Laparoscopic Mini-gastric Bypass Research Articles

Bile reflux after laparoscopic mini/one anastomosis gastric bypass: the problem and prevention

Currently, laparoscopic mini-gastric bypass (LMGB) is a common bariatric surgical operation. One of the reasons for reoperations after LMGB is pathological bile reflux, which, in addition to a noticeable decrease in the quality of life of patients, poses a potential threat to the neoplastic processes in the stomach and esophagus. This study aimed to systematize and analyze modern literature information on terminology, diagnosis and frequency of detection, pathophysiological significance, and methods of preventing bile reflux post-LMGB. Russian and English full-text studies on bile reflux after LMGB in the bibliographic databases of the Russian Science Citation Index, PubMed, Google Scholar, and ScienceDirect were analyzed. The frequency of diagnosing bile reflux after LMGB varies from 2.0 to 57.9%, depending on the instrumental diagnostic methods used: flexible endoscopy, 24-hour pH impedance measurements, spectrophotometry of bilirubin in refluxate, and hepatobiliary scintigraphy. The pathogenetic effect of the contents of the small intestine on the mucous membrane of the stomach and esophagus after LMGB is noted because of the direct cytotoxic and receptor-mediated effects of bile acids. The safety of the main stages of LMGB (creation of a gastric pouch and formation of a single anastomosis) is currently being reviewed from the standpoint of minimizing the risk of developing bile reflux. Furthermore, novel techniques have been proposed to reduce the likelihood of intestinal contents entering the stomach and esophagus; however, their effectiveness remains controversial.

Remission of Diabetes Mellitus Type 2 after Mini Gastric Bypass In BMI Less Than 40 (Meta-Analysis)

Abstract Background Obesity is a potent risk factor for the development and progression of type 2 diabetes, and weight loss is a key component of diabetes management. Bariatric surgery results in significant weight loss and remission of diabetes in most patients. After surgery, glycemic control is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin secretion. Aim and Objectives to review the currently available evidence for the effect of laparoscopic mini gastric bypass in obese patients on remission of diabetes type 2. Subjects and Methods This was a systematic review, including all available studies meeting the eligible criteria: well conducted descriptive studies, case reports and series, cohort, articles, accepted manuscripts, clinical trials, analytic studies and literature of reviews. Excluding other systematic reviews, technical notes, letters, and comment. Intervention done in all the studies concerning this subject including laparoscopic mini gastric bypass. Result Mean number of Improved, % (no.) [HbA1c <7%] were 64%, mean Partial remission, % (no.) [HbA1c <6.5%] was 77% and mean Complete remission, % (no.) [HbA1c <6.0%, glucose <110 mg/dl] was 50.5%. Conclusion GB surgery is an effective treatment strategy for diabetes remission and control of metabolic syndrome. Duodenum exclusion plays a role in the mechanism of diabetes mellitus remission.

Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass on Liver Function at 6 Months in Morbid Obesity Patients: A Cross-Sectional Study

Background: Various weight loss surgeries exist, with no absolute superiority; each has pros and cons. Due to rising bariatric surgeries globally, it's vital to investigate comparisons between two-mini gastric bypass and Roux-en-Y gastric bypass (RYGB), especially regarding their impact on liver function. Objectives: The purpose of this study was to "draw comparisons between the effects of mini gastric bypass and laparoscopic Roux-en-Y gastric bypass on liver function at 6 months among patients with morbid obesity." Methods: This cross-sectional study included 90 bariatric surgery candidates (Body Mass Index (BMI) 35 - 50) from 2018 - 2021. Forty-five had laparoscopic mini gastric bypass surgery, while 45 had Roux-en-Y gastric bypass. Demographic, anthropometric, lab, and sonographic tests were conducted at baseline, 3-, and 6-months post-surgery. Data was analyzed using SPSS. Results: In a study of 90 patients (75.6% female, mean age 38.6 ± 10.4 years), both surgeries (Mini gastric bypass (MGB) and RYGB) effectively reduced body weight, BMI, and waist circumference at 3- and 6-months post-surgery. However, MGB showed significantly higher BMI and weight loss compared to RYGB (P = 0.003). In 90 patients, both surgeries reduced weight and BMI. However, MGB showed better BMI/weight loss. LFTs (ALT, AST, ALP) remained stable after MGB but worsened at 3 months after RYGB before recovering by 6 months. Mini gastric bypass also showed better GGT improvement. Both procedures improved fatty liver grading, FBS, and HbA1C levels equally. No significant differences were observed in blood pressure, platelet count, hemoglobin, or MCV. Ferritin levels increased in both groups but were higher in RYGB. CRP was higher in RYGB at 3 months. Conclusions: Roux-en-Y gastric bypass temporarily exacerbated liver enzymes and inflammation, but MGB resulted with more weight reduction. In comparison to RYGB, MGB improved LFTs more consistently.

