Mini-gastric Bypass Research Articles

A Specifically Tailored Multistrain Probiotic and Micronutrient Mixture Affects Nonalcoholic Fatty Liver Disease—Related Markers in Patients with Obesity after Mini Gastric Bypass Surgery

BackgroundNonalcoholic fatty liver disease (NAFLD) is frequent among patients undergoing bariatric surgery. Beyond weight reduction, dietary supplements like micronutrients or probiotics that modify insulin resistance and lipotoxicity can be used to prevent or delay the progression of liver disease. ObjectivesWe evaluated the effect of a dietary approach with a specifically tailored multistrain probiotic and micronutrient mixture compared with a basic care micronutrient supplement on serum alanine aminotransferase (ALAT) in obese patients after mini gastric bypass (MGB) surgery. MethodsThis randomized, double-blind, controlled trial included 60 obese patients (age: 40 ± 10 y; BMI: 44 ± 3 kg/m²). Patients received a combination of specifically tailored multistrain probiotic powder and a specific micronutrient mixture (Pro+SM) or a control treatment consisting of a placebo and a basic care micronutrient mixture (Con+BM), with some micronutrients in lower doses than SM, for 12 wk after hospital discharge. Primary (serum ALAT) and secondary outcomes [serum aspartate aminotransferase (ASAT), fatty liver index, NAFLD fibrosis score, glucose metabolism, blood pressure (BP), heart rate] were assessed at week 0 and week 12. Data were analyzed using unpaired Student’s t-tests or Mann-Whitney U tests to compare the changes due to each treatment to one another. ResultsA total of 48 patients were included in the analyses. Changes in serum ALAT concentrations did not differ between groups. Compared with Con+BM, Pro+SM improved serum ASAT (difference: –8.0 U/L, 95% CI: –17.0, –4.0; P = 0.043), NAFLD fibrosis score (difference: –0.39; 95% CI: –0.78, 0; P = 0.048), serum triglycerides (difference: –22.8 mg/dL; 95% CI: –45.6, –0.1; P = 0.049) and the visceral adiposity index (difference: –0.70; 95% CI: –1.31, –0.08; P = 0.027). ConclusionSupplementation with a specifically tailored probiotic and micronutrient mixture improved NAFLD-related markers more than a basic micronutrient mixture in obese patients following MGB surgery. The trial was registered under clinicaltrials.gov as NCT03585413.

Comparative Study on Nutritional Intake and Nutritional Status of Elective Pre- and Post-operative Bariatric Surgery Patients

Obesity is a global epidemic affecting populations worldwide. Bariatric surgery is effective in treating morbid obesity in individuals who fail to lose weight even after modifying lifestyle, dietary habits, and pharmacotherapy. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of patients before surgery. The aim of this study was to assess and compare pre- and post-surgery nutritional status of bariatric candidates. Obesity is the basis for cluster of non-communicable diseases creating an enormous socioeconomic and public health burden. For this, laparoscopic bariatric procedures; sleeve gastrectomy, Roux-en Y Gastric Bypass, and Mini Gastric Bypass were done for treating obesity and other related co-morbidities. The medical records of 50 subjects were reviewed for this study. Mean age and body mass index are 42.2 ± 12.9 (kg/m2) and 42.77 ± 7.9 (kg/m2), respectively. The pre-surgery mean intake of energy, carbohydrate, protein, and fat was 3048 ± 485.4 (kcal/d), 200.4 ± 40.1 (g/d), 101.6 ± 17.02 (g/d), and 156.09 ± 108.4 (g/d), respectively, which were above Recommended Dietary Allowances. The mean intake of energy, carbohydrate, protein, and fat was significantly decreased post operatively (P > 0.001) to 1400 ± 99 (kcal/d), 132.1 ± 22.3 (g/d), 69.9 ± 3.6 (g/d), and 30.9 ± 6.4 (g/d), respectively. Low intake of fiber, Vitamin A (74%), and Vitamin C (32%) was observed during pre-operative condition. The findings in this study advocates nutritional intervention and tailored supplementation pre- and post-bariatric surgery for promising results.

