Mini gastric bypass versus R-En-Y gastric bypass in meddle aged super obese Egyptian patients
Mansour M Abdelkhalek, Ibraheem G Ramadan, Gamal M Aboelenin
Conflict of interest: A multidisciplinary coordinated team work involvinglaparoscopic bariatric surgeon, internal medicine and radiologist of paramount importanceto accomplish accurate and early complication management if it arises. Aim of the study: Comparative study between outcomes efficacy and safety of Laparoscopic Mini Gastric Bypass (LMGB) versus LaparoscopicR-En-Y Gastric Bypass (LRGB) for the treatment of middle aged super-obese Egyptian patients.Introduction: Advantages of the Mini Gastric Bypass. The single anastomosis that confers a degree of technical simplicity and the benefit of potentially fewer sites for anastomotic leaks to occur and fewer sites for internal hernias, with MGB because the potential sites for internal hernias are reduced to one (Petersen’s defect). Reduced Technical Complexity is evident with a shorter learning curve and a shorter operative time. Furthermore, ease of reversal and revision has been described in published reports on this procedure. Demonstrated safety and efficacy .There is now published experience with this procedure by a number of surgeons from different parts of the world. Their results, to date, suggest non-inferiority of MGB compared to the gold standard Roux en-Y Gastric Bypass in terms of mortality, weight loss, comorbidity resolution, and quality of life. Patients & Methods: two hundred and forty patients divided into two groups.120 patients underwent LMGB and 120 underwent LRGB at the AL-Azhar university hospitals and other certified hospitals and private centers, from Jun. 2013 to Nov.2015 were done. Results: Mean operative time of the procedure was significantly lower in the LMGB group(50±5 minutes vs. 120±15 minutes). Intraoperative complications are more frequent in LRGB group, bleeding 2 cases controlled by sutures and clips and electrocautery. 3 cases of injuries to the liver, LMGB group, 2 cases (1.6%) of leaks required readmission and insertion of endoscopic stent. gastro-esophageal reflux confirmed by Endoscopy that responded well to proton pump inhibitors, abstinence of smoking, diet instructions. Abdominal pain, vomiting, pain (7 patient =5.8%) due to cholecystitis 2 cases laparoscopic cholecystectomy done easily. Compared with LRGB 4 cases (3.3%) of leaks need readdmision and insertion of endoscopic stent, one case of hematoma aspirated under CT guidance, 2 cases suffered from severe vomiting due to stomal oedema treated by conservative IV fluid. 2 cases of marginal ulcer and abdominal pain, vomiting (13 patient=10.83%) 6 cases were founded to have stricture treated by endoscopic dilatation after an initial upper gastrointestinal endoscopy and contrast study, 4 cases of calcular cholecystitis underwent laparoscopic cholecystectomy, 2 cases of marginal ulcer conservatively managed and 2 cases of internal hernia diagnosed laparoscopically then converted to open due to gangrenous loops. No mortality in both group. Discussion: Mini Gastric Bypass considered the 3rd most frequently performed procedure for weight control worldwide nowadays. MGB has a high patient acceptance and most patients report a significant improvement in the quality of life, Mini Gastric Bypass, a quick to perform and low risk procedure with minimal postoperative complications experienced by the patients. Because of the minimum trauma associated with this procedure, the postoperative recovery period is in the region of 24 hours. The patients recover quickly and can resume their activities within two to three days. The weight loss that occurs subsequently, is not accompanied by nutritional or metabolic disturbances. Conclusion: The efficacy and safety ofMini Gastric Bypass is evident as it is a simple procedure, its outcomes were found to be favorable with a low complication rate, no mortalities and favorable weight loss compared with Roux-En-Y Gastric Bypass. It is less time consuming and requires shorter hospital stay.