Single Anastomosis Gastric Bypass Research Articles

How I do it Afferent loop obstruction (ALO) with hyper-amylasemia and deranged liver function test , are we going to see this complication more frequently again? Emergency conversion of One anastomosis gastric bypass (OAGB) to a Roux-en-Y Gastric bypass (

Abstract
 Afferent loop syndrome is a known complication of gastric surgery specifically after Billroth II and to a lesser extent a Roux –en-Y reconstruction. However the incidence decreased over the years proportionally with the decrease in the number of gastric surgery.
 Afferent loop syndrome can be either acute or chronic with different presentation and treatment options. The acute type can occur early post operatively or it could be delayed presentation. Acute ALS is associated with complete closed loop obstruction and considered a surgical emergency, whereas chronic ALS is mostly related to partial obstruction of the afferent loop.
 This rare complication can occur after the single anastomosis gastric bypass (Omega loop bypass) as it is a type of Billroth II reconstruction of gastric pouch –jejunostomy.
 With the increase in the number of SAGB performed all over the world as weight reduction surgery for morbidly obese patient s surgeons should be aware of this complication and the treatment options. 

Evaluation of Single Anastomosis Gastric Bypass

Abstract Objective The study was performed to evaluate the technique of laproscopic single anastomosis gastric bypass for treatment of morbidly obese patient. Study design The patients were enrolled in a Prospective observational study, from May 2013 till May 2015, including 100 patients set for laparoscopic Single anastomosis gastric bypass. Surgical procedures and follow up were performed at Ain Shams University hospitals. Patient and methods The study includes one hundred patients; 33 males and 67 females with a mean age of 33±10 years (range, 20–59), who fulfilled the criteria for bariatric surgery with BMI >35 with associated co-morbidities, all patients underwent laparoscopic single anastomosis gastric bypass. Results The average operative time was 90 minutes, and the median length of hospital stay was 2 day. No mortality reported within 30 days postoperatively. early postoperative complication within 30 day, no cases of leak reported, endo luminal hemorrhage (2%)treated conservatively. long-term complications were bile reflux(1%), with failed medical treatment which Laparoscopically converted to RYGBP. iron deficiency anemia (1%.). Average weight loss at 1 year was 46 kg (70.08% of excess body weight). (88.8%) of the obesity-associated co morbidities are resolved within 1 year. Conclusion Laparoscopic single anastomosis gastric bypass offers major benefits with great satisfactory results over most alternative procedures, is a successful procedure for weight loss and maintaining the weight reduction in morbid obesity, it has highly safe with good technical feasibility, short hospital stay, a low rate of major postoperative complications and growing learning curve

Comparative Study between the Effect of Single Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass in Morbidly Obese Patient as Regard Remission of Type-2 DM

Abstract Background Accumulating evidence obviously supports the superiority of weight loss surgery over non-surgical treatments for management of morbidly obese patients in terms of outcomes as sustained weight loss, improved quality of life and prevention, reduction, or resolution of comorbidities (e.g., Type 2 Diabetes Mellitus, dyslipidemia), as well as reduced overall mortality. Objective To compare Type 2 DM remission as well as the metabolic effects of 2 types of bariatric surgery; Single Anastomosis gastric Bypass and Roux-en-Y Gastric bypass, in the first year postoperative follow up in relation to DiaRem Scoring system. Patients and Methods This is a prospective randomized clinical trial study conducted in AinShams University Hospitals bariatric surgery unit over 40 patients with minimal follow-up of 12 months. 2 groups of patients: Group A: composed of 20 patients that undergoing OAGB as a metabolic surgery for control of Type 2 DM. Group B: composed of 20 patients that undergoing Reux-en-Y gastric bypass as a metabolic surgery for control of Type 2 DM. Patients were randomly distributed among both groups using simple randomization odds and evens where odd patients were included in group A and even patients were included in group B. Results We find that Roux-en-Y operation is more potent as regard remission of DM than MGB/OAGB (80% versus 65%) and that remission of DM depends on diabetes itself (duration, HBA1C, C-PEPTIDE) and these are the main determinants of remission. And DiaRem score is good predictor of DM remission in low scoring categories however in high scoring categories it is poor in prediction of DM remission Conclusion No statistical difference between both groups as regard remission of DM however numerically it is obvious that Roux-en-Y is more potent metabolic surgery in order to be statistically significant the study needs to be repeated over larger sample size. The main determinant noticed during the study influencing remission is the duration of DM and preoperative C-peptide level-in addition to HBA1C level. We must put into our consideration the post operative complications of MGB/OAGB as regard biliary reflux and failure which are more less in Roux-enY operation but in order to be evaluated longer duration of follow up is needed. We recommend Roux-en-Y as a metabolic surgery for patients with early onset DM type II with BMI ranging from 30-40. The study needs to be repeated over larger sample size and longer duration to determine the long term effects of metabolic surgery.

