Primary Results of Laparoscopic Mini-Gastric Bypass in a French Obesity-Surgery Specialized University Hospital

Abstract

Since 2002, we have performed 350 laparoscopic Roux-en-Y gastric bypasses (LRYGB). We decided to evaluate the laparoscopic mini-gastric bypass (LMGB), an operation reported as effective, yet simpler than LRYGB. It consisted of a long lesser curvature tube with a terminolateral gastroenterostomy, 200 cm distal to the Treitz ligament. From October 2006 to November 2007, 100 patients (23 men and 77 women) underwent LMGB. The mean age was 40.9 +/- 11.5 years (17.5-62.4), the preoperative mean body weight was 131 +/- 23.1 kg (82-203) and the mean BMI was 46.9 +/- 7.4 kg/m(2) (32.8-72.4). Twenty-four patients had prior restrictive procedure: 20 LAGB of which nine were already removed and four VBG (two laparoscopic and two by open surgery). In preoperative gastric endoscopy Helicobacter pylorii was present in 26 patients and eradicated. All procedures were completed laparoscopically by six different surgeons. Mean operative time was 129 +/- 37 min. There was no death. Seven patients (7%) presented major early complications: three reoperations for incarcerated herniation of small bowel in the trocar wound, one peritonitis due to a traumatic injury of the biliary limb, one perianastomotic abscess, one intraabdominal bleeding requiring splenectomy, and one endoscopic haemostasis for anastomotic bleeding. One patient presented anastomotic stenosis that required endoscopic dilatation 2 months postoperatively. Mean BMI at 3 months was 38.7 kg/m(2) (31.2-60.9) and at 6 months 35.1 (23.6-53.0). Nine patients complained of diarrhea that resolved 3 months postoperatively and, significantly, only two patients complained of biliary reflux. Pending long-term evaluation, LMBG seems a good alternative to LRYGB, giving the same results with a more simple and reproductible technique.