Total Weight Loss (kg)
LSG v MGB
LSG MGB
Year 1 27 43
Year 2 25 48
Year 3 20 46
Includes
16 (21%)
Revisions of
Failed LSG pts

12. LSGxRevisions v
MGB-AgeWt Matched (kg)
LSG
xRevisions
MGB
AgeWt Match
Year 1 34 32
Year 2 32 35
Year 5 15 34

13. Weight Loss (Kg) Stratified SG & MGB
0
5
10
15
20
25
30
35
40
0 2 4 6
Years
Kg
SGxRevisions
MGBaw

14. LSGxRevisions v
MGB-AgeWt Matched (%EWL)
LSG
xRevisions
MGB
AgeWt Match
Year 1 69% 63%
Year 2 63% 72%
Year 3 36% 69%

15. LSGxRevision v MGB-AgeWt Match
(Resolution Co-Morbidities)
LSG
xRevisions
MGB
AgeWt Match
Diabetes 76% 92%
Hyperlipidemia 66% 88%
Sleep Apnea 84% 96%
GERD 35% 82%

16. Patient Satisfaction
5=Excellent, 2=Dissatisfied
LSG MGB
1 month 2 5
6 months 3 5
1 year 3 5
3 years 3 5
5 years 2 4

17. 1 month
6 month
1 year
3 Years
5 Years
SG
MGB0
1
2
3
4
5
SG
MGB
Mean Patient
Satisfaction
5 Extremely satisfied
4 Satisfied
3 Medium
2 Dissatisfied
1 Very Dissatisfied

18. 1 month
1 year
5 years
SG
MGB
0
1
2
3
4
5
Nausea Vomiting
SG
MGB
Likelihood of Complaint of Nausea and Vomiting Score; Likelihood:
5 Extremely Likely, 4 Somewhat Likely, 3 Medium, 2 Unlikely, 1 Very Unlikely

19. How Likely to Recommend
LSG/MGB to Friends & Family
How Likely to Recommend
LSG 2 Unlikely
MGB 5 Extremely Likely
Likelihood to Refer a Friend or Family Member:
5 Extremely Likely, 4 Somewhat Likely, 3 Medium,
2 Unlikely, 1 Very Unlikely.

20. Volume Food Intake @ 5 yrs
Estimated Volume of
Food Intake
LSG 75%
MGB 25%
Likelihood to Refer a Friend or Family Member:
5 Extremely Likely, 4 Somewhat Likely, 3 Medium,
2 Unlikely, 1 Very Unlikely.

21. Bariatric Surgeons
Fear Bile reflux
From Billroth II
General Surgeons
Routinely
Use the Billroth II

22. Gastric Cancer Surgeons Routinely
Use MGB Type Billroth II
Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal
gastrectomy for gastric cancer. Lee J, Kim D, Kim W.Department of Surgery,
The Catholic University of Korea School of Medicine, Seoul, Korea.
Proximal
Stomach
Loop
Proximal
Stomach
Loop

23. Non-MGB Bariatric Surgeons
Fear Billroth II & Bile Reflux
General Surgeons
Use the Billroth II
Every Day
Bariatric Surgeons Have
Forgotten their
General Surgery
Training

24. Bile Reflux Not a Problem
GERD in LSG = Problem
• 72 MGB Patients
• Followed 5 Years
• Bile Reflux
• 2 patients 2.7%
• Sleeve => 24% GERD
• GERD => Esophageal Cancer

25. Conclusions
• Kular Hospital; Rural India Requires
• Extremely High Levels of Safety and
Effectiveness
• Sleeve and MGB chosen for reports
of safety and efficacy
• Report on the Results 5 years Later

26. Sleeve; Good News Bad News
• LSG was as reported; Safe, simple
operation with good short term weight loss
(Like the Lap Band)
• But (as reported)
• Patient Satisfaction Low,
Referral Rate Low
• Inc Food Intake, New Onset GERD,
Weight Regain, Revision Rate High

27. MGB; All Good News
• MGB was as reported; Safe, simple
operation with good short term and long
term weight loss
• and as reported:
• Patient Satisfaction High
Referral Rate High
• Food Intake, New GERD, Weight Regain,
Revision Rates All Low

28. Sleeve: Restrictive Procedure with
Good Early Results; Poor Long Term
Results (Like the Band)