Monitoring for micronutrient deficiency after bariatric surgery—what is the risk?

BackgroundBariatric surgery may increase the risk of micronutrient deficiencies; however, confounders including preoperative deficiency, supplementation and inflammation are rarely considered.ObjectiveTo examine the impact of bariatric surgeries, supplementation and inflammation on micronutrient deficiency.SettingTwo public hospitals, Australia.MethodsParticipants were recruited to an observational study monitoring biochemical micronutrient outcomes, supplementation dose, inflammation and glycaemic control, pre-operatively and at 1–3, 6 and 12 months after gastric bypass (GB; Roux-en-Y Gastric Bypass and Single Anastomosis Gastric Bypass; N = 66) or sleeve gastrectomy (SG; N = 144). Participant retention at 12 months was 81%.ResultsPre-operative micronutrient deficiency was common, for vitamin D (29–30%), iron (13–22%) and selenium (39% GB cohort). Supplement intake increased after surgery; however, dose was <50% of target for most nutrients. After SG, folate was vulnerable to deficiency at 6 months (OR 13 [95% CI 2, 84]; p = 0.007), with folic acid supplementation being independently associated with reduced risk. Within 1–3 months of GB, three nutrients had higher deficiency rates compared to pre-operative levels; vitamin B1 (21% vs. 6%, p < 0.01), vitamin A (21% vs. 3%, p < 0.01) and selenium (59% vs. 39%, p < 0.05). Vitamin B1 deficiency was independently associated with surgery and inflammation, selenium deficiency with improved glycaemic control after surgery and inflammation, whilst vitamin A deficiency was associated with inflammation only.ConclusionIn the setting of prophylactic post-surgical micronutrient prescription, few nutrients are at risk of de novo deficiency. Although micronutrient supplementation and monitoring remains important, rationalising high-frequency biochemical testing protocols in the first year after surgery may be warranted.

Gastric remnant perforation after single anastomosis gastric bypass

Introduction: Acute perforation of gastric remnants after single anastomosis gastric bypass are scarcely reported in the literature. The leak of gastrointestinal contents into the abdomen increases morbidity and if not promptly recognized can lead to mortality from sepsis. Case Report: A 42-year-old male developed abdominal pain and fever after laparoscopic removal of adjustable gastric band, hiatus hernia repair, and single anastomosis gastric bypass. Computed tomography showed evidence of viscus perforation, bowel obstruction, and intra-abdominal infection. Operative findings suggested bowel obstruction of the afferent small bowel loop led to perforation at the gastric remnant staple line which was repaired primarily. Conclusion: Patients presenting with early sepsis after single anastomosis gastric bypass should be investigated with computed tomography. Gastrointestinal leaks should be promptly addressed with surgical washout, primary repair, and suture reinforcement.

Effectiveness of laparoscopic sleeve gastrectomy and one anastomosis gastric bypass on the resolution of metabolic syndrome — a review

The main cause of the development of metabolic syndrome seems to be an imbalance of calorie intake and energy expenditure. However genetic and epigenetic factors, sedentary lifestyle, poor food quality, and disturbances in gut microbiota also play a major role. There is no single effective method of treatment for metabolic syndrome. Dietary therapy and an increase in physical activity along with pharmacological treatment are not fully effective to recommend them as a therapy for metabolic syndrome. Today, modern bariatric-metabolic procedures such as laparoscopic sleeve gastrectomy or single anastomosis gastric bypass give the best chances of successful resolution of metabolic syndrome.

