Abstract
Mini gastric bypass is being explored by many bariatric surgeons as a standalone bariatric procedure. Several surgeons from different parts of the world have now published their extensive experience with this procedure. It appears to be an effective bariatric procedure with acceptable weight loss, co-morbidity resolution, and complication rates in the short and medium term. Its proponents claim that it is safer and easier than the gold standard Roux-en-Y gastric bypass. However, concerns with regard to symptomatic gastric or oesophageal biliary reflux requiring revisional surgery and long-term risk of gastric and oesophageal cancers persist. This paper reviews the published experience to date with this procedure and examines the surrounding controversy.
Similar content being viewed by others
Abbreviations
- MGB:
-
Mini gastric bypass
- PRISMA:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- EWL:
-
Excess weight loss
- RCT:
-
Randomised controlled trial
- IWQoL:
-
Impact of weight on quality of life
- RYGB:
-
Roux-en-Y gastric bypass
- LAGB:
-
Laparoscopic adjustable gastric banding
- VBG:
-
Vertical banded gastroplasty
References
Rutledge R. The mini-gastric bypass: experience with the first 1274 cases. Obes Surg. 2001;11(3):276–80.
Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15(5):648–54.
Fisher BL, Buchwald H, Clark W, et al. Mini-gastric bypass controversy. Obes Surg. 2001;11(6):773–7.
Olchowski S, Timms MR, O’Brien P, et al. More on mini gastric bypass. Obes Surg. 2001;11(4):532.
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.
Collins BJ, Miyashita T, Schweitzer M. Gastric bypass. Why Roux-en-Y? A review of experimental data. Arch Surg. 2007;142(10):1000–3.
McQuaid KR, Laine L, Fennerty MB, et al. Systematic review: the role of bile acids in the pathogenesis of gastro-oesophageal reflux disease and related neoplasia. Aliment Pharmacol Ther. 2011;34(2):146–65. doi:10.1111/j.1365-2036.2011.04709.x. Epub 2011 May 25.
Gillen P, Keeling P, Byrne PJ, et al. Implication of duodenogastric reflux in the pathogenesis of Barrett’s oesophagus. Br J Surg. 1988;75(6):540–3.
Kauer WK, Peters JH, DeMeester TR, et al. Mixed reflux of gastric and duodenal juices is more harmful to the esophagus than gastric juice alone. The need for surgical therapy re-emphasized. Ann Surg. 1995;222(4):525–31.
Noun R, Zeidan S. Laparoscopic mini-gastric bypass: an effective option for the treatment of morbid obesity. J Chir (Paris). 2007;144(4):301–4 [Article in French].
Chevallier JM, Chakhtoura G, Zinzindohoué F, et al. (Paris). [Laparoscopic mini-gastric bypass]. 2009; 146(1): 60–4
Copăescu C, Munteanu R, Prala N, et al. Laparoscopic mini gastric bypass for the treatment of morbid obesity. Initial experience. Chir (Bucur). 2004;99(6):529–39 [Article in Romanian].
Hu XG, Zheng CZ, Ji XR, et al. Short-term outcome of laparoscopic gastric bypass and minigastric bypass on obesity patients with type 2 diabetes mellitus. Zhonghua Wei Chang Wai Ke Za Zhi. 2009;12(6):554–7 [Article in Chinese].
Guo X, Yin K, Zhuo GZ et al. Efficacy comparison between 2 methods of laparoscopic gastric bypass surgery in the treatment of type 2 diabetes mellitus. Zhonghua Wei Chang Wai Ke Za Zhi. 2012; 15(11): 1125–8 [Article in Chinese].
García-Caballero M, Valle M, Martínez-Moreno JM, et al. Resolution of diabetes mellitus and metabolic syndrome in normal weight 24–29 BMI patients with One Anastomosis Gastric Bypass. Nutr Hosp. 2012;27(2):623–31.
Kim Z, Hur KY. Laparoscopic mini-gastric bypass for type 2 diabetes: the preliminary report. World J Surg. 2011;35(3):631–6.
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.
Lee WJ, Lee YC, Ser KH, et al. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2011;7(4):486–91.
Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI > 35 and <35 kg/m2. J Gastrointest Surg. 2008;12(5):945–52.
Lee WJ, Wang W, Lee YC, et al. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18(3):294–9.
Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242(1):20–8.
Peraglie C. Laparoscopic mini-gastric bypass (LMGB) in the super-super obese: outcomes in 16 patients. Obes Surg. 2008;18(9):1126–9.
Chakhtoura G, Zinzindohoué F, Ghanem Y, et al. Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital. Obes Surg. 2008;18(9):1130–3.
Piazza L, Ferrara F, Leanza S, et al. A laparoscopic mini-gastric bypass: short-term single-institute experience. Updates Surg. 2011;63(4):239–42.
Carbajo M, García-Caballero M, Toledano M, et al. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg. 2005;15(3):398–404.
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.
Noun R, Riachi E, Zeidan S, et al. Mini-gastric bypass by mini-laparotomy: a cost-effective alternative in the laparoscopic era. Obes Surg. 2007;17(11):1482–6.
