Laparoscopic Roux-en-Y Vs. Mini-gastric Bypass for the Treatment of Morbid Obesity: a 10-Year Experience

BackgroundLaparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for the treatment of morbid obesity but is technically challenging and results in significant perioperative complications. While laparoscopic mini-gastric bypass (LMGB) has been reported to be a simple and effective treatment for morbid obesity, controversy exists. Long-term follow-up data from a large number of patients comparing LMGB to LRYGB are lacking.MethodsBetween October 2001 and September 2010, 1,657 patients who received gastric bypass surgery (1,163 for LMGB and 494 for LRYGB) for their morbid obesity were recruited from our comprehensive obesity surgery center. Patients who received revision surgeries were excluded. Minimum follow-up was 1 year (mean 5.6 years, from 1 to 10 years). The operative time, estimated blood loss, length of hospital stay, and operative complications were assessed. Late complication, changes in body weight loss, BMI, quality of life, and comorbidities were determined at follow-up. Changes in quality of life were assessed using the Gastrointestinal Quality of Life Index.ResultsThere was no difference in preoperative clinical parameters between the two groups. Surgical time was significantly longer for LRYGB (159.2 vs. 115.3 min for LMGB, p < 0.001). The major complication rate was borderline higher for LRYGB (3.2 vs. 1.8 %, p = 0.07). At 5 years after surgery, the mean BMI was lower in LMGB than LRYGB (27.7 vs. 29.2, p < 0.05) and LMGB also had a higher excess weight loss than LRYGB (72.9 vs. 60.1 %, p < 0.05). Postoperative gastrointestinal quality of life increased significantly after operation in both groups without any significant difference at 5 years. Obesity-related clinical parameters improved in both groups without significant difference, but LMGB had a lower hemoglobin level than LRYGB. Late revision rate was similar between LRYGB and LMGB (3.6 vs. 2.8 %, p = 0.385).ConclusionsThis study demonstrates that LMGBP can be regarded as a simpler and safer alternative to LRYGB with similar efficacy at a 10-year experience.

[1]  E. Mason,et al.  Gastric bypass in obesity. , 1967, The Surgical clinics of North America.

[2]  V. Young,et al.  A Prospective Comparison of Gastric and Jejunoileal Bypass Procedures for Morbid Obesity , 1977, Annals of surgery.

[3]  L. Melton,et al.  The risk of gastric carcinoma after surgical treatment for benign ulcer disease. A population-based study in Olmsted County, Minnesota. , 1983, The New England journal of medicine.

[4]  H. Buchwald,et al.  Gastritis after gastric bypass surgery. , 1985, Surgery.

[5]  Shiriki K. Kumanyika,et al.  Gastrointestinal surgery for severe obesity , 1991 .

[6]  J. Gorman,et al.  Long-limb gastric bypass in the superobese. A prospective randomized study. , 1992, Annals of surgery.

[7]  W. Y. Marcus.  Gastrointestinal surgery for severe obesity: a response. , 1992, Maryland medical journal.

[8]  J. Williams,et al.  Gastrointestinal Quality of Life Index: Development, validation and application of a new instrument , 1995, The British journal of surgery.

[9]  H. Adami,et al.  The risk of stomach cancer in patients with gastric or duodenal ulcer disease. , 1996, The New England journal of medicine.

[10]  K. Higa,et al.  Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. , 2000, Archives of surgery.

[11]  P. Schauer,et al.  Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity , 2000, Annals of surgery.

[12]  R. Rutledge.  The Mini-Gastric Bypass: Experience with the First 1,274 Cases , 2001, Obesity surgery.

[13]  B. E. Terry,et al.  Mini-gastric bypass controversy. , 2001, Obesity surgery.

[14]  B. Fisher.  The Elite II™ Bariatric Surgery Retractor System: A Recent Addition to the Bariatric Surgeon's Tool Chest , 2001, Obesity surgery.

[15]  J. Mckenney,et al.  Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). , 2001, JAMA.

