The Long-Term Outcomes of Mini-Gastric Bypass in Patients with Type 2 Diabetes and Morbid Obesity

Morbid obesity co-exists with non-alcoholic fatty liver disease in up to 90% of cases. Laparoscopic sleeve gastrectomy leads to a reduction in body mass and thus may improve the course of non-alcoholic fatty liver disease. The aim of this study was to evaluate the effect of laparoscopic sleeve gastrectomy on the resolution of non-alcoholic fatty liver disease. The study included 55 patients with non-alcoholic fatty liver disease who underwent laparoscopic sleeve gastrectomy at a tertiary institution. The analysis consisted of preoperative liver biopsy, abdominal ultrasound, weight loss parameters, Non-Alcoholic Fatty Liver Fibrosis Score and selected laboratory parameters. Before the surgery, 6 patients were diagnosed with grade 1 liver steatosis, 33 patients with grade 2 and 16 patients with grade 3. One year after the surgery, only 21 patients had features of liver steatosis at ultrasound. All weight loss parameters showed statistically significant changes during the observation; the median percentage of total weight loss was 31.0% (IQR: 27.5; 34.5) with p = 0.0003, the median percentage of excess weight loss was 61.8% (IQR: 52.4; 72.3) with p = 0.0013 and the median percentage of excess body mass index loss was 71.0% (IQR: 61.3; 86.9) with p = 0.0036 12 months after laparoscopic sleeve gastrectomy. The median Non-Alcoholic Fatty Liver Fibrosis Score at baseline was 0.2 (IQR: -0.8; 1.0) and decreased to -1.6 (IQR: -2.4; -0.4) (p < 0.0001). Moderate negative correlations between Non-Alcoholic Fatty Liver Fibrosis Score and percentage of total weight loss (r = -0.434, p < 0.0001), percentage of excess weight loss (r = -0.456, p < 0.0001) and percentage of excess body mass index loss (r = -0.512, p < 0.0001) were found. The study supports the thesis that laparoscopic sleeve gastrectomy is an effective method for treatment of non-alcoholic fatty liver disease in patients with morbid obesity.

Background. The effect of sleeve gastrectomy (SG) and mini-gastric bypass (MGB) are still being studied; there is a reason to believe that these methods are completely comparable in terms of achieving good bariatric results and metabolic effects.The aim of the study. To assess the effectiveness of laparoscopic sleeve gastrectomy and one-anastomosis gastric bypass in patients with morbid obesity and type 2 diabetes mellitus by conducting a comparative analysis.Methods. We carried out retrospective cohort study. From August 2019 to May 2023, we operated 55 patients with morbid obesity and type 2 diabetes mellitus (DM): 23 patients – in the MGB group, 32 patients – in the SG group. Median follow-up was 21 and 15 months, average age 47.6 ± 9.6 and 47.6 ± 10.7 years, body mass index (BMI) – 51.4 ± 7.8 and 50.8 ± 7.7 kg/m2, median duration of type 2 DM – 36 and 17 months, respectively. Fasting blood glucose was 7.16 ± 1.5 and 8.61 ± 2.95 mmol/l (U = 249; p = 0.022), and glycosylated hemoglobin (%HbA1c) – 6.66 ± 1.04 and 7.35 ± 1.86 % (U = 296; p = 0.222), respectively.Results. BMI at the follow-up was 33.8 ± 6.5 kg/m2 in the MGB group and 35.5 ± 5.2 kg/m2 in the SG group (p = 0.147). Excess weight loss percentage was 68.4 ± 16.4 and 59.8 ± 14.4 (p = 0.040); total weight loss percentage – 34.1 ± 8.6 and 29.7 ± 8.0 (p = 0.109), respectively. Fasting blood glucose was 5.48 ± 1.84 and 5.39 ± 0.59 (p = 0.247), %HbA1c level – 5.3 ± 0.5 and 5.44 ± 0.58 (p = 0.230), respectively. All patients in the SG group and 22 patients in the MGB group were normoglycemic with target values of %HbA1c achieved after the surgery within a period from 3 to 12 months. There were no statistically significant differences in the number of complications (according to Clavien – Dindo II).Conclusion. Sleeve gastrectomy and mini-gastric bypass in patients with morbid obesity and type 2 diabetes demonstrate almost similar bariatric results in the medium term. Both methods make it possible to achieve compensation for type 2 diabetes mellitus with equal efficiency within a period from 3 to 12 months after surgery.

