A 7-Year Clinical Audit of 1107 Cases Comparing Sleeve Gastrectomy, Roux-En-Y Gastric Bypass, and Mini-Gastric Bypass, to Determine an Effective and Safe Bariatric and Metabolic Procedure

Sep 5, 2015Obesity surgery

Seven-Year Review of 1107 Patients Comparing Three Weight Loss Surgeries to Find the Safest and Most Effective Option

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Abstract

The mortality rate for mini-gastric bypass (MGB) was 0%, compared to 2.1% for laparoscopic sleeve gastrectomy (LSG) and 0.3% for Roux-en-Y gastric bypass (RYGB).

Leaks occurred in 1.5% of LSG cases, 0.3% of RYGB cases, and were absent in MGB.
Weight regain was reported at 14.2% for LSG and 8.5% for RYGB, while MGB showed 0% weight regain.
Hypoalbuminemia was noted in 13.1% of earlier MGB patients with bypass lengths over 250 cm.
Resolution of comorbidities, including dyslipidemia and type 2 diabetes, was greatest in MGB.
Gastroesophageal reflux disease (GERD) was highest in LSG at 9.8%, compared to 1.7% in RYGB and 0.6% in MGB.

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BACKGROUND: The epidemic of obesity is engulfing developed as well as developing countries like India. We present our 7-year experience with laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) to determine an effective and safe bariatric and metabolic procedure.

METHODS: The study is an analysis of a prospectively collected bariatric database of 473 MGBs, 339 LSGs, and 295 RYGBs.

RESULTS: Mortality rate was 2.1% in LSG, 0.3% in RYGB, and 0% in MGB. Leaks were highest in LSG (1.5%), followed by RYGB (0.3%), and zero in MGB. Bile reflux was seen in <1% in the MGB series. Persistent vomiting was seen only in LSG. Weight regain was 14.2% in LSG, 8.5% in RYGB, but 0% in MGB. Hypoalbuminemia was minimal in LSG, 2.0% in RYGB, and 13.1% in MGB (in earlier patients where bypass was >250 cm). The following resolution of comorbidities: dyslipidemia, type 2 diabetes (T2D), hypertension, and percent excess weight loss (%EWL) was maximum in MGB. GERD was maximum in LSG (9.8%), followed by RYGB (1.7%), and minimal in MGB (0.6%).

CONCLUSIONS: RYGB and MGB act on the principle of restriction and malabsorption, but MGB superseded RYGB in its technical ease, efficacy, revisibility, and reversibility. Mortality was zero in MGB. %EWL and resolution of comorbidities were highly significant in MGB. Based on this audit, we suggest that MGB is the effective and safe procedure for patients who are compliant in taking their supplements. LSG may be done in non-compliant patients and those ready to accept weight regain.

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A 7-Year Clinical Audit of 1107 Cases Comparing Sleeve Gastrectomy, Roux-En-Y Gastric Bypass, and Mini-Gastric Bypass, to Determine an Effective and Safe Bariatric and Metabolic Procedure

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