Effect of laparoscopic mini gastric bypass versus laparoscopic single anastomosis sleeve ileal bypass on serum iron and calcium levels

Background Although bariatric surgery techniques are very effective in the treatment of obesity, they are usually associated with evident nutritional deficiencies. Such operations require ongoing medical care along with vitamin (Vit) and nutrition supplements. Aim Is to determine and compare the effect of Laparoscopic mini gastric bypass (MGB) versus laparoscopic single anastomosis sleeve ileal bypass (SASI) on serum iron and calcium levels. Methodology The current prospective Randomized controlled study included 62 patients who were randomly allocated into one of two equal groups. Group A (n=31) underwent MGB while group B (n=31) underwent SASI. Follow-up was designed for 6 and 12 months in both groups for the serum iron profile, serum folate, Vit B12, Vit D, parathyroid hormone, and calcium level. Results There was a statistically significant decrease in Excess weight loss (EWL)% in both groups after 1, 6, and 12 months and a significant EWL % in group A more than group B (P=0.045*). There was a statistically significant drop in the Iron profile components’ levels in both groups after 1, 6, and 12 months in comparison with the corresponding baseline levels. There was a statistically significant decrease in the calcium level as well as Vit D3 within both groups at 1, 6, and 12 months follow-up with a significant increase in Parathyroid hormone in both groups at the same interval of follow-up. Conclusion Both MGB and SASI are effective methods for the treatment of morbid obesity. However, adherent follow-up for the Iron profile, Vit B12, Vit D3, parathyroid hormone, and calcium levels are mandatory.

Laparoscopic mini-gastric bypass versus laparoscopic Roux-en-Y gastric bypass in redosurgery after failed vertical banded gastroplasty with long gastric pouch

Background Up to 50% of patients who undergo vertical band gastroplasty (VBG) experienced weight regain or complications, like band erosion or slippage, within 5–10 years of the procedure, the aim of the study to evaluate laparoscopic mini-gastric bypass versus laparoscopic Roux-en-Y gastric bypass as a redosurgery after failed VBG. Patients and methods We analyzed the data of 102 patients (38 males and 64 females) underwent revisional surgery after failed VBGs from July 2021 to August 2022, with mean age 45.92 years, follow up for 1 year in Ain Shams University Hospitals. Results The mean hospital stay was 1.8 days (1–4 days), 2.9 days (2–7 days) in Redo laparoscopic mini gastric bypass (R-LMNGB) and Redo laparoscopic roux en Y gastric bypass (R-LRYGB) respectively. Postoperative BMI after 1 year 31.16±27.83 and 31.94±3.69 in R-LMNGB and R-LRYGB, respectively, %EWL show significant difference between two groups after 3 months and 1 year. Postoperative complications rates were 3.92% in R-LRYGB. Conclusions R-LMNGB after failed VBG has almost the same results of R-LRYGB as regard weight loss, improvement of obesity-related comorbidities with less operative time, hospital stay, less anastomosis, and complications.