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.
Rutledge R. Hospitalization before and after mini-gastric bypass surgery. Int J Surg. 2007;5(1):35–40.
Begg C, Cho M, Eastwood S. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996;276(8):637–9.
Sacks BC, Mattar SG, Qureshi FG, et al. Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2(1):11–6.
Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis. 2006;2(4):460–3.
Dallal RM, Bailey LA. Ulcer disease after gastric bypass surgery. Surg Obes Relat Dis. 2006;2(4):455–9.
McCarthy HB, Rucker RD, Chan EK, et al. Gastritis after gastric bypass surgery. Surgery. 1985;98:68–71.
Scozzari G, Trapani R, Toppino M, et al. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis. 2013;9(1):133–42.
Babor R, Booth M. Adenocarcinoma of the gastric pouch 26 years after loop gastric bypass. Obes Surg. 2006;16(7):935–8.
Taha AS, Angerson WJ, Morran CG. Reflux and Barrett’s oesophagitis after gastric surgery—long-term follow-up and implications for the roles of gastric acid and bile in oesophagitis. Aliment Pharmacol Ther. 2003;17(4):547–52.
Nason KS, Farrow DC, Haigh G, et al. Gastric fluid bile concentrations and risk of Barrett’s esophagus. Interact Cardiovasc Thorac Surg. 2007;6(3):304–7.
Champion G, Richter JE, Vaezi MF, et al. Duodenogastroesophageal reflux: relationship to pH and importance in Barrett’s esophagus. Gastroenterology. 1994;107(3):747–54.
Theisen J, Peters JH, Fein M, et al. The mutagenic potential of duodenoesophageal reflux. Ann Surg. 2005;241(1):63–8.
Lagergren J, Lindam A. The risk of oesophageal adenocarcinoma after gastrectomy for peptic ulcer disease. Eur J Cancer. 2012;48(5):749–52.
Lagergren J, Lindam A, Mason RM. Gastric stump cancer after distal gastrectomy for benign gastric ulcer in a population-based study. Int J Cancer. 2012;131(6):E1048–52.
Freedman J, Lagergren J, Bergström R, et al. Cholecystectomy, peptic ulcer disease and the risk of adenocarcinoma of the oesophagus and gastric cardia. Br J Surg. 2000;87(8):1087–93.
Lacaine F, Houry S, Huguier M. Stomach cancer after partial gastrectomy for benign ulcer disease. A critical analysis of epidemiological reports. Hepatogastroenterology. 1992;39(1):4–8.
Avidan B, Sonnenberg A, Schnell TG, et al. Gastric surgery is not a risk for Barrett’s esophagus or esophageal adenocarcinoma. Gastroenterology. 2001;121(6):1281–5.
Lundegårdh G, Adami HO, Helmick C, et al. Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med. 1988;319(4):195–200.
Fisher SG, Davis F, Nelson R, et al. A cohort study of stomach cancer risk in men after gastric surgery for benign disease. J Natl Cancer Inst. 1993;85(16):1303–10.
Birgisson S, Rice TW, Easley KA, et al. The lack of association between adenocarcinoma of the esophagus and gastric surgery: a retrospective study. Am J Gastroenterol. 1997;92(2):216–21.
Nishijima K, Miwa K, Miyashita T, et al. Impact of the biliary diversion procedure on carcinogenesis in Barrett’s oesophagus surgically induced by duodenoesophageal reflux in rats. Ann Surg. 2004;240(1):57–67.
Freedman J, Ye W, Näslund E, et al. Association between cholecystectomy and adenocarcinoma of the esophagus. Gastroenterology. 2001;121(3):548–53.
Lorusso D, Pezzolla F, Linsalata M, et al. Duodenogastric reflux and gastric mucosal cell proliferation after cholecystectomy or Billroth II gastric resection. Gastroenterol Clin Biol. 1994;18(11):927–31.
Hansson LE, Nyrén O, Hsing AW, et al. The risk of stomach cancer in patients with gastric or duodenal ulcer disease. N Engl J Med. 1996;335(4):242–9.
Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984;1(8390):1311–5.
Moose D, Lourie D, Powell W, et al. Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting. Am Surg. 2003;69(11):930–2.
Wang W, Huang MT, Wei PL, et al. Laparoscopic mini-gastric bypass for failed vertical banded gastroplasty. Obes Surg. 2004;14(6):777–82.
Noun R, Zeidan S, Riachi E, et al. Mini-gastric bypass for revision of failed primary restrictive procedures: a valuable option. Obes Surg. 2007;17(5):684–8.
Rutledge R. Revision of failed gastric banding to mini-gastric bypass. Obes Surg. 2006;16(4):521–3.
Sources of Funding
None
Conflict of Interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mahawar, K.K., Jennings, N., Brown, J. et al. “Mini” Gastric Bypass: Systematic Review of a Controversial Procedure. OBES SURG 23, 1890–1898 (2013). https://doi.org/10.1007/s11695-013-1026-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-013-1026-8