Acute hepatic porphyria attack following mini gastric bypass surgery

Acute Intermittent Porphyria, (AIP) is a rare disease caused by Hydroxymethylbilane Synthase (HMBS) deficiency. It is characterized by acute neurovisceral attacks, in which excessive heme production is induced following exposure to a trigger. One of the suggested triggers is low carbohydrate intake. We report a 32-year-old female who suffered from severe abdominal pain, nausea and general weakness following a bariatric mini gastric bypass surgery. There was a positive family history of AIP, but the patient had a normal Porphobilinogen urine test as a child, therefore diagnosis was not made. During current symptoms, urinary porphobilinogen was highly increased and AIP was diagnosed. Treatment with IV dextrose and Heme Arginate alleviated the patient’s symptoms. After discharge, Family genetic testing revealed a novel pathogenic mutation in the HMBS gene. Had genetic testing been performed earlier, diagnosis of AIP could have been established earlier. Early diagnosis may prevent attacks and reduce their severity. Since a bariatric surgery leads to low intake of carbohydrates, it might be an indirect trigger of an acute porphyria attack. Keywords: porphyria; bariatric surgery; porphobilinogen.

Surgical management of refractory severe protein-calorie malnutrition following Mini Gastric Bypass – One Anastomosis Gastric Bypass: Shortening of biliopancreatic limb with gastrojejunal anastomosis preservation

Surgical management of refractory severe protein-calorie malnutrition following Mini Gastric Bypass – One Anastomosis Gastric Bypass: Shortening of biliopancreatic limb with gastrojejunal anastomosis preservation

БАРИАТРИЧЕСКИЕ ОПЕРАЦИИ ПРИ МОРБИДНОМ ОЖИРЕНИИ

Objective. To improve the results of surgical treatment of patients with morbid obesity. Methods. The database of bariatric surgery (2014-2020 yrs) was created and analyzed in the center, retrospectively and prospectively. Total 292 operations, including 150 sleeve gastrectomy, 84 mini gastric bypass procedures, 37 adjustable gastric bandings, 12 Roux-en-Y gastric bypasses, 5 gastric plications and 4 gastric plications with gastric fundus resection have been included in this database. There were 215 females and 77 males. The mean age was 41 years. All surgeries were performed laparoscopically and meanoperative time was 108 minutes. Results. As the result of performed bariatric surgeries, 36 complications were registered. Total complication rate was 11,8% without any case of mortality. Staple line and anastomotic leakage rate after surgery, related to the stomach resection or bypass, was 3,4%. Staple line and anastomotic bleeding rate after the same procedures - 3,1%. The the aforementioned complications were the most frequent and accounted up to 47% of all bariatric surgery complications. Other complications occurred much less frequently with incidence rate 0,4% - 1,2%. Conclusion. The bariatric surgery database allows analyzing the structure of performed operations and its complications as well as identifying the regularity of their development. That would help to develop methods of the most frequent complication prevention and their early diagnostics. Compatibility of the database format with IFSO Global Registry allows providing the collected data for further analysis at the international level. Data on the spectrum and frequency of postoperative complications in the center correlate with international experience. The most significant complications in the practice of the center are incompetence, anastomotic leakage and bleeding from the lines of sutures and anastomoses after operations associated with gastric resection or bypass. Therefore, the specific measures for improvement preventionofcomplications permits increasing significantly bariatric surgery safety. What this paper adds The structure of postoperative complications of bariatric surgical interventions performed in a multidisciplinary hospital has been determined. Staplelinefailure withgastricleak are the most common early complications after the operations related to resection or gastric bypass and account for more than 47% of all complications. Prevention of complications to improve outcome significantly increases the safety of the performed bariatric interventions.