Analysis of learning curves for mini-gastric bypass in 341 patients with obesity

To analyze learning curves and appropriate experience on the features of mini-bypass surgery in 341 obese patients. A total of 341 laparoscopic mini-gastric bypass surgeries performed by one surgeon were studied. The median age of patients was 40.5 [34; 48.3] years. There were 284 (83.2%) women and 57 (16.8%) men. The median BMI was 45 [40;52] kg/m2. The period of MGB development consisted of 138 interventions. Surgery time was 120 [100; 130] min and 90 [82.5; 100] mins after development of this technique (p=0.001). Complications occurred in 5 (1.5%) patients (1 patient with Clavien Dindo grade IIIA and 4 ones with grade IIIB). Of these, there were 3 patients with stapler suture defects. There were no complications only in the 4th quartile of surgeries. Surgical experience significantly affects postoperative outcomes. Surgery time was more influenced by surgical skill rather technique of anastomosis imposing. Polynomial regression objectively characterizes development of surgical skills lasting 138 interventions. MGB is safe for morbid obesity with a complication rate of 1.5% and no mortality.

IBC-Oxford University2023_BJSOral_10Selection of the Length of the Biliopancreatic Loop in OAGB-MGB

Abstract Introduction One anastomosis gastric bypass (Omega loop gastric bypass/minigastric bypass/single bypass) has gained supporters worldwide, especially in recent years in Europe and Asia. Several studies have shown that this is a simple, safe and effective bariatric surgery. However, there are many controversial and ambiguously accepted technical aspects of this procedure. The purpose of this study is to report on the clinical results of choosing the length of the biliopancreatic loop in laparoscopic mini-gastric bypass. Methods From April 2018 to April 2023, we performed OAGB-MGB in 678 obese patients, 586 of them had type 2 diabetes. Median age: 46.2 years (29 to 63 years). The average weight was 122 ± 11.5 kgs (98-244); BMI on average 44.8±8.7 kg/m2 (37-72); The average operation time was 74±9.6 minutes (52-140). All examined patients were divided into 2 groups, the control group and main group of patients. The control group had 302 patients (2018-2020) and the length of the biliopancreatic loop (BPL) ranged from 180 to 250 cms. The main group had 376 (2021-2023) patients and the length of the BPL ranged from 150 to 200 cms, depending on BMI. At BMI < 40 kg/m2, the length of the BPL was 150 cms; at BMI > 40 kg/m2, it was 180 cms; at BMI > 50 kg/m2, the length of the BPL was 200 cms. Results Analysis of the results of treatment of patients in the control group showed that the number of complications were high, especially protein and vitamin-mineral deficiencies were observed. Therefore, we have developed a computer programme for selecting the length of the biliopancreatic loop depending on BMI. This program was taken as the basis for performing OAGB-MGB in patients of the main group. Analysis of the results of treatment of patients in the main group showed the effectiveness of this technique, which resulted in a decrease in the number of early and late postoperative complications in the main group compared with the control group. Conclusions OAGB/MGB is a feasible, safe and effective bariatric surgery. When performing OAGB/MGB, depending on the patient's BMI, it is necessary to individually select the length of the biliopancreatic loop. The length of the biliopancreatic loop of more than 250 cms increases the risk of developing protein, vitamin and mineral deficiencies.

Mini-gastric bypass with Nissen fundoplication for the treatment of obesity and gastroesophageal reflx disease