Comparing Patient Selection and 30-day Outcomes Between Single Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass: a Retrospective Cohort Study of 47,384 Patients.

Single anastomosis gastric bypass (SAGB) offers a novel bariatric procedure with increasing popularity. However, its adoption, patient selection, and short-term safety remain poorly characterized. The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) was analyzed comparing SAGB to Roux-en-Y gastric bypass (RYGB). Bivariate analysis and multivariable logistic regression models compared difference between groups and factors associated with 30-day serious complications and mortality. Overall, 47,384 patients were evaluated, with 1344 (2.8%) undergoing SAGB. SAGB patients had a higher BMI (45.2 ± 7.6kg/m2 vs 44.6 ± 7.9kg/m2, p = 0.006) and younger age (44.3 ± 12.1years vs. 45.4 ± 11.5years, p = 0.0008) than RYGB patients respectively. SAGB patients were less likely to have GERD (42.6% SAGB vs. 45.7% RYGB, p = 0.02), sleep apnea (37.8% SAGB vs. 41.1% RYGB, p = 0.02), and chronic steroid use (1.3% SAGB vs. 2.2% RYGB, p = 0.04). There were no significant difference in diabetes, hypertension, or dyslipidemia rates. Operative length for SAGB was significantly less than for RYGB (101 ± 53.7min SAGB vs. 131.5 ± 63.3min RYGB, p < 0.0001). SAGB was independently associated with decreased serious complications (4.7% vs. 8.4%, p < 0.0001) within 30days compared to RYGB. Additionally, SAGB patients were less likely to experience reoperation (1.6% vs. 2.6%, p = 0.03), and readmission (2.2 vs. 5.8%, p < 0.0001) compared to RYGB respectively. Compared to RYGB, patients undergoing SAGB were younger with marginally higher BMI. After adjusting for comorbidities, SAGB was associated with decreased odds of serious complications. Ongoing prospective studies analyzing long-term outcomes following SAGB remain needed.

Visual Analysis of Nutrient Deficiency and Treatment Protocols in Bariatric Surgery Based on VOSviewer.

Objective To analyze the global literature on nutritional deficiencies in bariatric surgery (BS) since January 1, 1985, and to discuss the current status of research, research hotspots, and new development trend and treatment of nutritional deficiency in bariatric surgery. It provides ideas and basis for promoting the development of bariatric surgery and new alternative therapy or treatment protocols. Methods The Web of Science (WOS) database core collection was used as the data source, and VOSviewer 1.6.17 software was used to search the literature on the topic of “nutritional deficiencies in bariatric surgery.” The number of published literature, the distribution of authors, institutions, and countries, keyword cooccurrences, and journal cocitations were visualized and analyzed. Results A total of 1015 relevant publications was obtained after searching and screening, and the overall trend of literature published was on the rise. The most published countries, institutions, and authors were USA, University of Sao Paulo, Ramalho, Andrea; Obesity Surgery has been the most frequently cited journal (7943 citations), and the top 10 journals had high impact factors. Keyword cooccurrence analysis showed that “bariatric surgery” and “nutritional deficiencies” are the hot topics of research in this field. Conclusion There is an urgent need for bariatric surgery issuing institutions and authors to strengthen cross-institutional, cross-team, and multicenter and multidisciplinary cooperation, to promote and facilitate the exchange and cooperation in the field of bariatric surgery between developed countries in Europe and America and developing countries in Asia, Africa, and Latin America, to draw the attention of developing countries to the health problems caused by obesity, and to encourage and support the development of developing countries in this field. Bariatric surgery, obesity, weight loss, Y-type gastric bypass, gastric bypass, and nutritional deficiency are the hot research topics in the field of nutritional deficiency in bariatric surgery, and metabolic surgery, single anastomosis gastric bypass, micronutrient supplementation, micronutrient deficiency, intestinal microbiology, and guidelines are the new trends in this field.