Biliary reflux after laparoscopic modified antireflux monoanastomotic gastric bypass surgery

Aim. Determination of biliary reflux in patients with morbid obesity after a single-anastomotic gastric bypass operation performed in the clinic's modification and according to the classical Roux-en-Y gastric bypass technique. Development of diagnostic criteria for biliary reflux Materials and methods. The results of treatment of 36 patients with morbid obesity who underwent bypass surgery were studied. The patients are divided into two groups. Clinically modified laparoscopic monoanastomotic gastric bypass surgery was performed in 25 patients (main group). The control group included 11 patients after the standard technique of Roux-en-Y laparoscopic gastric bypass. Inclusion criteria were: persons of both sexes aged 18-60 years with morbid obesity and a body mass index of 40 or more, as well as 35 or more in the presence of comorbid diseases (type 2 diabetes mellitus, arterial hypertension, dyslipidemia, sleep apnea syndrome). In both groups, impedance pH measurements were performed in the postoperative period. Statistical processing was performed using the Statistica 13.0 software package using parametric and nonparametric statistical methods. Results: Clinical manifestations of the enterogastric biliary reflex were found in both groups; in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. The analysis of daily pH-metry in the studied groups showed that in the esophagus the time with pH <4 in the main group 2.83 (1.55; 3.95)% 3.00 (2.30; 3.50)% in the control group, time with pH 4-6.9 (physiological for the esophagus) 92.40 (90.65; 94.20)% and 94.10 (89.80; 95.50)%, respectively, time with pH> 7 (weak alkaline) was 4.80 (3.45; 5.85)% and in the control group 2.90 (1.20; 7.20)%. There was no statistically significant difference in these indicators (p> 0.05). Conclusions. Monoanastomotic gastric bypass surgery in the modification of the clinic has the same positive properties as the Rouen-Wye technique, allowing you to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone mini-gastric bypass surgery require a thorough examination with fibrogastroscopy in combination with pH impedance measurement at least 1 time per year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stomach stump. The level of quality of life of patients after surgery in the control group and the main group does not significantly differ, as evidenced by the results of the questionnaire survey using the GERG Q questionnaire, which indicates the effectiveness of the methodology of laparoscopic monoanastomotic gastric bypass surgery modified in the clinic. Key words: morbid obesity, gastric bypass surgery, surgical treatment, mini-gastric bypass, biliary reflux.

Evaluation of the metabolic status and sarcopenia in the long-term period after Roux-en-Y gastric bypass and mini-gastric bypass surgery

INTRODUCTION. Bariatric operations lead to changes in body composition. The desired fat loss may be accompanied by decrease of muscle mass, thus raising the risk of sarcopenia.The OBJECTIVE was to evaluate the long-term results of surgical treatment of morbid obesity and concomitant comorbid conditions, as well as a decrease of muscle mass in the pre - and long-term postoperative period.METHODS AND MATERIALS. This prospective randomized controlled blind trial included the results of treatment of 241 patients. Patients were divided into 2 groups depending on the type of surgical treatment. The first group consisted of 116 people who underwent RYGB; the second group included 125 patients who underwent OAGB/MGB. 83 patients from the first group and 95 patients from the control group at the preoperative stage and 24 months after the operation randomly underwent bioelectrical impedance with the determination of skeletal muscle mass (SMM) and skeletal muscle mass index (SMMI)=SMM/Height2. The calculated SMMI index for men normally corresponds to >10.76 kg/m2; moderate sarcopenia SMMI=8.51–10.75 kg/m2; the SMMI index of ≤8.5 kg/m2 corresponds to severe sarcopenia. For women, this index is normally ≥6.76 kg/m2; moderate – 5.76–6.75 kg/m2; severe sarcopenia ≤5.75 kg/m2. Bioelectrical impedance were performed on a «AVS-01 Medass» bioelectrical impedance body composition analyzer (Russia). RESULTS. The difference in changes in the results of anthropometric indicators, as well as laboratory indicators of diabetes compensation within 24 months in both groups was statistically insignificant (p>0.05). According to bioelectrical impedance data, the incidence of sarcopenia in patient groups was as follows: the initially normal ratio of muscle mass to the square of growth in meters, i.e. normal SMMI in 71 (85.5 %) patients in the group with RYGB, and in 78 (85.7 %) patients in the group with OAGB/MGB. Moderate sarcopenia was detected in 12 (14.5 %) patients with RYGB and 13 (14.3 %) patients with OAGB/MGB. 24 months after the operation, SMMI was distributed as follows – Norm in 59 (71.1 %) patients of the study group and 47 (51.6 %) patients in the control group. Moderate sarcopenia was found in 16 (19.3 %) patients in the group of patients with RYGB, and in 29 (31.9 %) cases in the group of patients with OAGB/MGB. Severe sarcopenia was observed in 8 (9.6 %) patients of the first group and 15 (16.5 %) patients of the second group (p=0.0001).CONCLUSIONS. Bariatric bypass surgery results in significant changes in body composition 24 months after surgery. Bioelectrical impedance allows to effectively detect these changes. The desired weight loss is associated with a significant decrease in skeletal muscle mass, mineral mass. Thus, patients after bypass surgery are at risk of sarcopenia. Sarcopenia is more pronounced in patients after OAGB/MGB than after RYGB.

