Five Year Outcome Sleeve Gastrectomy & Mini-Gastric Bypass:

From a Community Hospital in Punjab, India

Dr K S KularKular Medical Education & Research Society

Kular Group of Institutesdrkskular@gmail.com

www.kularhospital.com

Sleeve Vs MGB

• Sleeve• MGB• Kular Hospital• Sleeve v MGB (Hint: MGB Better)• Weight Loss Raw Data, Weight Loss

Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux

• Conclusions

Sleeve Gastrectomy

• Popular• Reported Very Good Results• Primarily Gastric Procedure• Problems Weight Regain • Problems New Onset GERD• Chosen by Kular Hospital

Mini-Gastric Bypass

• Very Safe/Very Good Results

• Gastric + Bypass

• Min Weight Regain

• Min GERD

• High Patient Satisfaction

Kular Hospital

• Community Hospital

• Rural Small City

• Indian Healthcare and Bariatric Surgery

• Implications for Selection of Operation

• Safety and Effectiveness

Kular Hospital

• 5 year follow up

• Prospectively collected bariatric

database of 104 MGB and 118 LSG

• Five year follow-up was achieved in

72 MGB and 76 LSG

Revisions

• 2 (2.7%) of MGB patients

1 for bile reflux

1 for weight regain

• 16 (21%) LSG patients

13 for weight regain

3 for Gastro-Esophageal Acid Reflux ).

• There was no mortality or leak

LSG v MGBRevisions

LSG MGB

Revision 21% 2.7%

No Revision 79% 97.3%

Total Weight Loss (kg)LSG v MGB

LSG MGB

Year 1 27 43

Year 2 25 48

Year 5 20 46

Raw Weight Loss (kg)

4643

48

2027 25

0

10

20

30

40

50

60

0 2 4 6

Years Post Op

Kg

MGB

SG

Total Weight Loss (kg)LSG v MGB

LSG MGB

Year 1 27 43

Year 2 25 48

Year 3 20 46

Includes 16 (21%)

Revisions of Failed LSG pts

LSGxRevisions v MGB-AgeWt Matched (kg)

LSGxRevisions

MGBAgeWt Match

Year 1 34 32

Year 2 32 35

Year 5 15 34

Weight Loss (Kg) Stratified SG & MGB

0

5

10

15

20

25

30

35

40

0 2 4 6Years

Kg

SGxRevisions

MGBaw

LSGxRevisions v MGB-AgeWt Matched (%EWL)

LSGxRevisions

MGBAgeWt Match

Year 1 69% 63%

Year 2 63% 72%

Year 3 36% 69%

LSGxRevision v MGB-AgeWt Match (Resolution Co-Morbidities)

LSGxRevisions

MGBAgeWt Match

Diabetes 76% 92%

Hyperlipidemia 66% 88%

Sleep Apnea 84% 96%

GERD 35% 82%

Patient Satisfaction5=Excellent, 2=Dissatisfied

LSG MGB

1 month 2 5

6 months 3 5

1 year 3 5

3 years 3 5

5 years 2 4

1 month6 month

1 year3 Years

5 Years

SG

MGB0

1

2

3

4

5

SG

MGB

Mean Patient Satisfaction

5 Extremely satisfied 4 Satisfied3 Medium

2 Dissatisfied 1 Very Dissatisfied

1 month1 year

5 years

SG

MGB0

1

2

3

4

5

Nausea Vomiting

SG

MGBLikelihood of Complaint of Nausea and Vomiting Score; Likelihood: 5 Extremely Likely, 4 Somewhat Likely, 3 Medium, 2 Unlikely, 1 Very Unlikely

How Likely to Recommend LSG/MGB to Friends & Family

How Likely to Recommend

LSG 2 Unlikely

MGB 5 Extremely Likely

Likelihood to Refer a Friend or Family Member: 5 Extremely Likely, 4 Somewhat Likely, 3 Medium,

2 Unlikely, 1 Very Unlikely.

Volume Food Intake @ 5 yrs

Estimated Volume of Food Intake

LSG 75%

MGB 25%

Likelihood to Refer a Friend or Family Member: 5 Extremely Likely, 4 Somewhat Likely, 3 Medium,

2 Unlikely, 1 Very Unlikely.

Bariatric SurgeonsFear Bile refluxFrom Billroth II

General SurgeonsRoutinely

Use the Billroth II

Gastric Cancer Surgeons Routinely Use MGB Type Billroth II

Comparison of laparoscopy-assisted and totally laparoscopic Billroth-II distal gastrectomy for gastric cancer. Lee J, Kim D, Kim W.Department of Surgery, The Catholic University of Korea School of Medicine, Seoul, Korea.

ProximalStomach

Loop

ProximalStomach

Loop

Non-MGB Bariatric SurgeonsFear Billroth II & Bile Reflux

General SurgeonsUse the Billroth II

Every DayBariatric Surgeons Have

Forgotten theirGeneral Surgery

Training

Bile Reflux Not a ProblemGERD in LSG = Problem

• 72 MGB Patients

• Followed 5 Years

• Bile Reflux

• 2 patients 2.7%

• Sleeve => 24% GERD

• GERD => Esophageal Cancer

Conclusions

• Kular Hospital; Rural India Requires

• Extremely High Levels of Safety and Effectiveness

• Sleeve and MGB chosen for reports of safety and efficacy

• Report on the Results 5 years Later

Sleeve; Good News Bad News

• LSG was as reported; Safe, simple operation with good short term weight loss (Like the Lap Band)

• But (as reported)• Patient Satisfaction Low,

Referral Rate Low• Inc Food Intake, New Onset GERD, Weight

Regain, Revision Rate High

MGB; All Good News

• MGB was as reported; Safe, simple operation with good short term and long term weight loss

• and as reported:

• Patient Satisfaction High Referral Rate High

• Food Intake, New GERD, Weight Regain, Revision Rates All Low

Sleeve: Restrictive Procedure with Good Early Results; Poor Long Term

Results (Like the Band)