Disclosure: Y. Sofer: None. I. Sarig: None. Y. Greenman: None. W. Abu Ahmad: None.Background: Bariatric surgery (BS), is a highly effective and cost-efficient intervention for achieving long-term weight loss in individuals with obesity. In recent years, the Mini Gastric Bypass (MGB) procedure has gained popularity in Israel, accounting for approximately 70% of all bariatric surgeries performed. Assessing the success of BS often involves measuring the total and mean percentage of excess weight loss (%EWL). While various factors predict %EWL, the impact of gender on this outcome remains controversial, with conflicting results in both general BS and specifically in MGB studies. Aims: Examine the impact of gender on MGB outcomes in Israeli patients up to two years following the operation. Methods: We conducted a retrospective cohort study among patients who underwent MGB procedure at a single tertiary hospital. Data was obtained from medical records of the patients who underwent both preoperative and postoperative evaluations in obesity clinic between 2013 to 2023. The primary outcome was the %EWL at 6-month, 1-year, and 2-year intervals following the procedure. Using a multivariant analysis we calculated weight loss and %EWL according to gender. Results: A total of 187 patients were included, 133 (71.1%) females, 54 (28.9%) males. Median age was 46.7 (34.8-55.5) years for women and 49 (39.49-58.8) years for men. Over time, participants experienced significant weight reductions. At 6-12 months post-surgery, the total weight decreased by 20.4 (15.1-26.2) kg relative to the baseline, and by 1-2 years, median weight loss was 36.2 (29-48.1) kg. Gender differences were observed, where males experienced higher weight reductions over time. At 6-12 months, males lost 20.4 (15.1-26.2) kg whereas women lost 15.4 (10.4-21.4) kg. Likewise, at 1-2 years, males experienced a weight reduction that was 12 kg higher than that of females [(44.4 (36.8-51.7) kg compared to 32.4 (24.7-40.6) kg; p<0.01]. This difference remained significant even after multivariate analysis, which accounted for factors such as age, underlying chronic conditions (including diabetes, dyslipidemia, and metabolic dysfunction-associated steatotic liver disease, OSA), glucose and HbA1c levels and medications (insulin, statins, calcium channel blockers). %EWL was also significantly higher for men, 85+/-29% compared to 77+/-28% in women. Conclusions: This study highlights the significant impact of gender on weight loss outcomes following MGB. Further research is warranted to explore the underlying mechanisms and potential implications for treatment strategies and patient counseling to optimize outcomes for both male and female patients.Presentation: Monday, July 14, 2025

In patients with BMI greater than 50, sleeve gastrectomy (SG) may not be adequate to treat obesity. To determine whether one-anastomosis gastric bypass (OAGB) can provide better outcomes compared with SG in patients with BMI greater than 50, a systematic review and meta-analysis was conducted, including a total of nine retrospective studies with a total of 2332 participants. There was a significant difference in the percentage of excess weight loss [weighted mean difference (WMD): 8.52; 95% CI: 5.81–11.22; P<0.001) and percentage of total weight loss (WMD: 6.65; 95% CI: 5.05–8.24; P<0.001). No significant differences were seen in operative time (WMD: 1.91; 95% CI: −11.24 to 15.07; P=0.77) and length of stay in hospital (WMD: −0.41; 95% CI: −1.18 to 0.37; P=0.30) between the two groups. There were no significant differences between OAGB with SG in Clavien–Dindo grades I–III [odds ratio (OR): 1.56; 95% CI: 0.80–3.05], or grade IV complications (OR: 0.72; 95% CI: 0.18–2.94). The meta-analysis on remission of type 2 diabetes indicated a comparable effect between SG and OAGB (OR: 0.77; 95% CI: 0.28–2.16). The OAGB group had a significantly higher rate of remission of hypertension compared with the SG group (OR: 1.63; 95% CI: 1.06–2.50). The findings of this meta-analysis suggest that the OAGB accomplished a higher percentage of total weight loss and percentage of excess weight loss at short-term and mid-term follow-up but, there was no major difference between the OAGB and SG operations in terms of perioperative outcomes, complications, and diabetes remission.