Aim. To develop bariatric and antireflx surgery for the treatment of patients with obesity and GERD, and to assess its effectiveness and safety.Methods. A prospective controlled study included 28 patients who underwent laparoscopic mini-gastric bypass with Nissen fundoplication, and their progress was monitored for three years postoperatively. This study covered the surgical procedure and its technical aspects. Surgical treatment was evaluated using GERD-HRQL, BAROS, and GIQLI questionnaires, as well as instrumental studies (esophagogastroscopy and X-ray of the esophagus and stomach).Results. According to the GERD-HRQL questionnaire, mini-gastric bypass with Nissen fundoplication demonstrated excellent control over GERD symptoms during all stages of postoperative follow-up. The most signifiant reduction in body weight occurred within the fist year after the operation, with sustained effects throughout the observation period. The maximum percentage of excess body weight loss was observed two years post-operation. The GIQLI questionnaire showed an average score increase of 54 % three years after surgical treatment compared to baseline. Evaluation of the bariatric treatment’s effectiveness using the BAROS system criteria consistently indicated «excellent and very good results» throughout the entire postoperative follow-up period. No signifiant postoperative complications were identifid, both in the early and long-term periods.Conclusion.The developed mini-gastric bypass with a Nissen fundoplication proves to be a safe and effective surgical treatment method for patients with obesity and GERD. Following further clinical studies and the analysis of long-term results, the proposed operation could be recommended as an alternative to RYGB and MGB-OAGB for patients with obesity and GERD.

Laparoscopic minigastric bypass as a revisional choice for failed restrictive bariatric procedure and its metabolic impact

Background Restrictive bariatric procedures, like laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG), are associated with an increased risk of long-term failure. The efficacy of One-anastomosis gastric bypass (OAGB) has been described in primary and revisional settings, with a lack of Egyptian studies regarding OAGB as a revisional surgery. Herein, we describe our experience regarding 1-year outcomes of OAGB as a revisional surgery after failed LSG or LAGB. Patients and methods Fifty patients with failed LSG or LAGB were enrolled in this prospective study. All cases underwent laparoscopic OAGB, and its effects on weight loss and obesity-related comorbidities were noticed after 3, 6, and 12 months. Results The duration of the operation ranged between 45 and 120 min Postoperative complications included leakage (2%), hemorrhage (2%), and port site infection (2%). OAGB as a revisional surgery led to a significant and effective weight loss, as the percent of excess weight loss (%EWL) had mean values of 23.72%, 51.54%, and 80.25% at the scheduled visits, respectively. The procedure was associated with a significant rise in hemoglobin and albumin, significant decline in blood sugar, glycosylated hemoglobin, vitamin B12, and most lipid profile parameters, with no significant changes in serum calcium and high-density lipoproteins. Beneficial effects (remission or improvement) were noticed in 88.9% of diabetic cases, 80% of hypertensive cases, and 100% of reflux cases at one-year follow-up visit. Conclusion Laparoscopic OAGB as a revisional surgery is a safe and efficacious procedure in the management of patients with failed previous restrictive procedures like LSG and LAGB.

Effect of laparoscopic mini-gastric bypass versus laparoscopic sleeve gastrectomy on hypertension and dyslipidemia in obese type 2 diabetes mellitus patients.

The aim of the research was to compare the effect of the laparoscopic mini-gastric bypass (LMGB) technique with the laparoscopic sleeve gastrectomy (LSG) technique in bariatric surgery on type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia in obese T2DM patients. A prospective, cross-sectional study, conducted in Surgery Department at Al-Mouwasat and Al-Assad University Hospitals in Damascus, and included T2DM obese patients who would undergo bariatric surgery using the LMGB or LSG technique. The research included two groups: the LSG group (92 patients, 60.9% female, age 44.6 year, BMI 41.85kg/m2) and the LMGB group (137 patients, 59.1% female, age 47.1 year, BMI 43kg/m2). Before surgery, the prevalence of HTN and dyslipidemia were similar in the two groups. After one year: T2DM improvement and remission rate in the LMGB group (13.9, 80.3%) were greater than in the LSG group (13, 62%), the difference was statistically significant. The HTN improvement and remission rate in the LMGB group (52.9, 41.4%) were greater than in the LSG group (47.5, 39%), the difference was not statistically significant. The dyslipidemia improvement rate was greater in LSG group (47.2 vs. 32.7%), while the dyslipidemia remission rate was greater in LMGB group (67.3 vs. 52.8%), the difference was statistically significant. The authors found that the LMGB technique was more effective than the LSG technique in controlling cardiovascular risk factors of obesity, T2DM, HTN, and dyslipidemia.