SP2.1.4 Predictors of Type-2 Diabetes Remission Following Bariatric Surgery After a Two-Year Follow Up

Abstract Purpose Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures. Methods This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n=83) and sleeve gastrectomy (LSG, n=68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission. Results Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p &amp;lt; 0.001, for both), higher C-peptide and GLP-1 levels (p &amp;lt; 0.001 and p = 0.002, respectively), and bypass surgery (p = 0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR. Conclusion Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.

Predictors of type-2 diabetes remission following bariatric surgery after a two-year follow-up

Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures. This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n=83) and sleeve gastrectomy (LSG, n=68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission. Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p<0.001, for both), higher C-peptide and GLP-1 levels (p<0.001 and p=0.002, respectively), and bypass surgery (p=0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR. Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.

Short-Term Results of Single-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy

Abstract Background It is already known that Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain is considered as a complication. Demand for secondary surgery is rising, partly for this reason, but through that study we try to discover the efficacy of conversion of failed sleeve gastrectomy to one anastomosis gastric bypass (OAGB) regarding weight loss and metabolic outcomes. Objective To asses the efficacy and safety of one anastomosis gastric bypass (OAGB) as a conversion surgery post Sleeve Gastrectomy failure as regard weight loss and metabolic outcomes. Patients and Methods This study is a retrospective cohort study which included 20 patients underwent one anastomosis gastric bypass at Ain-Shams University El-Demerdash Hospital, Cairo, Egypt and specialized bariatric center, Cairo, Egypt From February 2019 to July 2019 with 6 months of postoperative follow up till January 2019. Results In this study, we reviewed and analyzed the outcomes from the revision of the SG due to either inadequate weight loss or weight regain to one anastomosis gastric bypass (OAGB) with %EBWL of 6.65% at 1 month, 13.61 % at 3 months and 20.86% at 6 months. Conclusion OAGB appears to be an effective and safe therapeutic technique as a revisional surgery for failed primary SG with good short-term results for treating morbid obesity and its associated comorbidities with a significantly low rate of complications. However the EBWL was less than what is reported after primary OAGB weight. Multicenter studies with larger series of patients and longer term follow up after SG revisions to OAGB are warranted.

A Case Series of Neglected Pregnancies at the Time of Bariatric Surgery

The aim of this study was to describe three neglected pregnancy at the time of bariatric surgery (BS) who had negative pregnancy test before surgery and underwent single-anastomosis gastric bypass surgery in obesity clinic in Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. The first case was a 38 years old woman with BMI of 47.1 suffering from nausea and vomiting one month after surgery that medical treatment did not work and it was found positive βHCG test as and 13W + 6D fetus in sonography. The second case was a 30 years old woman with BMI of 46.2 suffering uterus bleeding four months after surgery. The third case was a 32 years old woman with BMI of 44.6 with suffering from resistant nausea and vomiting, epigastric pain, and delayed mense three month after surgery. These cases show the necessity of βHCG test at the time of bariatric surgery for childbearing females.

Revisional bariatric surgery to single-anastomosis gastric bypass: a large multi-institutional series

