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Published in: Obesity Surgery 9/2017

01-09-2017 | Original Contributions

Laparoscopic Silastic Ring Mini-Gastric Bypass (SR-MGBP): Up to 11-Year Results from a Single Centre

Authors: Laila Sheikh, Lyn A. Pearless, Michael WC Booth

Published in: Obesity Surgery | Issue 9/2017

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Abstract

Background

Bariatric surgery is well established as an effective method for treating obesity and its related comorbidities. The laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to a Roux-en-Y gastric bypass (RYGBP). The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports long-term results from a cohort of patients undergoing a SR-MGBP in a single centre.

Methods

Long-term outcomes (up to 11 years) in a cohort of 156 patients undergoing surgery between August 2005 and January 2008 were analysed. A combination of follow-up questionnaires and electronic hospital records were used to assess weight loss, comorbidity resolution and complications.

Results

A total of 156 patients (mean body mass index 46 kg/m2) underwent surgery. Ninety-two patients responded to the follow-up questionnaires. Computer-based hospital information was available on a total of 139 patients. Mean percent excess weight loss (%EWL) at 11 years was 84.3%. Comorbidity resolution, determined by medication use, showed a reduction in diabetes (21.8% to 7.1%), hypertension (37.2% to 21.4%) and hypercholesterolaemia (40.4% to 13.4%). Five of 139 patients (3.6%) had SR problems needing removal. Two other patients had the SR changed to a bigger size and a further two had endoscopic removal of the SR for erosion. Of the 139 patients, 9.4% required conversion to a Roux-en-Y gastric bypass (RYGBP). The number of patients on anti-reflux medications increased from 5.1% to 44.6% at 11 years. There were two deaths unrelated to surgery.