Is belching increasing after bariatric bypass surgery in the long term period?

Gastric bypass surgery effectively treats obesity; however, its association with belching, which occurs in other bariatric surgeries, remains unclear. Hence, we aimed to evaluate belching occurrence after gastric bypass surgery. We enrolled 12 healthy volunteers and 17 patients (12 and 5 underwent Roux-en-Y gastric bypass and mini-gastric bypass surgeries 24 (18-54) months prior, respectively). Gastrointestinal symptoms were assessed. Gastroscopy was performed, followed by the 24-hour pH-impedance analysis. Age and sex were not statistically different between the two groups (P > 0.05). Patients had a significantly higher mean DeMeester score than the healthy controls (9.11 ± 19.40 vs. 6.04 ± 5.60, P = 0.048), but the pathologic acid reflux (DeMeester score > 14) rate was similar in both groups (11.8% vs. 8.3%). Regarding the impedance, symptom-association probability was positive in 11.8% of patients. The patients also had higher alkaline reflux rates (6% vs. 0%); additionally, 50% of them experienced belching based on the questionnaire, and 25% had esophagitis based on gastroscopy. Furthermore, patients had a significantly higher number of gas reflux (123.24 ± 80 vs. 37.2 ± 21.5, P = 0.001) and supragastric/ gastric belches (182 ± 64/228 ± 66.69 vs. 25.08 ± 15.20/12.17 ± 17.65, P = 0.001). Supragastric belching was more frequent than gastric belching in the controls, whereas gastric belching was more frequent in the patients. Belching increases after gastric bypass surgery in a long-term period. Gastric belching was more frequent than supragastric belching in these patients.

Pathological and Histological Aspects of Biliary Reflux After Mini-Gastric Bypass

Background: One anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) is considered to be the best alternative to Roux-en-Y gastric bypass due to the shorter operative time and fewer possible complications. Objectives: The purpose of this study is to determine biliary reflux in patients who undergo OAGB/MGB with a hand-sewn gastroenteroanastomosis, and OAGB/MGB with a linear stapled gastroenteroanastomosis. Materials and Methods: This prospective-retrospective study includes the results of treatment of 122 obese patients who underwent laparoscopic OAGB/MGB. Patients were divided into two clinical groups depending on the method of performing gastroenteroanastomosis. In the postoperative period, the possibility of developing biliary reflux was assessed using fibrogastroscopy with biopsy of the gastric mucosa. Histopathology of biopsy materials was evaluated. Microscopy of biopsy specimens was performed by a pathologist who evaluated each sample of gastric tissue in accordance with the system for determining the biliary reflux index (BRI). Results: With fibrogastroscopy, 9 (15.5%) cases in the study group and 16 (26.6%) cases in the control group, biliary reflux was diagnosed. In the study group of patients, BRI >14 was determined in 3 patients (5.153%). In the control group of patients, BRI >14 was found in 7 cases (10.94%). The difference is significant (p < 0.05). Conclusion: Determination of the BRI index in patients undergoing an OAGB/MGB can be used as a screening method to diagnose biliary reflux for its prevention and the development of tactics for the further management of patients with a high risk of complications associated with the toxic effects of aggressive bile. Hand-sewn gastroenteroanastomosis carries less risk of bile reflux gastritis and anastomositis than stapled gastroenteroanastomosis. Clinical Trial Registration number NCT04845438

