Laparoscopic Mini-gastric Bypass Research Articles

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.

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.

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.

Changes in Body Composition, Basal Metabolic Rate, and Blood Albumin during the First Year following Laparoscopic Mini-Gastric Bypass.

Bariatric surgery is currently the only method that can significantly and continuously reduce weight and improve obesity-related comorbidities in morbidly obese patients. Significant weight loss through bariatric surgery can lead to changes in body composition. This study shows the changes in body composition, basal metabolic rate (BMR), and serum albumin in obese people following bariatric surgery. The study included 880 patients who underwent laparoscopic mini-gastric bypass surgery (LMGBP) between 2016 and 2020. The body mass index (BMI), bioelectrical impedance analysis (BIA), age, gender, blood albumin, WC (waist circumference), HC (hip circumference), BMR, and blood albumin were recorded at 0, 3, 6, and 12 months, postoperatively. The reduction in serum albumin concentration was not consistent with weight loss. Bariatric surgery promotes the breakdown of both fat and lean mass on the arms, torso, and thighs. This size reduction usually aggravates the concomitant skin redundancy in these areas which is a challenge for the plastic surgery team. Interestingly, the rate of lean mass reduction of the arms is faster than that of the torso and thighs. Excessive loss of lean body mass will also lower BMR and lead to subsequent weight gain. Despite the faster loss of proteins and lean mass in somatic areas, internal organs and viscera lose fats faster than proteins. According to this study, visceral proteins are the latest proteins to be affected by weight loss. This finding shows a different metabolic response of viscera comparing to somatic areas.

The effect of laparoscopic mini-gastric bypass on the compensation of carbohydrate metabolism in patients with morbid obesity and type 2 diabetes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Liver assessment post laparoscopic mini gastric bypass versus sleeve gastrectomy operation in obese and morbidly obese patients

Background: Morbid obesity is a severe disorder associated with major co‐morbidities reduced quality of life (QoL) and reduced life expectancy. Aim and objectives: The purpose of the study was to compare the effect of laparoscopic mini gastric bypass versus sleeve operation on liver function in a prospective randomized study. Subjects and methods: This study was a prospective study conducted on 80 patients who visit the general surgery clinic at Damietta university hospital (Al Azhar University) and National hepatology and tropical medicine research institute (NHTMRI); patients were being divided into 2 groups: Group A (40 patients): Undergoing laparoscopic sleeve gastrectomy surgery. Group B (40 patients):  undergoing laparoscopic mini gastric bypass surgery. Results: There a gradual significant decrease from preoperative to 12 months postoperative regarding ALT and AST in Group A, while there a gradual significant decrease from preoperative to 12 months postoperative regarding AST in Group B, Conclusion: This study demonstrated a low prevalence of abnormal LFT in our morbidly obese patients who underwent bariatric surgery. This may serve as an indirect indication of a lower prevalence of significant liver damage in these subjects.

The study of laparoscopic mini gastric bypass in patients of morbid obesity

Background: Laparoscopic mini gastric bypass (MGB) is considered superior in terms of weight loss, co-morbidity resolution and less complications, thus improve quality of life.Methods: A prospective interventional study using laparoscopic MGB in 52 morbidly obese patient over a period of 2 years.Results: Weight loss with average percentage excess weight loss (%EWL) at the end 6 months is 72.62%, at the end of 1st year 80.55% and at the end of 2nd year it is 85.83%. Out of 15 diabetic patients, 66.66% had complete remission of Diabetes mellitus resulting in discontinuation of medications and 20% of them had partial remission. Out of the 18 hypertensive patients, 88.88% had complete remission and 5.55% of them had partial remission and other 5.55% had decrease in dosage medications. Out of 20 patients of obstructive sleep apnoea syndrome (OSAS), 75% patients had complete remission and 25% of them had partial remission.Conclusions: Laparoscopic MGB is an effective procedure with >50% EWL as early as 3 months. Laparoscopic MGB causes complete or partial remission of the comorbidities like diabetes mellitus, Hypertension and OSAS. 

GASTRO-ESOPHAGEAL REFLUX DISEASE BEFORE AND AFTER BARIATRIC SURGERIES

Background: The relationship between obesity and gastro esophageal reflux disease (GERD) risk has been well established. Many authors suggest performing esophagogastroduodenoscopy (OGD) in all patients before bariatric procedures. On the other hand, many other investigators advocate a selective approach for asymptomatic patients. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered by most experts the procedure of choice for the management of GERD in obese patients; however, the effect of LSG on GERD is still unclear. Objective: To identify presences or absences of GERD in patients undergoing different types of bariatric surgery and the effect of this surgery on GERD status post operatively. Patients and Methods: This study included forty successive morbidly obese patients who present to Surgery Department of Al-Azhar University Hospitals seeking for bariatric surgery, during the period from January 2018 to April 2020. Seventeen (42.5%) of the patients were males, while twenty-three (57.5%) were females. Upper endoscopy was performed preoperatively in all cases. Full history, physical examination and special investigations were taking, Patients was classified into laparoscopic sleeve gastrostomy (LSG) group (14 cases), laparoscopic greater curvature gastric plication (LGCGP) group, (3 cases), LRYGB group, (19 cases), and laparoscopic mini gastric bypass (LMGB) group, (4 case). OGD was done preoperatively in all patient and yearly postoperatively for two successive year. Result: In LSG group (14 cases), post-operatively with follow up by OGD, there was five cases (35.7%) have GERD sings and the rest of cases, nine cases (64.3%) have normal esophageal mucosa. In LRYGB group, all patients have normal esophageal mucosa after operation. In LGCGP group, three cases, post-operatively with follow up by OGD, there was one case (33.3%) have GERD signs, and the rest of cases, two cases (66.7%) have normal esophageal mucosa. In LMGB group, two case 50% improved in the 2nd year, one (25%) improved from the 1st year, and one case (25%) has increased GERD symptoms, signs, and biliary reflux. Conclusion: OGD should be done before bariatric procedures routinely or selectively, Laparoscopic Roux-en-Y gastric bypass (LRYGB) was considered the procedure of choice for the management of GERD in obese patients, However LSG still unclear on obese patient with GERD.