Conclusions

SR-MGBP appears to be a safe and effective operation for the morbidly obese. It is durable, with good weight loss at up to 11 years post-surgery. The SR can easily be removed or exchanged for another size and is reasonable to consider when performing a MGBP. Concerns about bile reflux appear to be well founded, and some patients who are poorly controlled medically will require revision.
Literature
1.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. J Am Med Assoc. 2004;292(14):1724–37.CrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. J Am Med Assoc. 2004;292(14):1724–37.CrossRef
2.
go back to reference Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001;11(3):276–80.CrossRefPubMed Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001;11(3):276–80.CrossRefPubMed
3.
go back to reference Lee WJ, Ser KH, Lee YC, et al. Laparoscopic roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22(12):1827–34.CrossRefPubMed Lee WJ, Ser KH, Lee YC, et al. Laparoscopic roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22(12):1827–34.CrossRefPubMed
4.
go back to reference Lee WJ, Lin YH. Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence. Obes Surg. 2014;24(10):1749–56.CrossRefPubMed Lee WJ, Lin YH. Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence. Obes Surg. 2014;24(10):1749–56.CrossRefPubMed
5.
go back to reference Mahawar KK, Jennings N, Brown J, et al. "Mini" gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890–8.CrossRefPubMed Mahawar KK, Jennings N, Brown J, et al. "Mini" gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890–8.CrossRefPubMed
6.
go back to reference Disse E, Pasquer A, Espalieu P, et al. Greater weight loss with the omega loop bypass compared to the Roux-en-Y gastric bypass: a comparative study. Obes Surg. 2014;24(6):841–6.CrossRefPubMed Disse E, Pasquer A, Espalieu P, et al. Greater weight loss with the omega loop bypass compared to the Roux-en-Y gastric bypass: a comparative study. Obes Surg. 2014;24(6):841–6.CrossRefPubMed
7.
go back to reference Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015;11(2):321–7.CrossRefPubMed Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015;11(2):321–7.CrossRefPubMed
8.
go back to reference Chevallier JM, Arman GA, Guenzi M, et al. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg. 2015;25(6):951–8.CrossRefPubMed Chevallier JM, Arman GA, Guenzi M, et al. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg. 2015;25(6):951–8.CrossRefPubMed
9.
go back to reference Johnson WH, Fernanadez AZ, Farrell TM, et al. Surgical revision of loop ("mini") gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):37–41.CrossRefPubMed Johnson WH, Fernanadez AZ, Farrell TM, et al. Surgical revision of loop ("mini") gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):37–41.CrossRefPubMed
10.
go back to reference Lee WJ, Lee YC, Ser KH, et al. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2011;7(4):486–90.CrossRefPubMed Lee WJ, Lee YC, Ser KH, et al. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2011;7(4):486–90.CrossRefPubMed
11.
go back to reference Mahawar KK, Parikh C, Carr WRJ, et al. Primary banded Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2014;24(10):1771–92.CrossRefPubMed Mahawar KK, Parikh C, Carr WRJ, et al. Primary banded Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2014;24(10):1771–92.CrossRefPubMed
12.
go back to reference Buchwald H, Buchwald JN, McGlennon TW. Systematic review and meta-analysis of medium-term outcomes after banded Roux-en-Y gastric bypass. Obes Surg. 2014;24(9):1536–51.CrossRefPubMed Buchwald H, Buchwald JN, McGlennon TW. Systematic review and meta-analysis of medium-term outcomes after banded Roux-en-Y gastric bypass. Obes Surg. 2014;24(9):1536–51.CrossRefPubMed
13.
go back to reference Clarke MG, Wong K, Pearless L, et al. Laparoscopic silastic ring mini-gastric bypass: a single centre experience. Obes Surg. 2013;23(11):1852–7.CrossRefPubMed Clarke MG, Wong K, Pearless L, et al. Laparoscopic silastic ring mini-gastric bypass: a single centre experience. Obes Surg. 2013;23(11):1852–7.CrossRefPubMed
14.
go back to reference Kular KS, Manchanda N, Rutledge R. Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: a report from the Indian sub-continent. Obes Surg. 2014;24(10):1724–8.CrossRefPubMed Kular KS, Manchanda N, Rutledge R. Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: a report from the Indian sub-continent. Obes Surg. 2014;24(10):1724–8.CrossRefPubMed
15.
go back to reference Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22(5):697–703.CrossRefPubMed Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22(5):697–703.CrossRefPubMed
16.
go back to reference Obeid A, Long J, Kakade M, et al. Laparoscopic Roux-en-Y gastric bypass: long term clinical outcomes. Surgical Endoscopy and Other Interventional Techniques. 2012;26(12):3515–20.CrossRefPubMed Obeid A, Long J, Kakade M, et al. Laparoscopic Roux-en-Y gastric bypass: long term clinical outcomes. Surgical Endoscopy and Other Interventional Techniques. 2012;26(12):3515–20.CrossRefPubMed
17.
go back to reference Spivak H, Abdelmelek MF, Beltran OR, et al. Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States. Surgical Endoscopy and Other Interventional Techniques. 2012;26(7):1909–19.CrossRefPubMed Spivak H, Abdelmelek MF, Beltran OR, et al. Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States. Surgical Endoscopy and Other Interventional Techniques. 2012;26(7):1909–19.CrossRefPubMed
18.
go back to reference Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73.CrossRefPubMed Suter M, Donadini A, Romy S, et al. Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg. 2011;254(2):267–73.CrossRefPubMed
19.
go back to reference Higa K, Ho T, Tercero F, et al. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25.CrossRefPubMed Higa K, Ho T, Tercero F, et al. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25.CrossRefPubMed
20.
go back to reference Bhandari M, Bhandari S, Mishra A, et al. Comparison between banded and nonbanded Roux-en-Y gastric bypass with 2-year follow-up: a preliminary retrospective analysis. Obes Surg. 2016;26(1):213–8.CrossRefPubMed Bhandari M, Bhandari S, Mishra A, et al. Comparison between banded and nonbanded Roux-en-Y gastric bypass with 2-year follow-up: a preliminary retrospective analysis. Obes Surg. 2016;26(1):213–8.CrossRefPubMed
21.
go back to reference Rasera I, Coelho TH, Ravelli MN, et al. A comparative, prospective and randomized evaluation of roux-en-Y gastric bypass with and without the silastic ring: a 2-year follow up preliminary report on weight loss and quality of life. Obes Surg. 2016;26(4):762–8.CrossRefPubMed Rasera I, Coelho TH, Ravelli MN, et al. A comparative, prospective and randomized evaluation of roux-en-Y gastric bypass with and without the silastic ring: a 2-year follow up preliminary report on weight loss and quality of life. Obes Surg. 2016;26(4):762–8.CrossRefPubMed
22.
go back to reference Bessler M, Daud A, Kim T, et al. Prospective randomized trial of banded versus nonbanded gastric bypass for the super obese: early results. Surg Obes Relat Dis. 2007;3(4):480–4.CrossRefPubMed Bessler M, Daud A, Kim T, et al. Prospective randomized trial of banded versus nonbanded gastric bypass for the super obese: early results. Surg Obes Relat Dis. 2007;3(4):480–4.CrossRefPubMed
23.
go back to reference Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15(9):1304–8.CrossRefPubMed Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15(9):1304–8.CrossRefPubMed
24.
go back to reference Csendes A, Burgos AM, Smok G, et al. Latest results (12-21 years) of a prospective randomized study comparing billroth ii and roux-en-y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Ann Surg. 2009;249(2):189–94.CrossRefPubMed Csendes A, Burgos AM, Smok G, et al. Latest results (12-21 years) of a prospective randomized study comparing billroth ii and roux-en-y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Ann Surg. 2009;249(2):189–94.CrossRefPubMed
25.
go back to reference Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15(5):648–54.CrossRefPubMed Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15(5):648–54.CrossRefPubMed
Metadata
Title
Laparoscopic Silastic Ring Mini-Gastric Bypass (SR-MGBP): Up to 11-Year Results from a Single Centre
Authors
Laila Sheikh
Lyn A. Pearless
Michael WC Booth
Publication date
01-09-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 9/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2659-9

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