Invasive candida infection after bariatric surgery for morbid obesity presenting as late anastamotic leak

Introduction: Gastrointestinal (GI) leaks are one of the most dreaded complications following bariatric surgery because of the difficulty in diagnosing them and the associated increased morbidity and mortality. Case report: Presenting one such case of 49 yr old gentleman who was on follow-up post bariatric surgery presented lately as acute abdomen and diagnosed as GI perforation and further evaluation and procedure carried out. Discussion: GI leakage after bariatric surgery has been identified as an independent risk factor associated with perioperative death. This highlights the importance of high index of suspicion for diagnosis of this potentially lethal complication. A positive radiology should not be awaited for before exploring patients in whom the diagnosis is still unclear. Conclusion: Histopathologic examination (HPE) remains one of the major diagnostic tools in mycology because it permits rapid, presumptive identification of fungal infections, even when blood cultures are negative. There are different ways to manage leaks, depending on the magnitude of the collection and the clinical presentation. Keywords: surgical pathology; gastrointestinal candidiasis; diagnosis; mini gastric bypass; bariatric surgery; candida.

1139 Effectiveness of One-Anastomosis Gastric Bypass Vs Sleeve Gastrectomy in Short- And Long-Term Weight Loss – A Review

Abstract Aim Bariatric surgery has been the most efficient treatment option for moderate to severe obesity. Recently, the sleeve gastrectomy (SG) has become the most widely performed bariatric surgery. However, the one-anastomosis gastric bypass (OAGB) has exponentially increased recently and is associated with excellent short- and long-term weight loss benefits. Hence, the aim of this review is to compare the effectiveness of OAGB vs SG in short- (≤ 1 year) and long-term (&amp;gt; 1 year) weight loss. Method A comprehensive literature search of PubMed, Scopus and Google Scholar databases were conducted. Search criteria included keywords such as one-anastomosis gastric bypass, mini-gastric bypass, omega-loop gastric bypass, sleeve gastrectomy, short-term weight loss and long-term weight loss. Selection criteria included any randomised controlled trials (RCTs) and cohort studies comparing the effects of OAGB vs SG in weight loss, published from the years 2010 onwards. Only full text studies and papers published in English language were chosen. Results nine studies were selected to be reviewed in this study. 62.5% of studies which had reports for short-term weight loss showed that OAGB was able to achieve a significantly greater % excess weight loss (%EWL) or % excess BMI loss (%EBMIL) (P &amp;lt; 0.05). Whereas 80% of studies which had reports for long-term weight loss showed that OAGB achieved a significantly greater %EWL or %EBMIL, up to five years. Conclusions This review suggests that OAGB is associated with significantly greater short-and long-term weight loss than SG. However, due to the small number of RCTs on OAGB vs SG, more long-term RCTs should be conducted for greater evaluation.

Comparative study between Single Anastomosis Sleeve Ileal Bypass (SASI) and Mini Gastric Bypass (OAGB) in treatment of Morbid Obesity

Abstract Background Single anastomosis sleeve ileal bypass (SASI) procedure appears as anew metabolic and bariatric surgery based on santoro's operation, in which sleeve gastrectomy is followed by side to side gastro-ileal loop anastomosis. Aim of the Work to compare between Single Anastomosis Sleeve Ileal Bypass (SASI) and Mini Gastric Bypass (OAGB) in treatment of morbid obesity. Patients and Methods Our study was a prospective randomized comparative study in Ain Shams University hospitals involving 50 patients suffering from morbid obesity and in whom surgical management was indicated. Our patients were randomly divided using closed envelopment method into two groups: Group (1): (25 patients) were treated by laparoscopic SASI. Group (2): (25 patients) were treated by laparoscopic MGB. Results One year after the surgery, there was significant diabetic remission rate and there was improvement of most of obesity-associated metabolic parameters Conclusion Our study suggests that both SASI and MGB are highly effective in controlling diabetes mellitus, hypertension and hyperlipidemia.