Abstract Background Reoperation is often required after bariatric procedures. Single-anastomosis gastric bypass (SAGB) is increasingly utilized as a primary bariatric procedure. Few series document SAGB as a revisional bariatric procedure. Objectives To describe our short-term experience with revisional SAGB, focusing on weight loss and reflux symptom outcomes. Setting Three hospitals in Australia with both private and public (government funded) patients. Methods We reviewed all revisional SAGB cases from 2012 to 2019 at. Complications were considered significant if they were Clavien-Dindo grade 3a or higher. A phone survey was conducted to assess weight loss outcomes, patient satisfaction, reflux symptoms, and other complications. Results We identified 254 patients who had a revisional bariatric procedure to SAGB (21 previous sleeve gastrectomies and 233 previous adjustable bands), with a mean follow-up of 22 ± 15.6 months (range, 1–55 mo). The mean percentage of excess weight loss was 77% (183 patients, 72%), and the number of patients with follow-ups at 1 and 4 years was 184 (73%) and 35 patients (14%). Within 30 days, there were 29 patients (11%) who required reinterventions (21 endoscopies, 1 interventional radiology procedure, and 7 reoperations) with no deaths. Beyond 30 days, 27 patients (11%) required rerevision to Roux-en-Y gastric bypass for reflux symptoms and 10 (4%) required a laparotomy or laparoscopy for another reason (e.g., bowel obstruction). At a median follow-up of 36.6 months, 87 patients (34%) completed a phone survey, 45 (52%) of whom were taking proton pump inhibitors and 66 patients (76%) of whom were satisfied with their experience. Conclusion In our series, revision to SAGB was safe, with low short-term morbidity and favorable weight loss outcomes. However, beyond 1 year, a large proportion of patients experienced severe reflux symptoms and required rerevision.

Laparoscopic sleeve gastrectomy versus laparoscopic single anastomosis gastric bypass: short-term outcome

Objective To compare laparoscopic sleeve gastrectomy (LSG) and laparoscopic single anastomosis gastric bypass (LSAGB) for morbidly obese patients. Both procedures were compared regarding % of excess weight loss (%EWL), resolution of comorbidities, hospital stay, morbidity, mortality, and bariatric analysis and reporting outcome system (BAROS) on short-term basis. Background Bariatric surgery has been proved to be a successful treatment option, leading to long-term weight loss with improvement of obesity-related comorbidities. The LSG is now one of the most popular bariatric procedures worldwide, whereas the LSAGB is now rising worldwide. Patients and methods This prospective study involved 40 patients blindly divided into two groups: 20 of them underwent LSG and 20 of them underwent LSAGB. Written informed consent was obtained from all patients for the procedures and possible complications and conversion. The study was approved by the local ethical committee. All the patients had a 1-year period of follow-up postoperatively and were evaluated for % EWL, resolution of comorbidities, hospital stay, morbidity, mortality, and BAROS. Results A total of 40 obese patients were blindly divided into two groups: LSG included 20 patients, comprising three males and 17 females, with mean BMI of 43.7 kg/m2. Among them, four had type 2 diabetes mellitus (T2DM), three had hypertension (HTN), five had osteoarthritis, two had obstructive sleep apnea (OSA), five had dyslipidemia, and one had polycystic ovary. LSAGB group included 20 patients, comprising four males and 16 females, having a mean BMI of 45.1 kg/m2. Of them, 25 had T2DM, four had HTN, three osteoarthritis, one OSA, eight dyslipidemia, and two polycystic ovary. The mean operative time was 66 min in LSG, whereas it was 72.6 min in LSAGB. The mean duration of hospital stay was 2.5 days in LSG, whereas it was 3.5 days in LSAGB. Mean %EWL was 33.4% at 1 month and 77.22% at 12 months in LSG and was 20.13% at 1 month and 80.4% at 12 months in LSAGB. Overall, two patients with T2DM had complete and two had partial resolution in LSG, whereas three patients with T2DM in LSAGB. Moreover, two patients had complete resolution regarding HTN in LSG and all of them in LSAGB. There was resolution of osteoarthritis, OSA, and polycystic ovary in all patients in both groups. Bleeding was seen in one case in LSG. Wound infection was recorded in one case in LSG and in two cases in LSAGB. Postoperative nausea and vomiting was seen in three cases in LSG and in one cases in LSAGB. Symptomatic cholelithiasis was seen in seven patients in LSG group, and two patients needed surgery, whereas in LSAGB, five patients had symptomatic cholelithiasis, and three patients needed surgery. A total of eight patients had dumping symptoms only in LSAGB. According to BAROS, it was revealed that in LSG, 12 of the patients evaluated the quality of life as ‘excellent’ and two as ‘very good,’ whereas in LSAGB, 14 of the patients evaluated the quality of life as ‘excellent’ and three as ‘very good.’ Conclusion LSG has proved to be a safe and effective bariatric surgery with a rate of success that is similar to the LSAGB. LSAGB appears to reduce obesity-related comorbidities with low complication rate. Both procedures offer a good quality of life according to BAROS.

