Has mini gastric bypass come of age?

Abstract

Bruzzi et al. are to be congratulated for their contribution to the literature by describing 5-year outcomes of laparoscopic mini gastric bypass (LMGB) with 72% follow up. This contribution is important because LMGB is growing in numbers in countries outside the United States. The authors show that their LMGB patients had good weight loss and improved quality of life at 5 years. The mean percent excess body mass index loss was 71.5% with no mortality. Notably, 82% of patients had a complete remission of type 2 diabetes. The Gastrointestinal Quality of Life Index (GIQLI) score was significantly higher in patients who were 5 years post-LMGB compared with the preoperative control-group (110.3±17.4 versus 92.5±15.9) with an increase in physical, psychological, and social functions. These are excellent results. However, 9.6% of their patients required a surgical procedure for an early or late surgical complication. The incidence of weight loss failure was 4%, and the incidence of revision was 3.2% for excessive weight regain. This incidence of reoperation is higher than after a Roux-en-Y gastric bypass (RYGB), as pointed out by the authors themselves in their discussion [ 1 Nandipati K. Lin E. Husain F. et al. Factors predicting the increased risk for return to the operating room in bariatric patients: a NSQIP database study. Surg Endosc. 2013; 27: 1172-1177 Crossref PubMed Scopus (37) Google Scholar , 2 Sudan R. Nguyen N.T. Hutter M.M. Brethauer S.A. Ponce J. Morton J.M. Morbidity, mortality, and weight loss outcomes after reoperative bariatric surgery in the USA. J Gastrointest Surg. Epub. 2014 Sep 4; Google Scholar ]. The authors had vast experience in bariatric surgery including RYGB before performing LMBG and note that later in their LMBG experience, the reoperation rate declined, suggesting that there may be nuances that need to be learned to successfully perform and manage these patients. Although, the authors showed improved quality of life in LMGB patients, this study compares the preoperative and postoperative GIQLI scores in different sets of patients, and hence these conclusions need to be interpreted cautiously. Another statement that bears caution is that in the current experience, no cases of internal herniation were found with LMGB, and is a significant difference from RYGB. However, it should be noted that that the original description of internal hernia by Dr. Petersen was in patients who underwent a loop gastrojejunostomy (GJ) and which eventually resulted in mortality [ [3] Rogers A.M. Ionescu A.M. Pauli E.M. Meier A.H. Shope T.R. Haluck R.S. When is a Petersen’s hernia not a Petersen׳s hernia. J Am Coll Surg. 2008; 207: 121-124 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ]. Thus, one should be cautious to look for internal herniation in all anastomotic bariatric procedures and mesenteric closure is recommended. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-upSurgery for Obesity and Related DiseasesVol. 11Issue 2PreviewLaparoscopic mini-gastric bypass (LMGB) is an alternative to the laparoscopic Roux-en-Y gastric bypass (LRYGB), which is considered to be the gold standard in the treatment of morbid obesity. Full-Text PDF