Comparison between Early Results of Laparoscopic Mini Gastric Bypass and Sleeve Gastrectomy regarding Weight Loss, Remission of Type II Diabetes Mellitus and Hypertension

Abstract Background Bariatric Surgery leads to a dramatic improvement in morbid obesity and associated type 2 Diabetes Mellitus (T2DM) and hypertension. Objectives The aim of the study was to compare between early results of Laparoscopic Mini Gastric Bypass and Sleeve gastrectomy regarding excess weight loss, remission of Type II diabetes mellitus and hypertension. Patients and Methods Type of the study, retrospective study. study setting, Our study was carried out at The General Surgery Department Ain Shams University Hospitals. study period,. All cases were operated during the period February and march 2019. Follow up of patients 6 months after operation was done (retrospective study). Last follow up was done on September 2019. The study included 50 patients aged 18-60 years with Type II Diabetes Mellitus and hypertension of at least 6 months duration, BMI 35 65 kg/m2 for at least 5 years. Results In this study There was no statistical significant difference between studied groups as regard age,gender,and baseline clinical data. there was a statistical significant difference between patients in LMGB group as well as between patients in LGS group before and six months after surgery as regard weight in kg, BMI and HbA1C and.remission of hypertention (P value 0.000). there was high statistical significant difference between studied groups as regard percentage of change of weight and BMI(P value 0.000) However, there was no statistical significant difference between studied groups as regard percent of change of HbA1C. (P value 0.613),remission of T2DM.(p value 0.123 ) and control of hypertension. (p value 0.136 ). Further results and data could be reached on long-term follow up of patients involved in this study. Conclusion Patients receiving mini-gastric bypass had more advantageous indexes than patients receiving sleeve gastrectomy, such as higher six months EWL% (excess weight loss), higher T2DM remission rate and higher hypertension remission rate. Especially on long term follow up and that was proved by meta analysis of previous studies but on short term follow up there is no statistical singnificant difference between both studied groups except in percentage of change of weight and BMI. Mini-gastric bypass is simple, safe and more effective bariatric procedure than laparoscopic sleeve gastrectomy.

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.

OUTCOME OF MINI GASTRIC BYPASS AFTER FAILED VERTICAL BAND GASTROPLASTY IN TREATMENT OF MORBID OBESE PATIENTS

Background: Bariatric surgery has long been introduced for weight control if conservative treatment failed and was widely accepted in the past decades. Compared with nonsurgical strategies, bariatric surgery proves more effectiveness for moderately to severely obese people to lose weight. Besides, bariatric surgery was demonstrated to induce significant and long-term remission of obesity related comorbidities.Aim of The Work: The aim of this study to review the outcome of Mini gastric bypass as a line of management of failed VBG operation in treatment of morbid obese patients as regard weight loos, intraoperative complications, postoperative complications and other comorbidities within one year follow up after operation.Patients and Methods: Our study includes thirty (30) morbidly obese patients who fulfilled the criteria for bariatric surgery with BMI >40 or >35 with associated co-morbidities with failure of previous restrictive operation (VBG). These patients were enrolled in a prospective study and had a retrospectively gathered outcome analysis at the department of surgery Ain-Shams University Hospitals. Our study was conducted in El-Demerdash hospital, Ain- Shams University. Thirty patients were selected and operated upon from June 2017 till June 2019 and followed up to June 2020.Results: In our study causes of revision in (30) patients: weight regain (10) patients severe GERD (9) patients, un satisfactory weight loss (8) patients, eating difficulties (3) patients. In our study The mean initial BMI for the patients was The preoperative BMI with mean ± SD: 42.9 ± 7.21 kg/m2, was higher than post-operative BMI at 3 months with mean ± SD value of 38.03± 5.62 kg/m2), than post-operative BMI at 6 months with mean ± SD value of 33.98 ± 4.58 kg/m2, than post-operative BMI at 12 months with mean ± SD value of 29.22 ± 3.60 kg/m2.Conclusion: Mini-gastric bypass offers major benefits with quite satisfactory results over most alternative procedures. Our data, which includes follow up of two years, indicates that mini gastric bypass is: An effective procedure for the treatment of failed restrictive procedure (VBG). Technically feasible. Safe operation with a low rate of major postoperative complications. Has a significant reduction in patient’s hospital stay. Helps in the achievement of a significant weight loss and improvement of obesity related metabolic co morbidities. Efficient in loosing excess weight and in maintaining the weight loss. so it is considered a promising revisional bariatric procedure operation for patients with failed prior open or laparoscopic VBG

A new approach in bariatric operations: bridged mini gastric by-pass. Is rabbit model suitable for an experimental study?