A rare complication of single anastomosis gastric bypass surgery: perforated marginal ulcer

A rare complication of single anastomosis gastric bypass surgery: perforated marginal ulcer

Short-term results of single-anastomosis gastric bypass after failed sleeve gastrectomy

Background It is recognized that sleeve gastrectomy (SG) is one of the most common bariatric procedures worldwide. It is considered a relatively safe and effective option in the treatment of morbid obesity. However, SG operations may fail in the treatment of obesity. In cases of unsuccessful SG surgery, revisional bariatric surgery may be used. One anastomosis gastric bypass (OAGB) was considered as an outstanding choice for revision surgery. Objective To assess the efficacy and safety of OAGB as a redo surgery after the failure of previous sleeve gastrectomy operation. Patients and methods This study is a retrospective cohort study, conducted in Bariatric Surgery Unit, Ain Shams University Hospital, Cairo, Egypt, from February 2018 to July 2019, with 6 months of postoperative follow-up till January 2020. We included 50 patients who underwent OAGB who were adults fit for surgery, aged between 18 and 60 years, with a history of failed SG. Results A total of 50 patients with history of failed SG underwent OAGB surgery with excess body weight loss of 14.10% at 1 month, 28.85% at 3 months, and 45.43% at 6 months. Weight loss was 7.14–32.43 kg (SD 6.14). The type 2 diabetes mellitus remission rate was 100% by 6 months, with glycated hemoglobin level of 5.88±0.77 (range, 5.4–7.2). Hypertension resolution was 40%. Overall, 100% of patients with sleep apnea improved symptomatically. No morbidity or mortality cases were reported. Conclusion OAGB operation is considered to be an effective and safe revisional surgical procedure after a failed primary SG operation.

Long-term outcomes of metabolic surgery in overweight and obese patients with type 2 diabetes in Asia.

To assess the outcomes of metabolic surgery in overweight and obese patients in Asia with type 2 diabetes (T2D). The treatment outcomes of 1999 patients from the Asian Diabetes Surgery Summit database were analysed. The changes in treatment effects across time were assessed with respect to the surgical procedures performed by using generalized estimating equations. The most commonly performed procedure was the single-anastomosis gastric bypass (32.6%). Weight (from 106.2 ± 25.1 to 77.9 ± 18.8 kg), body mass index (BMI; from 38.7 ± 7.9 to 28.5 ± 5.9 kg/m2 ), blood sugar (from 9.3 ± 4.1 to 5.7 ± 1.8 mmol/L) and HbA1c (from 8.4% ± 1.8% to 6.0% ± 1.1%) significantly improved from baseline to 1 year (P < .001) and remained stable at 5 years (weight, 86.3 ± 23.3 kg; BMI, 31.7 ± 7.9 kg/m2 ; blood sugar, 5.8 ± 1.8 mmol/L, and HbA1c, 6.4% ± 1.2%; all P < .001 vs. baseline). Blood pressure and most lipid disorders also improved significantly. Of the treatment procedures, single-anastomosis gastric bypass had the most satisfactory outcomes with statistical significance for most disorders, whereas adjustable gastric banding displayed the least satisfactory outcomes. Metabolic surgery remarkably improved body weight, T2D and other metabolic disorders in Asian patients. However, the efficacy of individual procedures varied substantially.

Comparative effectiveness of bariatric surgeries in patients with obesity and type 2 diabetes mellitus: A network meta‐analysis of randomized controlled trials

