Mini-gastric Bypass Research Articles

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.

The Role of Mini Gastric Bypass in the Control of Type 2 Diabetes Mellitus

The Role of Mini Gastric Bypass in the Control of Type 2 Diabetes Mellitus

The Role of Mini Gastric Bypass in the Control of Type 2 Diabetes Mellitus

The Role of Mini Gastric Bypass in the Control of Type 2 Diabetes Mellitus

Marginal ulcer after mini gastric by-pass and sleeve gastrectomy with transit bipartition

Marginal ulcer after mini gastric by-pass and sleeve gastrectomy with transit bipartition

Endoscopic diagnosis and treatment of patient with early cardioesophageal cancer three months after gastric bypass surgery

Problems of obesity and its accompanying metabolic disorders remain relevant throughout the world and are due to an increased risk of disability and early mortality in patients with this pathology. Currently, bariatric surgery is recognized as the most effective treatment for morbid obesity. Of exceptional importance are not only the technical features of operation, but also a full preoperative examination. The occurrence of gastric cancer after bariatric surgery is a rare but occurring phenomenon, often associated with insufficient quality of preoperative endoscopic examination. We presented a clinical case of endoscopic diagnosis and removal of early cardioesophageal cancer in a patient with morbid obesity, three months after mini-gastric bypass surgery, as well as examine bypassed stomach with single- balloon enteroscope.

Safety and efficacy of OAGB/MGB during the learning curve: setting a benchmark in a bariatric center of excellence

Very little has been published on the learning curve (LC) of the One Anastomosis /Mini Gastric Bypass (OAGB/MGB). Aim of this study was to compare perioperative outcomes of OABG/MGBs performed during the LC of an experienced laparoscopic surgeon to global benchmark cut-offs. First 200 patients undergoing OAGB/MGB at our university hospital from 2010 to 2016 were retrospectively included in this study. LC of the surgeon was divided in two groups of 100 consecutive patients each and perioperative outcomes were compared to abovementioned global benchmarks for LSG and RYGB. A cumulative sum (CUSUM) analysis was performed for operative time and hospital stay. Uneventful postoperative recovery was recorded in 95% of patients. All benchmark values for RYGB were met in group 2. Comparison with cut-offs for LSG showed longer hospital stay and operative time in both groups but postoperative rate of complications resulted lower even for Group 1. CUSUM graph of the operative time runs randomly above the predetermined limit till the 40th cases but reaches the plateau after the 115th operation. CUSUM curve of the hospital stay reaches the plateau after the 57th case. OAGB/MGB confirms to be a feasible procedure, which can be safely and effectively performed during the learning curve. However, at least 100 hundred cases are required to reduce operative time and hospital stay.

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

TU1.7 The correlation between BITE score and weight outcomes in Mini/One Anastomosis Gastric Bypass patients – an update with 24-month post-operative results

Abstract Background The Bulimic Investigatory Test, Edinburgh (BITE) self-report questionnaire is used to assess the risk of bulimic and binge eating habits in bariatric patients preoperatively. This study aimed to investigate the correlation between preoperative BITE scores and weight loss at 3, 6, 12, 18 and 24 months follow up in patients with Mini-Gastric Bypass (MGB-OAGB). Method Consecutive patients who received MGB-OAGB between 2016–2018 completed the BITE questionnaire at initial assessment and were included in this prospective study. Baseline demographics were measured. Excess body weight loss (%EBWL) and total weight loss (%TWL) were calculated on the day of surgery and at 3, 6, 12, 18 and 24 months follow up. Results 120 patients were eligible with an average age of 43 (± 10.84) years. 21.67% (n=26) had high BITE scores (≥20), 44.17% (n=53) had medium BITE scores (10–19), and 34.17% (n=41) had low BITE scores (≤9). Low and Medium BITE groups had similar outcomes at each follow up. The low BITE group had greater %EBWL and %TWL compared to high BITE group across all the follow ups, however this difference was not significant. There were no reoperations or mortality. Conclusion MGB-OAGB results in good weight loss at 3, 6 and 12 months post-operatively independent of BITE scores. There was no significant difference between pre-operative binge eating behaviours on post-operative weight outcomes. To extend the study, further research between the effect of pre-operative psychological input on weight outcomes could be investigated. Going forward, comparative study in patients with RYGB and sleeve gastrectomy would be recommended.