Comparative Study between Laparoscopic Single Anastomosis Sleeve Ileal Bypass (SASI Bypass) versus Laparoscopic Mini-Gastric Bypass (MGB/OAGB) in Controlling Type 2 Diabetes in Morbidly Obese Patients

Abstract Background In our opinion, the most important criteria in the selection of a bariatric procedure remain the safety and efficacy in achieving both weight loss and remission of the metabolic consequences of obesity. Despite the intrinsic limitation imposed by a retrospective study, our results seem to confirm that LMGB is both safe and effective for the treatment of morbidly obese diabetic patients. Laparoscopic SASI bypass has been shown to be an effective, safe, and simple procedure for the treatment of morbid obesity and its associated metabolic consequences. Moreover, it results in minimal postoperative nutritional complications in comparison to other bariatric procedures. However, long-term follow-up period should be performed to evaluate postoperative weight loss, metabolic changes, and nutritional status of patients. Objective To compare Laparoscopic Single Anastomosis Sleeve Ileal (SASI) Bypass with Minigastric bypass (MGB/OAGB) in controlling type 2 Diabetes Mellitus in morbidly obese patients. Patients and Methods This study is a retrospective comparative study in which morbidly obese Patients with type 2 DM who underwent either Mini-gastric bypass or Single Anastomosis Sleeve Ileal (SASI) bypass with available preoperative Fasting blood Glucose, Hemoglobin A1c& serum cpeptide (As predictive measures for remission of diabetes after surgery) was collected & their data and results was compared to this1,3, 6 & 12 months postoperatively. Results As regard glycemic and lipid profile pre and postoperative mean values in MGB group, the present study showed that there were significant differences between before and after surgery as regard FBG, HbA1C, triglyceride, cholesterol, HDL and LDL. Laparoscopic mini-gastric bypass (MGB) is a technically simple and safe procedure in SSO patients. LMGB has the advantages of being a single stage procedure, being easily reversible and revisable in a laparoscopic procedure and does not sacrifice portions of the stomach or implant foreign materials. SASI bypass is a promising operation that offers excellent weight loss and metabolic result. The elimination of two ways for passage of food and one anastomosis decrease nutritional deficiency and the possibility of surgically related complications. Conclusion Metabolic surgery is a safe option for carefully selected patients with metabolic syndrome. The increased risk for type 2 diabetes and cardiovascular disease demands therapeutic attention for those at high risk. Our study suggests that both SASI and MGB are highly effective in controlling Diabetes mellitus, Hypertension and Hyperlipidemia.

Comparative study between Laparoscopic mini-gastric bypass versus laparoscopic single anastomosis sleeve jejunal bypass for treatment of morbidly obese patients

Comparative study between Laparoscopic mini-gastric bypass versus laparoscopic single anastomosis sleeve jejunal bypass for treatment of morbidly obese patients

#3253 STUDY OF THE EFFECT OF TWO BARIATRIC SURGERY TYPES ON RENAL FUNCTION AND MCP 1 LEVELS

Abstract Background and Aims Bariatric surgery has been the most effective and permanent treatment for severe obesity and has resulted in significant improvement or reduction of comorbidities due to obesity. To evaluate and compare the outcome of two types of bariatric surgery (LMGB and LSG) on renal functions and urinary MPC-1 level in morbidly obese patients after three months of surgery. Method Forty morbidly obese patients underwent bariatric surgery between October 2018 and July 2019. Two types of bariatric surgery were done; laparoscopic mini gastric bypass (LMGB) and laparoscopic sleeve gastrectomy (LSG). Group A include 26 patients underwent LSG and group B include 14 patients. Results There were no statistically significant difference in the postoperative mean weight, BMI, neck circumference, WC, Hip circumference, WHR, SBP and DBP in the cases between the 2 types of surgeries (LSG and LMGB) also, there were no statistically significant difference in the mean post urinary MCP1 (73.53±21.25&75.43±26.17,P>0.5), post microalbuminuria (8.83± 6.26 &10.02± 8.6,P>0.05),post urinary creatinine (109.21± 43.22&99.19±48.65,P>0.05), post MCP1/Cr ratio (0.78±0.36&1.01±0.70,P>0.05), post CRP(5.73± 3.04&5.77±3.17, P>0.05), post serum creatinine (0.74±0.05&0.75± 0.07,P>0.05), eGFR (100.32±9.54&104.39±9.54,P>0.05), s.cholesterol, s.HDL and s.TGs in the cases who had either LSG operation (group A) or LMGB operation (group B). Conclusion There were no statistically significant difference as regard renal function, urinary MCP-1 level and weight loss between LSG and LMGB.