SummaryA network meta‐analysis of randomized controlled trials (RCTs) was performed to determine the hierarchies of different bariatric surgeries in patients with obesity and type 2 diabetes mellitus (T2DM), in terms of diabetes remission and cardiometabolic outcomes. Seventeen RCTs and six bariatric surgeries, including single anastomosis (mini) gastric bypass (mini‐GBP), biliopancreatic diversion without duodenal switch (BPD), laparoscopic‐adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), Roux‐en‐Y gastric bypass (RYGBP), greater curvature plication (GCP) and nonsurgical treatments (NST) were included. Mini‐GBP, BPD, LSG, RYGBP and LAGB (from best to worst), as compared with NST, were all significantly associated with the remission of T2DM. For the follow‐up period > 3 years, BPD, mini‐GBP, RYGBP and LSG (from best to worst) were significantly superior to NST in achieving the remission of T2DM. For secondary outcomes, the overall ranking for bariatric surgeries was RYGBP > BPD > LSG > LAGB after comprehensively weighting glucose, weight, systolic and diastolic pressure, total cholesterol, triglycerides, high‐density lipoprotein cholesterol (HDL‐C) and low‐density lipoprotein cholesterol (LDL‐C). Mini‐GBP has the greatest probability of achieving diabetes remission in adults with obesity and T2DM, yet BPD was the most effective in long‐term diabetes remission. RYGBP appears to be the most favourable alternative treatment to manage patients with cardiometabolic conditions.

Laparoscopic Mini- Gastric Bypass in Management of Morbid Obesity A Prospective Study

Background: In recent years, a surgical technique known as single-anastomosis gastric bypass (SAGB) or minigastric bypass (MGB) has been developed. Its frequency of performance has increased considerably in the current decade. This procedure proposes a simplification of Roux-en-Y bypass by performing a single anastomosis, with a significant reduction of technical complexity, shorter operative time and a potential reduction in morbidity and mortality. Objective: This study aimed to evaluate if laparoscopic mini gastric bypass operation is safe and effective for treatment of different cases with morbid obesity and its associated comorbidities Material and methods: This was a prospective study of 100 patients with morbid obesity submitted to laparoscopic MGB from March 2018 to January 2019. This study was conducted in the Bariatric Surgery Unit, at Assuit university hospital and Osama Taha group clinic. Demographic and clinical data were prospectively collected from the preoperative evaluations. Results: The most important findings of this study were the safety and the high efficacy, which were translated into no mortality, very acceptable complications (early complication rate 4% and late complication rate 6 %). High excess weight loss (EWL) 72.26 ± 5.18 % and remission rate 92% of patients who had diabetes, as 100.0% of patients who had fatty liver, 96.0% of patients who had hyperlipidemia, 95.0% of patients who had sleep apnea and 94.0% of patients who had hypertension. Conclusion: MGB/ one-anastomosis gastric bypass (OAGB) is a simple, safe, effective, easy to learn and easy to reverse procedure. It has acceptable complications and mortality rates.

Laparoscopic Mini- Gastric Bypass in Management of Morbid Obesity A Prospective Study

Background: In recent years, a surgical technique known as single-anastomosis gastric bypass (SAGB) or minigastric bypass (MGB) has been developed. Its frequency of performance has increased considerably in the current decade. This procedure proposes a simplification of Roux-en-Y bypass by performing a single anastomosis, with a significant reduction of technical complexity, shorter operative time and a potential reduction in morbidity and mortality. Objective: This study aimed to evaluate if laparoscopic mini gastric bypass operation is safe and effective for treatment of different cases with morbid obesity and its associated comorbidities Material and methods: This was a prospective study of 100 patients with morbid obesity submitted to laparoscopic MGB from March 2018 to January 2019. This study was conducted in the Bariatric Surgery Unit, at Assuit university hospital and Osama Taha group clinic. Demographic and clinical data were prospectively collected from the preoperative evaluations. Results: The most important findings of this study were the safety and the high efficacy, which were translated into no mortality, very acceptable complications (early complication rate 4% and late complication rate 6 %). High excess weight loss (EWL) 72.26 ± 5.18 % and remission rate 92% of patients who had diabetes, as 100.0% of patients who had fatty liver, 96.0% of patients who had hyperlipidemia, 95.0% of patients who had sleep apnea and 94.0% of patients who had hypertension. Conclusion: MGB/ one-anastomosis gastric bypass (OAGB) is a simple, safe, effective, easy to learn and easy to reverse procedure. It has acceptable complications and mortality rates.