Introduction: Obesity is defined as abnormal or excessive fat accumulation that may impair health. Body Mass Index (BMI) is a simple index of weight for height (kg/m2 ) that is commonly used to classify overweight and obesity in adults. Mini Gastric Bypass (MGB) leads to improved quality of life, reduction in episodes of Gastroesophageal Reflux Disease (GERD), high patient acceptance, early safety, and efficacy. Laparoscopic Sleeve Gastrectomy (LSG) is a restrictive, irreversible procedure in which stomach capacity is markedly reduced by creating a lesser curvature tube. MGB is mildly restrictive but importantly, a malabsorptive operation. Many observational studies have concluded that better weight loss and diabetes remission are the advantages of MGB. However, comparative studies of outcomes and complications between Laparoscopic Sleeve Gastrectomy (LSG) and MGB are still scarce. Aim: To compare the effectiveness and outcomes regarding weight loss after LSG and MGB in morbidly obese patients. Materials and Methods: This prospective cohort study was carried out in the Department of Surgery of SPS Hospital, Ludhiana, Punjab, India from 1st June 2018 to 31st May 2019. Adults between 20-70 years of age and with BMI &gt;37.5 without co-morbidities, and BMI &gt;32.5 with co-morbidities Type II Diabetes Mellitus (T2DM) were included. The authors included 59 patients; 34 patients underwent MGB (22 were female and 12 were male) and 25 patients underwent LSG (18 were female and 7 were male). A comparison of continuous variables between the study groups was done using the Student’s t-test. For comparing categorical data, a Chi-square (χ2 ) test was performed. Results: The overall % Excess Weight Loss (EWL) after MGB ranged from 27.74 to 62.32% with a mean of 44.88±17.44%. The overall % EWL after LSG ranged from 26.62 to 45.8% with a mean of 36.21±9.59%. (p&lt;0.05) in % EWL at nine months in both procedures as MGB resulted in more % EWL than LSG. Perioperative results regarding the mean operative time for MGB was 3.24 hours and for LSG, 2.43 hours (p&lt;0.05). A total of 50% (5/10) of patients who underwent MGB had remission, and 25% (1/4) of patients who underwent LSG had remission of T2DM after nine months (p&gt;0.05). None of the patients required readmission post LSG, while 3% (1/34) required readmission post MGB. None of the patients had postoperative leakage in both groups. Conclusion: The better outcome was associated with MGB in terms of the percentage of Excess Weight Loss (EWL).

ABSTRACTBACKGROUND:Although bariatric surgery is highly effective for the treatment of obesity and its comorbidities, preoperative weight loss has an impact on its results.AIMS:The aim of this study was to correlate preoperative weight loss with the outcome of bariatric surgery using the Bariatric Analysis and Reporting Outcome System scores.METHODS:This is a cross-sectional, observational study with 43 patients undergoing bariatric surgery that compared a group of 25 patients with a percentage of preoperative excess weight loss ³8% with a group of 18 patients with a percentage of preoperative excess weight loss <8% or with weight gain. The research took place at the bariatric surgery outpatient clinic of the Oswaldo Cruz University Hospital with patients 1 year after the surgery.RESULTS:Patients had a mean age of 40.8 years (42.7 percentage of preoperative excess weight loss ≥8% vs. 38.2 percentage of preoperative excess weight loss <8%, p=0.095). No significant difference was found between the two groups regarding preoperative comorbidities and body mass index at entry into the program. Higher preoperative body mass index (48.69 vs. 44.0; p=0.029) was observed in the group with percentage of preoperative excess weight loss <8%. No significant difference was found regarding the percentage of excess weight loss (71.4±15.4%; percentage of preoperative excess weight loss ≥8% vs. 69.47%±14.5 percentage of preoperative excess weight loss <8%; p=0.671), the result of the surgery according to the Bariatric Analysis and Reporting Outcome System scores protocol, the resolution of comorbidities, the quality of life, and the surgical complications between the two groups.CONCLUSIONS:Based on the available data, it is reasonable that bariatric surgery should not be denied to people who have not achieved pre-established weight loss before surgery.

