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Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
A five-year study from Kular Hospital in Punjab, India, evaluated outcomes of sleeve gastrectomy (SG) versus mini-gastric bypass (MGB) procedures. MGB showed superior results in terms of weight loss, patient satisfaction, and lower rates of complications compared to SG, which had issues like weight regain and new onset gastro-esophageal reflux disease (GERD). The findings suggest that while SG may provide initial success, MGB is more effective for long-term outcomes in bariatric surgery.
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Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
- 1. Five Year Outcome SleeveGastrectomy & 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 • VerySafe/Very Good Results • Gastric + Bypass • Min Weight Regain • Min GERD • High Patient Satisfaction
- 5. Kular Hospital • CommunityHospital • Rural Small City • Indian Healthcare and Bariatric Surgery • Implications for Selection of Operation • Safety and Effectiveness
- 6. Kular Hospital • 5year 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 LSGMGB 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-AgeWtMatch (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 LSGMGB 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 1year 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 5years 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 toRecommend 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 Bilereflux From Billroth II General Surgeons Routinely Use the Billroth II
- 22. Gastric Cancer SurgeonsRoutinely 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 FearBillroth II & Bile Reflux General Surgeons Use the Billroth II Every Day Bariatric Surgeons Have Forgotten their General Surgery Training
- 24. Bile Reflux Nota 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 NewsBad 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 GoodNews • 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 Procedurewith Good Early Results; Poor Long Term Results (Like the Band)