Effect of mini-gastric bypass surgery for morbid obesity on indicators of carbohydrate metabolism

Objective. To analyze the long-term results of the effect of mini-bypass surgery for morbid obesity on the state of carbohydrate metabolism and the dynamics of changes of BMI.Materials and methods. A prospective uncontrolled randomized study was conducted on the basis of the Clinical Hospital ‘Russian Railways – Medicine’ ofCity of Barnaul (Russia), which included patients aged 22 to 56 years with an average body mass index of 45.23 kg/m2 and having a violation of carbohydrate metabolism: 17 patients with an established diagnosis of type 2 diabetes, 20 patients with insulin resistance. Patients with DM were canceled prior to surgery and short-acting insulin preparations were prescribed situationally. Laparoscopic minigastric bypass surgery was performed, for which anesthesia with limited use of opioids was used. Indicators were determined: fasting blood glucose in the pre- and early postoperative period, after 6 months and 2 years, glycated hemoglobin, HOMA-IR index, BMI before surgery and in control measurements.Results. The positive dynamics of the studied indicators was demonstrated in patients with impaired carbohydrate metabolism by the time of discharge from the hospital, which was performed on 4–5 days from the moment of surgery. In most patients, this trend persisted for 2 years after surgery. Positive changes in carbohydrate metabolism occurred against the background of a significant decrease of BMI.Conclusions. Laparoscopic mini-bypass surgery is an effective method of treating morbid obesity with concomitant metabolic syndrome for a long time.

Comparative Study between laparoscopic Sleeve Gastrectomy and laparoscopic Mini Gastric Bypass in Control of Type2 Diabetes Mellitus in obese patients

Comparative Study between laparoscopic Sleeve Gastrectomy and laparoscopic Mini Gastric Bypass in Control of Type2 Diabetes Mellitus in obese patients

IBCOx-8 Bile reflux after laparoscopic mini-gastric bypass; Is it really a major concern?

Abstract Background Laparoscopic mini gastric bypass MGB, first performed in late 1990s, become a popular bariatric procedure with proven comparable efficiency. Its popularity can be explained by many factors including: its technical simplicity and efficacy in weight loss compared to RYGB, its superiority in controlling metabolic syndrome compared to restrictive procedures and its efficacy as revision surgery for failed restrictive procedures. However, many debates still exist among bariatric surgery experts regarding its complications; mainly bile reflux and its consequences. We presented our experience, as a tertiary university institute in dealing with bile reflux complications after laparoscopic mini gastric bypass that necessitated endoscopic and/or operative interventions. Methods This is a retrospective study of all cases who were admitted in a tertiary hospital because of bile reflux related complications in one year duration. Results Three cases were admitted because of bile reflux complications. The first case presented by hemorrhagic shock due to massive hemorrhage at a marginal ulcer after 26 days of mini gastric bypass. The second case was re-operated electively because of intractable bile reflux after failure of medical treatment. The third case presented with peritonitis on top of perforated marginal ulcer seven month after mini gastric bypass. Conclusion Despite its claimed safety and efficacy, laparoscopic mini gastric bypass is not the procedure of no-morbidities. Incidence of postoperative bile reflux is under-estimated. All patients should undergo a regular endoscopy to assess it even if asymptomatic.