BackgroundObesity and diabetes as well as their related complications result in both individual and global health burdens. Among patients who present with both obesity and diabetes, bariatric surgery can lead to remission of both these diseases. However, the possible impact of diabetes on the magnitude of weight loss outcomes after bariatric surgery has not been quantified.MethodsTo address this question, we extracted data from Michigan Bariatric Surgery Cohort (MI-BASiC) to see whether diabetes at baseline could be a predictor of weight loss outcomes. Consecutive patients 18 years of age or older undergoing gastric bypass (GB) or sleeve gastrectomy (SG) for obesity at the University of Michigan between January 2008 and November 2013 were included in our retrospective cohort. All patients had either body mass index (BMI) > 40 kg/m2 or BMI 35 – 39.9 kg/m2 with comorbid condition. Firstly, we performed Generalized Linear Mixed Model (GLMM) analysis to compare the probability of achieving BMI under 30kg/m2 or achieving excess body weight loss (EBWL) 50% or more for patients with or without diabetes. We then further tested the effect of presence of diabetes for the BMI outcomes across time using Linear Mixed Model (LMM) analysis. Finally, we conducted a LMM analysis to determine if diabetes is a predictor of the future weight loss, percentage of total weight loss or percentage of excess weight loss over 5 years of follow up.ResultsBased on our criteria, 380 patients were included for GB [female 305 (80.3%), mean age 43.6±0.6 years, mean BMI 47.3±0.4kg/m2, diabetes 149 (39.2%), on insulin 45 (11.8%)] and 334 for SG [female 259 (77.5%), mean age 45.3±0.6 years, mean BMI 49.9±0.5kg/m2, diabetes 108 (32.3%), on insulin 29(8.7%)]. From GLMM analysis, the presence of diabetes at baseline did not impact the probability of achieving BMI under 30kg/m2 (p=0.0848), but substantially impacted the probability of achieving 50% or more EBWL (p=0.0021) with individuals without diabetes having a 1.6 (odds ratio 1.56, 95% CL [1.18-2.08]) times higher chance to achieve this threshold. We also showed that individuals with diabetes at baseline had a significant effect to modify BMI points lost, regardless of the surgery type (p=0.0178). The presence of diabetes at baseline diminished weight loss by 1.2 BMI points (95% CL [0.21- 2.20]) which is roughly 10 to 15% of the total BMI points to be lost. LMM analysis further confirmed that after adjusting the time, surgery type, age, gender and baseline weight, there was still a significant difference of absolute weight loss (p=0.0110), percentage of total weight loss (p=0.0089) and percentage of excess weight loss (p=0.0365) between individuals with diabetes versus individuals without diabetes.ConclusionIn conclusion, our data demonstrate that diabetes diminishes the ultimate weight loss effect of bariatric surgery. Further research is needed to understand why this is the case.

Introduction There is insufficient data regarding trocar access site hernias (TSH) in laparoscopic sleeve gastrectomy (LSG). This retrospective study aimed to identify the incidence and risk factors for hernia development in patients who did not undergo fascia repair at trocar entry sites. Materials and methods We retrospectively reviewed the records of 284 patients with morbid obesity who underwent LSG between January 2016 and December 2021. The fascia of the trocar entry site was not closed in any of the patients. Weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage oftotal weight loss (%TWL), comorbidities, and the occurrence of complications were recorded at one, six, 12, 18, and 24 months after surgery. Ultrasonography (USG) was performed and supplemented with computed tomography (CT) when necessary. Results All patients underwent a 24-month follow-up, during which four patients developed trocar site hernias, resulting in an overall prevalence of 1.4%. Of the total hernias, two occurred within the first 30 days. A single patient required surgical intervention for an incarcerated hernia on the 18th day. Before undergoing laparoscopic sleeve gastrectomy (LSG), the mean weight and body mass index (BMI) of the participants were 124.2 ± 16.7 kg and 43.4 ± 5.7 kg/m², respectively. After one year, the participants experienced a mean percentage of excess weight loss (EWL) of 77.1 ± 12.2% and a mean total weight loss (TWL) of 33.2 ± 6.2%. Hernia formation has been found to be associated with both type 2 diabetes (T2D) and female gender. Conclusion In laparoscopic sleeve gastrectomy (LSG), repair of the trocar port closure is not always necessary. The rates of hernia at port entry sites were similar between cases with and without fascial repair.

Genetic risk score based on obesity-related genes and progression in weight loss after bariatric surgery: a 60-month follow-up study

: ObjectivesThis study aimed to investigate and compare the adherence of patients treated for morbid obesity living in Poland and Germany. Methods: A cross-sectional international multicenter survey design was adopted. The study involved 564 adult subjects treated for morbid obesity at selected healthcare facilities in Germany (210 participants) and Poland (354 participants). A validated, custom-made questionnaire based on the literature related to this issue was used. Results: The degree of adherence was higher, but not statistically significant, among Polish patients (83.82% vs. 78.33%, p = 0.26140). Patient adherence was associated with gender, age, level of education, duration of obesity, number of health professionals involved in obesity treatment, and type of obesity treatment (p < 0.05). A positive correlation was observed in the case of age, level of education, and a growing number of health professionals involved in obesity treatment, whereas a negative correlation was observed in the case of the duration of obesity. Patients who underwent bariatric surgery significantly more often followed medical recommendations regarding lifestyle changes, compared to obese participants treated only conservatively. Adherence in the field of obesity treatment significantly increases the percentage of total weight loss and excess weight loss due to applied obesity treatment among both Polish and German groups (p < 0.001). Both the percentage of total weight loss and that of excess weight loss were significantly higher in the group of adherent patients compared to the nonadherent patients (p < 0.00001). The levels of perceived anxiety, stress, and depression were significantly higher in nonadherent patients in both countries. Conclusions: These findings confirm the role of adherence in the effective and satisfactory treatment of morbid obesity. There is a great need to improve patient adherence to overcome the consequences of the obesity pandemic.

