6,385 consecutive mini-gastric bypasses: 15 years later
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6,385 Consecutive Mini-Gastric Bypasses: 15 Years LaterTRANSCRIPT
Dr. Rutledge, [email protected]
6,385 Consecutive Mini-Gastric Bypasses: 15 Years Later
First International Consensus Conference on the Mini-Bypass / One Anastomosis Bypass
Paris 2012 October 18-19
Email [email protected]
The Mini-Gastric Bypass
• In spite of initial skepticism; there is growing evidence that mini-gastric bypass (MGB) is a safe and effective procedure with many of the features of an ideal bariatric surgery.
Methods:
• Outcome and long-term follow-up of a consecutive cohort of patients who underwent MGB are reported.
Results• The data on 6,385 patients who
underwent MGB from September 1997 to June 2011 were reviewed.
• Mean preoperative weight (+/- Standard Deviation) was 143 +/- 31 kg, BMI 47 +/- 7. & 83% were female.
• Mean operative time 41 minutes and median length of stay 1 day. Three deaths occurred within 30 days of surgery, (0.05%). The most recent death was 8 years ago
Results• Early complications occurred in 4.9%. • 44 (0.7%) patients had anastomotic
leaks. • Three (0.05%) patients presented
with dypepsia/bile reflux not responsive to medical therapy and were successfully treated by Braun side-to-side jejuno-jejunostomy.
• Gastritis/dyspepsia/marginal ulcer was the most serious long term complication; routinely treated medically.
Results• Excessive weight loss occurred in 1%
of patients; treated by take down of the bypass.
• Mean % excess weight loss (EWL) of 78%. 10 year weight regain 4.9%.
• >50% EWL was achieved for 95% of patients at 18 months and for 92% at 60 months.
• 6% of patient had inadequate weight loss or significant weight regain were treated by revision, (addition of ~2 meters to the bypass).
Results Mirror Dr Noun’s
• One thousand consecutive mini-gastric bypass: Noun R, et al. Journal Obes Surg. 2012 May;22(5):697-703
• Short-term complications occurred in 2.7% for primary vs. 11.6% for revisionnal MGB (p < 0.01). Five (0.5%) patients presented with leak
• Four (0.4%) patients, all with revisional MGB, presented with severe bile reflux and were cured by stapling the afferent loop and by a latero-lateral jejunojejunostomy.
• Excessive weight loss occurred in four patients; two were reversed and two were converted to sleeve gastrectomy.
• Percent excess weight loss (EWL) of 72.5%
IFSO Varianational Committee Survey
Over 100 Surgeons from Around the World:
IFSO Varianational Committee Survey
• Results (Preliminary)• Experience with 39,000 cases in
the prior year• Lap Band is a "Poor" Surgery• RNY & Sleeve Surgeons have
"lots" of leaks• MGB Surgeons Answered More
Correct than Non-MGB Surgeons
MGB: Major Weight Loss, Best?
MGB: Least Weight Regain
MGB: Low Risk of Reflux Sx
MGB: Revision is Easy
Conclusion
• MGB is an • effective, • relatively low-risk, and • low-failure bariatric procedure. • In addition, • it can be easily revised,
converted, or reversed.