Comparing the Effects of Two Methods of Bariatric Surgery, Laparoscopic Sleeve Gastrectomy and Mini Gastric Bypass, on the Weight Loss of Children and Adolescent Younger Than 19 Years Old: A Three-Year Follow-up Study

Background: There is little data about the surgical outcomes of different procedures in children. Objectives: We aimed to compare the difference in three-year surgical outcomes between laparoscopic sleeve gastrectomy laparoscopic sleeve gastrectomy (LSG) and one-anastomosis gastric bypass one-anastomosis gastric bypass (OAGB) in children undergoing these procedures. Methods: A total of 96 children aged ≤ 19 years were listed for bariatric surgery to be included in this prospective study. Demographic characteristics, such as age and gender, and anthropometric indices, including height, weight, body mass index, waist circumference, and hip circumference, as well as postoperative complications, were recorded. The participants underwent LSG and OAGB by the same surgical team. The variables were compared between the groups at baseline and 1, 3, 6, 12, 24, and 36 months after surgery. Results: At follow-up, the OAGB group had a higher waist circumference after 1 and 3 month(s) (P = 0.011 and 0.005, respectively) and higher hip circumference 3 months after surgery (P = 0.035). Time significantly affected the trend of changes in weight, body mass index, waist circumference, and hip circumference (P < 0.001). There were no cases of postoperative complications. Conclusions: Our experience showed that LSG had better outcomes after three months, while LSG and OAGB had favorable outcomes on the weight and body mass index (BMI) of children with morbid obesity until three years after surgery.

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.

Laparoscopic conversion of omega loop gastric bypass to Roux-en-Y gastric bypass for Barrett’s esophagus: case report

BackgroundThe number of mini gastric bypass / one anastomosis bypass (MGB-OAGB) procedures in bariatric patients that have been performed world-wide has drastically increased during the past decade. Nevertheless, due to the risk of subsequent biliary reflux and development of ulcer and neoplastic (pre)lesions caused by long-time bile exposure, the procedure is still controversially discussed. In here presented case report, we could endoscopically demonstrate a transformation from reflux oesophagitis to Barrett’s metaplasia most likely caused by bile reflux after mini-gastric bypass. To our knowledge, this is a first case study that shows development of Barrett’s metaplasia after MGB-OAGB.Case presentationWe present the case of a 50-year-old female which received a mini-gastric bypass due to morbid obesity (body mass index (BMI) 42.4 kg/m2). Because of history gastroesophageal reflux disease (GERD), a fundoplication had been performed earlier. Preoperative gastroscopy showed reflux esophagitis (Los Angeles classification grade B) with no signs of Barrett’s metaplasia. Three months post mini-gastric bypass, the patient complained about severe bile reflux under 40 mg pantoprazole daily. Six months postoperative, Endoscopically Barrett’s epithelium was detected and histopathologically confirmed (C1M0 after Prague classification). A conversion into Roux-en-Y gastric bypass was performed. The postoperative course was without complications. In a follow up after 6 months the patient denied reflux and showed no signs of malnutrition.ConclusionsThe rapid progress from inflammatory changes of the distal esophagus towards Barrett’s metaplasia under bile reflux in our case is most likely a result of previous reflux disease. Nevertheless, bile reflux appears to be a potential decisive factor. Study results regarding presence of bile reflux or development of endoscopically de-novo findings after MGB-OAGB are widely non-conclusive. Long-term prospective studies with regular endoscopic surveillance independent of clinical symptoms are needed.

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.

Metabolic and Histopathological Effects of Mini Gastric By-Pass: An Experimental Animal Model