Successful pregnancy with primary infertility as a result of simultaneous bariatric intervention and laparoscopic oophorectomy in women with large cystic ovarian teratoma and morbid obesity

The article presents a clinical observation of a patient with primary infertility on the background of morbid obesity (BMI – 64.6 kg/sq.m.) and large cystic teratoma of the right ovary, who underwent bariatric surgery – laparoscopic minigastric bypass and simultaneous laparoscopic right-sided oophorectomy. Along with the true gynecological causes of female infertility, which include, among others, benign formations of the uterine appendages, obesity is a proven significant factor in its development. The use of various infertility treatment options in obese women is ineffective, and pregnancy outcomes are often disappointing. The only proven effective treatment for morbid obesity is bariatric surgery. The implementation of bariatric intervention, and, as a result, a significant decrease in body weight, directly positively affects fertility rates. However, the polyetiological nature of primary infertility in women dictates the need for an integrated approach to treatment. A feature of the presented case is the simultaneous elimination of both etiological factors of infertility – gynecological and endocrine after one surgical intervention. The goal was achieved – after 10 months, the patient was diagnosed with a progressive uterine pregnancy for a period of 11 weeks, with a decrease in body weight by 49.9% of overweight. The course of pregnancy was uneventful. Childbirth independent, newborn full-term boy without deviations. After the birth of the child, the patient continued to reduce body weight and, 29 months after surgery, she achieved a loss of 67% of her excess weight. The presented case clearly demonstrates the advantages of simultaneous elimination of the most likely causes of primary infertility. However, the implementation of such interventions by laparoscopic access requires extensive surgical experience, technical equipment and comprehensive readiness of the medical institution.

Factors Affecting Muscle Mass Loss Following Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini Gastric Bypass Surgeries

Excessive muscle mass loss is common following bariatric surgery due to decreased protein intake. Therefore, this study aimed to examine factors associated with muscle mass loss after three months in patients who underwent Laparoscopic Sleeve Gastrectomy (LSG) and Mini-gastric bypass (MGB) in a bariatric surgery centre in Alexandria, Egypt. An observational study was performed on 50 patients, 25 of whom underwent LSG, whereas 25 underwent MGB. At baseline and after three months, physical activity level, energy and protein intake were assessed. Bioelectric impedance analysis assessed the body composition preoperatively and after three months. The current study's demonstrated that LSG and MGB three months postoperatively lost -17.3 ± 2.8 % and -18.5 ± 3.1 %, respectively, of their weight. Nevertheless, in MGB, patients lost more muscle mass (-17.2±12.4 %) compared to LSG (-11.5 ± 5.6 %) (p=0.063). In MGB, females lost -23.5 ± 11.6 % of their muscle mass compared to -7.9 ± 6.6 % in males (p<0.05). Muscle mass loss in < 60 g protein eaters was higher in MGB than LSG (M ± SD= 20.3 ± 12.5 % vs -13.0 ± 5.3 %, p=0.033). While muscle mass loss in ≥ 60 g protein eaters was -5.6± 1.5 % in LSG and 7.4± 5.9 % in MGB. In conclusion, females in MGB lost more muscle mass than males after three months. Protein intake ≥ 60 g/day during the first three months postoperative is associated with low muscle mass loss. High preoperative HbA1c correlates with muscle mass loss in MGB especially in females . High preoperative Hba1c and protein intake of < 60 g/d are associated with muscle mass loss in LSG.

A comparative study between intravenous and intraperitoneal magnesium sulphate for pain management in laparoscopic mini gastric bypass: a randomized clinical trial