Obesity is a global health epidemic with considerable co-morbidities. The increasing demand for bariatric surgery has led to the emergence of new techniques. We modified previously described Mini Gastric By-pass(MGB) technique via leaving a bridge at the most cranial 2 cm of the fundus of the human stomach to the follow-up and treatment of the remnant stomach and duodenum. We would like to entitle this new technique as Bridged MGB and aimed to apply on rabbits as an experimental study. The study was performed in the experimental animal laboratory of university after ethical approval was taken from the local ethics committee. Described new technique was applied to 2.1 and 3.2 kg 2 New Zealand rabbits. As a result of the operations, one of the rabbits died on the day of the operation; the other rabbit was exitus postoperatively on the third day. In autopsies, although no problem was detected at the anastomoses, necrosis was detected in the large curvature of both rabbits. Rabbit, one of the popular experimental animals, has been shown to be different from the human gastrointestinal system in both arterial and topographic aspects and it has been emphasized that it varies according to the species and even the diet and the climate. We believe that our study failed as a result of these differences and that animals more similar to humans should be used in gastrointestinal experimental studies.

Comparison between the Effect of Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini-gastric Bypass on Type 2 Diabetes Mellitus in Obese Patients: A Prospective Study

Comparison between the Effect of Laparoscopic Sleeve Gastrectomy and Laparoscopic Mini-gastric Bypass on Type 2 Diabetes Mellitus in Obese Patients: A Prospective Study

Reversal to normal anatomy after one-anastomosis/mini gastric bypass, indications and results: a systematic review and meta-analysis.

This review evaluates the indications and outcomes of one-anastomosis/mini gastric bypass (OAGB/MGB) reversal to normal anatomy. A systematic literature search and meta-analysis was performed in PubMed, Web of Science, and Scopus for articles published by October 1, 2020, including the keywords "one anastomosis gastric bypass," "OAGB," "mini gastric bypass," "MGB," "reversal," "reverse," "malnutrition," and "reversal bariatric surgery". After examining 182 papers involving 11,578 patients, 14 studies were included. A reversal was performed in 119 patients on average 23.6 months after the primary OAGB/MGB surgery. The mean body mass index (BMI) was 22.92 ± 3.47 kg/m2 and the mean albumin level was 25.17 ± 4.21 g/L at reversal. The mean length of the common channel (CC) was 383.57 ± 159.35 cm, with a mean biliopancreatic limb (BPL) length of 214.21 ± 48.45 cm. Pooled estimation of the meta-analysis of prevalence studies reported a prevalence of 1% for reversal. The major signs and symptoms of protein-energy malnutrition were the leading causes of the reversal of OAGB/MGB. Bleeding, leakage, and death due to severe liver failure were the most reported complications after reversal, with an overall incidence of 10.9%. In conclusion, OAGB/MGB reversal has a prevalence of 1% and has a complication rate of 10.9%. Protein-energy malnutrition with hypoalbuminemia was the most common etiology. The mean lengths of BPL and CC were reported as 215 cm and 380 cm, respectively, in the cases. Therefore, special attention should be paid to malnutrition in all OAGB/MGB patients during follow-up to prevent severe malnutrition and subsequent increase in reversal procedures.

The Efficacy of Mini-Gastric Bypass Surgery in Diabetic and Prediabetic Obese Patients

Background: Our aim was to investigate the efficacy of mini-gastric bypass (MGB) surgery in diabetic and prediabetic obese patients. Materials and Methods: Sixty-five patients who had MGB operation...

