Mini gastric Bypass, a safe and effective weightloss procedure.

A team of French researchers have reported that the single anastomosis or mini-gastric bypass is safe and effective in the long-term with outcomes comparable to those of RYGB. Reporting their findings in three separate papers, they added that the procedure is technically simple and is an option that should be considered by all bariatric surgeons.

In the first paper featured in the journal Surgery of Obesity and its Related Diseases, the investigators from the Hôpital Européen Georges Pompidou, Paris, France, examined the five-year results of 175 patients who had undergone a laparoscopic mini-gastric bypass (LMGB) between October 2006 and October 2008. Complete date was available in 126 of 175 patients (72%).

They assessed the mortality, morbidity, weight loss, co-morbidities, and quality of life  - the latter was analysed using the Gastrointestinal Quality of Life Index (GIQLI) and was compared with a retrospectively case matched preoperative control group.

They reported a 0% mortality rate with 13 patients (10.3%) developing major complications including; marginal ulcers (4%), incapacitating biliary reflux (1.6%), gastric pouch dilation (3.2%) and inadequate weight loss with severe malnutrition (1.6%).

At five-years, the mean BMI was 31±6 and mean %EBMIL was 71.5%±26.5%. Postoperative GIQLI score of the treatment group was significantly higher than preoperative score of the control group (110.3±17.4 versus 92.5±15.9, p<.001). Social, psychological, and physical functions were increased significantly. No significant differences were found in gastro-oesophageal reflux or diarrhoea symptoms between the two groups. Long-term follow-up showed an improvement in all co-morbidities.

They concluded that at five-years, LMGB was safe, effective, and provided interesting quality of life results.
In the second paper, published in .Obesity Surgery, they reported that single anastomosis gastric bypass is an effective procedure for morbid obesity with comparable outcomes to RYGB.

Data was collected on 1,000 consecutive patients, with a mean follow-up period of 31 months. They noted a mortality rate of 0.2 % and an overall morbidity rate of 5.5 %. Thirty four patients required reoperations: six leaks, five obstructions, five incisional hernias, seven biliary refluxes, two perforated ulcers, two bleeds, two abscesses, and one anastomotic stricture, with four patients required a re-operation for weight regain.

At five-years, percent excess body mass index loss was 71.6±27 %. One hundred patients with type-2 diabetes, with a mean preoperative HbA1C of 7.7 ± 1.9 %, were followed for  more than two years and the total resolution rate was 85.7 %.
They concluded that the study results not only confirm that MGB is an effective procedure but its appears to be safer than RYGB with a lower morbidity.                                                      

The third paper, published in Surgical Endoscopy, reported the outcomes from MGB in terms of its impact on type 2 diabetes.

Between December 2006 and September 2012, 804 laparoscopic MGB were performed, with 100 (12.4 %) patients having a glycated haemoglobin (HbA1c) level of <6 % without concomitant treatment.

Prior to the procedure seven patients (9%) had received no oral hypoglycaemic treatment, 30 (37%) had received monotherapy, 26 (32%) bitherapy, six (7%) tritherapy and 12 (15%) patients had used insulin. Over a mean follow-up of 26 months (range 1-75), mean weight decreased to 94±23 kg and mean BMI 35.

They report that 71 (88%) patients had complete remission of type 2 diabetes and the other ten (12 %) had reduced their treatment. Seven patients (58%) who were initially treated with insulin, no longer required insulin. The mean time to remission of diabetes for patients receiving one or more oral therapies versus insulin was 6.9 versus 17.9 months.

In conclusion the authors said the procedure is an effective treatment for obesity in terms of weight loss and remission of type 2 diabetes.

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