Abstract
 Background: Laparoscopic bariatric surgery has become a regular procedure, and it has largely replaced traditional open surgery. Patients experience postoperative pain even after laparoscopic surgery, although the intensity is low compared to open surgery. We compared the effectiveness of intravenous (IV) vs. intraperitoneal (IP) magnesium sulphate (MgSO4) injection in pain management in laparoscopic mini-gastric bypass surgery. 
 Methodology: We selected 100 patients based on convenient sampling and randomly divided into two groups; the IV group (50 patients) received MgSO4 50 mg/kg in 250 ml normal intravenously, and the IP group (50 patients) received MgSO4 50 mg/kg in 30 ml normal saline intraperitoneally. Nalbuphine was used as rescue analgesic and its total postoperative consumption during the first 24 h was recorded based on VAS score. Postoperative nausea and vomiting (PONV), sedation score and hemodynamic changes with pneumoperitoneum were also assessed.
 Results: Total nalbuphine consumption postoperatively was more in IV group than IP group (12 ± 3.03 mg vs. 8.3 ± 2.8 mg; P < 0.001). Postoperative pain score was significantly lower in IP group in comparison to IV group (P < 0.001). Intraoperative hypotension and bradycardia were significantly more (P = 0.03) in IV group (21% and 17% respectively) compared to IP group (10% and 7% respectively). Postoperative sedation and nausea and vomiting scores were reduced in IP group compared to IV group, the difference being highly significant (P < 0.001).
 Conclusion: Intraperitoneal MgSO4 instillation has better results than intravenous infusion in attenuation of postoperative pain and hemodynamic response associated with pneumoperitoneum, and results in less PONV when used in laparoscopic minigastric bypass patients.
 Key words: Analgesics / administration & dosage; Analgesics / pharmacology; Analgesics / therapeutic use; Bariatric; Magnesium Sulfate / administration & dosage; Magnesium Sulfate / pharmacokinetics; Magnesium Sulfate / therapeutic use; Mini-gastric bypass; Pain management; Pneumoperitoneum
 Citation: El-Sesy MG, Abdel Hameed AE, Abdelaziz AA, Ahmed IM, Elhennawy AM. A comparative study between intravenous and intraperitoneal magnesium sulphate for pain management in laparoscopic mini gastric bypass: a randomized clinical trial. Anaesth. pain intensive care 2022;26(4):450-457; DOI: 10.35975/apic.v26i4.1947
 Received: April 18, 2022; Reviewed: June 16, 2022; Accepted: July 10, 2022

Efficacy of whole-body cryotherapy in complex medical rehabilitation of patients after laparoscopic bariatric gastric bypass for the treatment of morbid obesity

The steady growth in the number of obese patients consequently leads to an increase in bariatric surgeries, while the issues of rehabilitation of these patients remain not fully resolved. Aim of the research: to evaluate the effectiveness of using the whole-body cryotherapy (WBC) in complex medical rehabilitation of patients after laparoscopic gastric bypass in the treatment of obesity. Materials and methods. An interventional, single-center, prospective, controlled, single-blinded, experimental, randomized study. The study included 2 stages. Stage 1: 40 patients underwent laparoscopic mini-gastric bypass with band-separated gastric pouch. Stage 2: the patients were divided into 2 groups: with the use of WBC as part of complex medical rehabilitation (Group A, n = 20) and without additional physiotherapy methods (Group B, n = 20). The course of WBC was 15 sessions of 1–3 minutes. The CryoSpace 2K device consists of a cryochamber (temperature –110 °С) and a pre-chamber (–60 °С). The procedures were carried out every other day; the exposure duration increased in parallel with the growth of cryoresistance. The patients were followed up for a total of 2 years. Results. Surgical results: the average duration of surgery was 85 ± 26 minutes; the length of stay in the hospital was 3.7 ± 1.5 days. One complication was registered. Initially, the patients in groups A and B did not differ in terms of sex, age, anthropometric data, and comorbidities composition. After 2 years of follow-up, BMI was significantly lower in group A with the use of WBC compared with group B (26.7 vs 29.4 kg/m2). The percentage of total weight loss, percentage of BMI loss and percentage of excess weight loss were significantly higher in group A. Conclusion. Taking into account the ongoing rehabilitation measures, the group with the use of WBC showed significantly better indicators for achieving ideal body weight and losing excess weight, which is an argument for recommending the use of this type of physiotherapy in the rehabilitation complex after bariatric procedures.