Aim: Bariatric surgery is becoming increasingly popular worldwide. One of these procedures, minigastric bypass (MGB), reduces the volume of the stomach and provides malabsorption and restriction, as well as hormonal changes, leading to practical results. In this study, we aimed to evaluate the effects of the MGB technique in rats. For this purpose, we studied the efficacy of mediators on gastric obesity and metabolism and analyzed histopathological data for effects on weight loss. Materials and Methods: Obese Wistar Hannover rats were evaluated by measuring their weight before and after surgery and by examining gastrin, ghrelin, and leptin levels in blood samples collected on day 30, and the rats were sacrificed for histopathological examination. Results: Significant weight loss was observed in the MGB group at postoperative month 1 compared with the control group. The biochemical analysis showed that the mean gastrin level in the MGB group was statistically higher compared with the control group (p = 0.0001). Mean levels of ghrelin and leptin were significantly lower in the MGB group than in the control group (p = 0.0001). According to the immunohistochemical analysis, the mean gastrin level at the cardia was significantly higher in the MGB group than in the control group. Mean ghrelin levels at the pylorus in the study group was significantly lower compared with the control group. Mean leptin level at the cardia in the MGB group was significantly lower compared with the control group. The histopathological examination of the MGB group showed that foveolar hyperplasia at the cardia was mild, whereas cystic gland dilatation and fibrosis at the anastomosis site were moderate and intense, respectively. Conclusions: This is a pilot study to identify the ideal bariatric technique and to investigate histopathological results of unknown aspects of metabolic surgery methods. This will encourage researchers to perform similar studies in the future.

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)

A CASE REPORT OF CHYLOUS ASCITES AND TRANSIENT MIDGUT VOLVULUS THROUGH PETERSENS DEFECT THREE YEARS POST ONE-ANASTOMOSIS GASTRIC BYPASS- MINIGASTRIC BYPASS

One-anastomosis gastric bypass- Minigastric bypass (OAGB-MGB) is an emerging bariatric surgery technique replacing the RYGP with reasonable short- and long-term side effects. Here we would like to present a late complication of OAGB-MGB associated with signs of peritoneal irritation and severe pain due to transient midgut volvulus associated with chylous ascites.. We observed peritoneal lymphatic collection in association with features suggestive for small bowel obstruction 3 years followingOAGB-MGB. So, we believe that such complication should be considered as a potential side effect during short and long term follow up after gastric bypass.A strong recommendation should be provided.

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.

Robotic-Assisted Mini-Gastric By-Pass for Diabetes in Children: A First Case Report and Review of the Literature

Objectives: Obesity is one of the most common diseases of children across the globe with repercussion because of comorbidities like diabetes for the future followed by premature deaths. We aimed to report the world first case of robotic-assisted mini-gastric by-pass in 15 years old boy to treat diabetes and obesity. Surgical technique and review of the literature has been presented. Patient and Methods: Fifteen years old male with Body Mass Index (BMI) 58.6 at 125 percentile, and the patient was followed by dietetic counseling and with increasing metformin dosage treatment because of insulin resistance in his country. After 3 years of follow up the patient’s treatment was not successful and therefore the family addressed to our obesity council. Our genetic consultant assured the boy doesn’t have MC4R mutation. Other endocrinologic comorbidities was evaluated by a pediatrician specialist on obesity and referred to a pediatric endocrinologist. The Type 2 diabetes was diagnosed. Robotic assisted mini-gastric by-pass was planned. Under general anesthesia five instrument ports were placed. Then the robot was docked. The stomach was divided with stapler at the junction of the body and antrum, at a location where the jejunal loop can be brought up comfortably. The jejunal loop is brought up antecolic, and the stapler is used to anatomose the stomach and the small bowel at this point. The distal end of the gastric tube is anastomosed to the side of the small bowel. Methylene blue was given to ensure there was no leakage at the anastomosis and the stapling sites. The antidiabetics were stopped by the operation. The patient was followed for a month with a normalization of blood glucose levels and without medical nor surgical complication. Results: Operative time was 105 minutes. No intraoperative complication was encountered. The patient started walking 6 hours postoperatively. The first postoperative day glucose levels were within the normal limits. Oral contrast CT demonstrated neither leakage nor obstruction on the first day. Patient started oral intake within 24 hours and was discharged in 3 days without any postoperative complication. After 1 month of follow up we didn`t saw any perturbation on blood glucose level. Conclusion: Robotic-assisted mini gastric by-pass is feasible in diabetic children. The main postoperative advantages are early recovery, less pain and better cosmesis with a easily revisable and reversible operation.

Incidence of Vitamin B1 (Thiamine) Deficiency Post Mini-Gastric Bypass: A Prospective Study

Incidence of Vitamin B1 (Thiamine) Deficiency Post Mini-Gastric Bypass: A Prospective Study