Dr. Rutledge, DrR@clos.net

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 DrR@CLOS.Net

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.