The Impact of Combined Bariatric Interventions on the Course of Non-Alcoholic Fatty Liver Disease

Background. Obesity is widely recognized as a disease that acquires the scale of an epidemic and is accompanied by a number of comorbidities, one of which is non-alcoholic fatty liver disease (NAFLD), while the issue of the impact of bariatric interventions on its course remains a subject of discussion, which determines the relevance of this study.Aims. Тo evaluate the impact of combined bariatric interventions - laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic mini-gastric bypass (LMGB-OAGB), - on the course of NAFLD and to determine the criteria that affect the dynamics of NAFLD after thеsе bariatric interventions.Materials and methods. The study included 56 patients who had one of 2 types of bariatric interventions performed between 2014 and 2017: LRYGB (26 (46,4%) patients) and LMGB-OAGB (30 (53,6%) patients). All patients underwent intraoperative liver biopsy, a range of laboratory and instrumental studies, FibroTest were calculated in dynamics. The frequency of complications in the postoperative period was estimated. The period of observation was 2 years. Results. In the group of laparoscopic Roux-en-Y gastric bypass 12 (46.2%) patients showed signs of liver fibrosis according to histological research, and 8 (30.8%) - signs of non - alcoholic steatohepatitis (NASH). There was an increase in transaminases in 5(19,2%), gamma-glutamyltranspeptidase (GGTP) in 19 (73.1%), and total bilirubin in 8 (30.8%) subjects. 20 (76.9%) participants had increased alkaline phosphatase (ALP), 22 (84.6%) had reduced high density lipoproteins (HDL) and increased triglycerides (TG). According to the results of ultrasound examination of the liver, 19 (73.1%) patients had enlarged liver size, 26 (100%) - diffuse heterogeneity, and 25 (96.2%) - hyperechogenicity. In the group of laparoscopic mini-gastric bypass, there were signs of liver fibrosis in 14 (46.7%) and NASH - in 14 (46.7%) patients. An increase in tranasminases was observed in 8 (26.7%), GGTP in 22 (73.3%), and total bilirubin in 6 (20%) patients. 9 (30%) of participants had increased ALP, 26 (86.7%) patients had reduced HDL and increased TG. 21 (70%) patients had enlarged liver size, 29 (96.7%) - diffuse heterogeneity, and 28 (93.3%) - hyperechogenicity.6 months after both types of interventions, there was a decrease in the clinical and biochemical characteristics of non-alcoholic fatty liver disease, which was transient and regressed by 1 year after surgery.After laparoscopic Roux-en-Y gastric bypass %EBMIL in 1 year was 75.25 [65.85-84.36] %. Normalization of transaminases was observed in 84.6%, cholestasis indicators in 87.2%, and FibroTest -in 46.2% of cases. % EBMIL 1 year after laparoscopic mini-gastric bypass was 74.77 [67.28-78.89] %. Normalization of transaminases was observed in 83.3%, cholestasis indicators in 78.9%, and FibroTest -in 43.3% of cases.Combined bariatric interventions were shown to be more effective in participants under 45 years of age compared to those over 45 years of age and in patients with initial stages of fibrosis F0-F2 by METAVIR compared to participants with stages F3-F4 by METAVIR. Patients with a BMI of more than 40 kg / m2 achieved higher FibroTest values after six months compared to subjects with a BMI of up to 40 kg/m2 and in fewer cases - FibroTest normalization by 1 year after surgery, respectively. The effectiveness of operations on the course of NAFLD was comparable.The results of the intervention on signs of non-alcoholic fatty liver disease were preserved for 2 years of postoperative follow-up. The mortality rate during the entire follow-up period was 0%. 47 (83,9%) patients were followed up to 2 years.Conclusion. Тhere was a high efficiency of RYGB and MGB-OAGB in patients with non-alcoholic fatty liver disease, while a transient aggravation of the course of non-alcoholic fatty liver disease was detected 6 months after the operation.Keywords: non-alcoholic fatty liver disease; obesity; metabolic syndrome; bariatric surgery; LRYGB; LMGB-OAGB; FibroTest; surgical intervention