15 years of the mini-gastric bypass

MINI-GASTRIC BYPASS (MGB) is an effective, relatively low-risk and low-failure procedure, according to 15-year outcomes from 6,385 consecutive cases.

Presenting the outcomes at the IFSO meeting in New Delhi, Dr Robert Rutledge, Nevada, said that these results add to the growing evidence that MGB is a safe and effective procedure with many of the features of an ideal bariatric surgery.

From September 1997 to June 2011, 6,385 patients underwent MGB, with the mean pre-operative weight (+/- standard deviation) was 143 +/-31kg, BMI 47+/-7; 83% of the patients were female.

Outcomes
The mean operative time was 41 minutes and median length of stay was one day. Early complications occurred in 4.9% of the patients; 44 patients (0.7%) had anastomotic leaks. Three patients (0.05%) presented with dypepsia/bile reflux that was 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. Three deaths (0.05%) occurred within 30 days of surgery. The most recent death was in 2004.

Weight loss
Excessive weight loss occurred in 1% of patients; treated by take down of the bypass. The mean percent excess weight loss was 78% and the ten-year weight regain, 4.9%. At 18 months, 95% of patients achieved >50% EWL and 92% at 60 months. Inadequate weight loss or significant weight regain was found in 6% of patients and these patients subsequently underwent a revision (addition of ~2 meters to the bypass). Rutledge said that these reported outcomes are comparable to other large, long term MGB series reported in the literature (Obes Surg. 2012 22(5):697-703).

Comparable procedures
In addition, Rutledge also presented the preliminary results from an IFSO Varianational Committee on New Procedures Survey that interviewed over 118 surgeons from 30 countries and who shared their career experience from over 39,000 bariatric cases. The surgeons were asked their expert opinion on laparoscopic gastric banding, sleeve gastrectomy,
Roux-en-Y gastric bypass (RNY) and MGB. 

Asked whether weight gain was common after each procedure, all experts agreed that weight gain was common after banding, 42% said weight gain was common after sleeve, 39% said weight gain was common after RNY bypass and only 9% said weight gain was common after MGB. 

When asked the converse question regarding major weight loss, 10% said major weight loss was common after banding, 78% said it was common after sleeve, 84% said it was common after bypass and 90% said it was common after MGB. Over 90% said that banding presented a risk of post operative acid reflux, 60% said the sleeve presented a risk of post op acid reflux, but only 5% said RNY bypass presented a risk of reflux, while 10% said MGB presented a risk of reflux. This is important because extensive data show that acid reflux can lead to oesophageal cancer.

Finally, when asked about the ease of revision surgery, 30% agreed that banding revision was easy, 52% agreed that sleeve revision was easy, 22% agreed that bypass revision was easy, while 90% said MGB agreed that sleeve revision was easy. “These 15 year data confirm other studies showing that the MGB is comparable, and in some instances preferable, to more common procedures such as banding, RNY bypass and sleeve,” concluded Rutledge. “In spite of initial scepticism, MGB is a safe and effective procedure and can be easily revised, converted or reversed.”