Laparoscopic gastric plication versus mini-gastric bypass surgery in the treatment of morbid obesity: A randomized clinical trial

Background Laparoscopic mini-gastric bypass (MGBP) is gaining popularity among the bariatric procedures today, and laparoscopic sleeve gastrectomy (SG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. Patients and methods Between October 2016 and July 2018, 50 obese patients were randomized, operated upon, and followed up for 12 months in Al Zahraa Hospital and Shebin El-Kom teaching Hospital. A total of 25 patients underwent SG, and 25 patients underwent MGBP. The mean BMI of all patients was 47.8 ± 5.5 kg/m2, their mean age was 30 ± 8.3 years, and 80% of them were female. Patients were followed up at 1, 3, 6, 9, and 12 months. Operative time, length of hospital stays, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions, and mortality were evaluated. Results Age, sex, BMI, and comorbidities were equal. The mean operative time for SG was 86.9 ± 51.6 min and that for MGBP was 108.4 ± 41.8 min; the percentage of 1-year excess weight loss was similar (76.2 ± 4.49% for SG and 80.3 ± 8.3% for MGBP). The comorbidities were significantly improved after both procedures, except for type 2 diabetes mellitus, which showed a higher resolution rate after MGBP. Conclusion Laparoscopic SG regarding excess weight loss is comparable to laparoscopic MGBP in short-term follow-up (1 year) with less metabolic effect. Further long-term studies are needed.

Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities; type 2 diabetes, hypertension and hyperlipidaemia.1 However, the literature is scarce regarding the long-term outcome after bariatric surgery, especially among multi-ethnic Asian populations. Considering the growing number of bariatric metabolic surgeries in Asia, we have attempted to provide a regional perspective on 5-year long-term clinical outcomes post bariatric surgery in Singapore. Between 2010 and 2016, all bariatric operative cases were included, and these comprised: laparoscopic sleeve gastrectomy (LSG), 393; laparoscopic Roux-En-Y gastric bypass (RYGB), 125; laparoscopic mini-gastric bypass (MGB), 43. The primary outcome measure was the percentage of excess weight loss (% EWL) at 6 months, 1, 2, 3, 4 and 5 years, with % remission of type 2 diabetes mellitus (T2DM) at 1 year following LSG (49.7%, 61.2%, 56.1%, 47.8%, 40.8% and 47.3%; 82.2%), RYGB (60.2%, 62.1%, 57.6%, 50.1%, 48.7% and 47.7%; 86.9%) and MGB (58%, 68.1%, 62.7%, 66.2%, 64.0%, 65.2%; 71.9%). In conclusion, MGB and RYGB showed the greatest % EWL at 5 years and are recommended for moderate T2DM. LSG is an effective bariatric operation with a high % EWL up to 2 years, and a high remission rate of mild T2DM. The remission rate of T2DM was equally high in all 3 surgical groups, independent of ethnic differences.

Background Laparoscopic one-anastomosis gastric bypass (LOAGB) is an effective, relatively low-risk procedure and can be reversed. Patients and methods Between June 2014 and September 2018, 310 morbidly obese patients have undergone LOAGB surgery. Results The mean operating room time was 69 min. Median postoperative length of stay was 2.1 days. The;Deg;BM;Deg;I has decreased from 49.3±9.9 to 38.8±9.7 kg/m2, 33.7±4.7 and 28.8 kg/m2 at 6, 12, and 24 months postoperatively, respectively. The percentage of excess weight loss is, respectively, 50±26, 62±25, and 72±18% at 6, 12, and 24 months postoperatively.. Major complications have occurred in a total of 11 (3.5%) patients. One patient has suffered from postoperative gastrojejunal anastomotic leakage. Five patients have suffered from massive postoperative bleeding. Two patients have intractable bile reflux after minigastric bypass. Omega loop gastric bypass was converted to Roux-en-Y gastric bypass in these two patients. One anastomotic stenosis needed dilatation over three sessions. One patient developed port site hernia 6 months postoperatively. This patient was explored and managed laparoscopically. One patient presented 15 months after minigastric bypass with perforated gastrojejunal anastomotic ulcer that was treated by omental patch repair. There were no postoperative mortalities. Conclusion LOAGB can be regarded as a simple, safe, effective, and reversible bariatric procedure.

Effectiveness of sleeve gastrectomy plus fundoplication versus sleeve gastrectomy alone for treatment of patients with severe obesity: a systematic review and meta-analysis