[16]  A. Fingerhut,et al.  Gastrointestinal Quality of Life Before and After Laparoscopic Heller Myotomy With Partial Posterior Fundoplication , 2002, Annals of surgery.

[17]  John D. Birkmeyer,et al.  National trends in utilization and in-hospital outcomes of bariatric surgery , 2002, Journal of Gastrointestinal Surgery.

[18]  Henry Buchwald,et al.  Bariatric surgery: a systematic review and meta-analysis. , 2004, JAMA.

[19]  P. Wei,et al.  Short-term Results of Laparoscopic Mini-Gastric Bypass , 2005, Obesity surgery.

[20]  Wei-Jei Lee,et al.  Bariatric Surgery: Asia-Pacific Perspective , 2005, Obesity surgery.

[21]  T. Walsh,et al.  Continued Excellent Results with the Mini-Gastric Bypass: Six-Year Study in 2,410 Patients , 2005, Obesity surgery.

[22]  M. Carbajo,et al.  One-Anastomosis Gastric Bypass by Laparoscopy: Results of the First 209 Patients , 2005, Obesity surgery.

[23]  P. Wei,et al.  Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity: A Prospective Randomized Controlled Clinical Trial , 2005, Annals of surgery.

[24]  P. Wei,et al.  Gastrointestinal Quality of Life Following Laparoscopic Adjustable Gastric Banding in Asia , 2006, Obesity surgery.

[25]  M. Suter,et al.  Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: A Continuous Challenge in Bariatric Surgery , 2006, Obesity surgery.

[26]  B. Oelschlager,et al.  Laparoscopic Roux-en-Y gastric bypass for morbid obesity. , 2006, MedGenMed : Medscape general medicine.

[27]  E. DeMaria,et al.  Surgical revision of loop ("mini") gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. , 2007, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[28]  Wei-Jei Lee,et al.  Effect of Laparoscopic Mini-Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI >35 and <35 kg/m2 , 2008, Journal of Gastrointestinal Surgery.

[29]  Claude Bouchard,et al.  Effects of bariatric surgery on mortality in Swedish obese subjects. , 2007, The New England journal of medicine.

[30]  A. Yazigi,et al.  Mini-Gastric Bypass by Mini-Laparotomy: A Cost-Effective Alternative in the Laparoscopic Era , 2007, Obesity surgery.

[31]  Wei-Jei Lee,et al.  Laparoscopic Mini-gastric Bypass: Experience with Tailored Bypass Limb According to Body Weight , 2008, Obesity surgery.

[32]  B. Wolfe,et al.  Perioperative safety in the longitudinal assessment of bariatric surgery. , 2009, The New England journal of medicine.

[33]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .

[34]  M. Castro,et al.  Effects of a balanced energy and high protein formula diet (Vegestart complet®) vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass): a prospective, double-blind randomized study. , 2010, Nutricion hospitalaria.

[35]  Z. Kim,et al.  Laparoscopic Mini-gastric Bypass for Type 2 Diabetes: The Preliminary Report , 2011, World Journal of Surgery.

[36]  K. Behrns.  Latest Results (12–21 Years) of a Prospective Randomized Study Comparing Billroth II and Roux-en-Y Anastomosis After a Partial Gastrectomy Plus Vagotomy in Patients With Duodenal Ulcers , 2010 .

[37]  Wei-Jei Lee,et al.  Revisional surgery for laparoscopic minigastric bypass. , 2011, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[38]  T. Alexandrides,et al.  Biliopancreatic Diversion with Roux-en-Y Gastric Bypass and Long Limbs: Advances in Surgical Treatment for Super-obesity , 2011, Obesity surgery.

[39]  R. Noun,et al.  One Thousand Consecutive Mini-Gastric Bypass: Short- and Long-term Outcome , 2012, Obesity Surgery.

[40]  K. Behrns.  Predicting Risk for Serious Complications With Bariatric Surgery: Results from the Michigan Bariatric Surgery Collaborative , 2012 .