Surgical Endoscopy

, Volume 28, Issue 1, pp 156–163 | Cite as

The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review

  • M. Musella
  • A. Susa
  • F. Greco
  • M. De Luca
  • E. Manno
  • C. Di Stefano
  • M. Milone
  • R. Bonfanti
  • G. Segato
  • A. Antonino
  • L. Piazza



Due to the failure of the “old Mason loop,” the mini-gastric bypass (MGB) has been viewed with skepticism. During the past 12 years, a growing number of authors from around the world have continued to report excellent short- and long-term results with MGB.


One university center, three regional hospitals, and two private hospitals participated in this study. From July 2006 to December 2012, 475 men (48.8 %) and 499 women (51.2 %) underwent 974 laparoscopic MGBs. The mean age of these patients was 39.4, and their preoperative body mass index was 48 ± 4.58 kg/m2. Type 2 diabetes mellitus (T2DM) affected 224 (22.9 %) of the 974 patients, whereas 291 of the 974 patients (29.8 %) presented with hypertension. The preoperative gastrointestinal status was explored in all the patients through esophagogastroduodenoscopia. The major end points of the study were definitions of both MGB safety and efficacy in the long term as well as the endoscopic changes in symptomatic patients eventually produced by surgery.


The rate of conversion to open surgery was 1.2 % (12/974), and the mortality rate was 0.2 % (2/974). The perioperative morbidity rate was 5.5 % (54/974), with 20 (2 %) of the 974 patients requiring an early surgical revision. The mean hospital length of stay was 4.0 ± 1.7 days. At this writing, 818 patients are being followed up. Late complications have affected 74 (9 %) of the 818 patients. The majority of these complications (66/74, 89.1 %) have occurred within 1 year after surgery. Bile reflux gastritis was symptomatic, with endoscopic findings reported for 8 (0.9 %) and acid peptic ulcers for 14 (1.7 %) of the 818 patients. A late revision surgery was required for 7 (0.8 %) of the 818 patients. No patient required revision surgery due to biliary gastritis. At 60 months, the percentage of excess weight loss was 77 ± 5.1 %, the T2DM remission was 84.4 %, and the resolution of hypertension was 87.5 %.


Despite initial skepticism, this study, together with many other large-scale, long-term similar studies from around the world (e.g., Taiwan, United States, France, Spain, India, Lebanon) demonstrated the MGB to be a short, simple, low-risk, effective, and durable bariatric procedure.


Mini-gastric bypass One anastomosis gastric bypass Bariatric surgery Laparoscopy Italian multicenter study 



Authors would like to thank Prof. M. Taglialatela and Dr. P. Bianco for their precious support.


M. Musella, A. Susa, F. Greco, M. De Luca, E. Manno, C. Di Stefano, M. Milone, R. Bonfanti, G. Segato, A. Antonino, and L. Piazza have no conflicts of interest or financial ties to disclose.


  1. 1.
    Rutledge R (2001) The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 11:276–280PubMedCrossRefGoogle Scholar
  2. 2.
    Rutledge R, Walsh W (2005) Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg 15:1304–1308PubMedCrossRefGoogle Scholar
  3. 3.
    Lee WJ, Yu PJ, Wang W et al (2005) Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity. Ann Surg 242:20–28PubMedCrossRefGoogle Scholar
  4. 4.
    Carbajo MA, Garcia-Caballero M, Toledano M et al (2005) One anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg 15:398–404PubMedCrossRefGoogle Scholar
  5. 5.
    Chakhtoura G, Zinzindohoué F, Ghanem Y, Ruseykin I, Dutranoy JC, Chevallier JM (2008) Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital. Obes Surg 18:1130–1133PubMedCrossRefGoogle Scholar
  6. 6.
    Peraglie C (2008) Laparoscopic mini-gastric bypass (LMGB) in the super–super obese: outcomes in 16 patients. Obes Surg 18:1126–1129PubMedCrossRefGoogle Scholar
  7. 7.
    Piazza L, Ferrara F, Leanza S, Coco D, Sarvà S, Bellia A, Di Stefano C, Basile F, Biondi A (2011) Laparoscopic mini-gastric bypass: short-term single-institute experience. Updates Surg 63:239–242PubMedCrossRefGoogle Scholar
  8. 8.
    Noun R, Skaff J, Riachi E, Daher R, Antoun NA, Nasr M (2012) One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg 22:697–703PubMedCrossRefGoogle Scholar
  9. 9.
    Lee WJ, Wang W, Lee YC, Huang MT, Ser KH, Chen JC (2008) Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg 18:294–299PubMedCrossRefGoogle Scholar
  10. 10.
    Mason EE, Ito C (1967) Gastric bypass in obesity. Surg Clin North Am 47:1345–1351PubMedGoogle Scholar
  11. 11.
    Fisher BL, Buchwald H, Clark W, Champion JK, Fox SR, MacDonald KG, Mason EE, Terry BE, Schauer PR, Sugerman HJ (2001) Mini-gastric bypass controversy. Obes Surg 11:773–777PubMedCrossRefGoogle Scholar
  12. 12.
    Johnson WH, Fernanadez AZ, Farrell TM, Macdonald KG, Grant JP, McMahon RL, Pryor AD, Wolfe LG, DeMaria EJ (2007) Surgical revision of loop (“mini”) gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis 3:37–41PubMedCrossRefGoogle Scholar
  13. 13.
    Collins BJ, Miyashita T, Schweitzer M, Magnuson T, Harmon JW (2007) Gastric bypass: why Roux-en-Y? A review of experimental data. Arch Surg 142:1000–1003PubMedCrossRefGoogle Scholar
  14. 14.
    Chevallier JM, Chakhtoura G, Zinzindohoué F (2009) Laparoscopic mini-gastric bypass. J Chir Paris 146:60–64PubMedCrossRefGoogle Scholar
  15. 15.
    Kim Z, Hur KY (2011) Laparoscopic mini-gastric bypass for type 2 diabetes: the preliminary report. World J Surg 35:631–636PubMedCrossRefGoogle Scholar
  16. 16.
    Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC (2012) Laparoscopic Roux-en-Y vs mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg 22:1827–1834PubMedCrossRefGoogle Scholar
  17. 17.
    Lee WJ, Chong K, Ser KH, Lee YC, Chen SC, Chen JC, Tsai MH, Chuang LM (2011) Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg 146:143–148PubMedCrossRefGoogle Scholar
  18. 18.
    Musella M, Milone M, Bellini M et al (2012) Effect of bariatric surgery on obesity-related infertility. Surg Obes Relat Dis 8:445–449PubMedCrossRefGoogle Scholar
  19. 19. Accessed 24 Sept 2012
  20. 20.
    Muñoz R, Ibáñez L, Salinas J, Escalona A, Pérez G, Pimentel F, Guzmán S, Boza C (2009) Importance of routine preoperative upper GI endoscopy: why all patients should be evaluated? Obes Surg 19:427–431PubMedCrossRefGoogle Scholar
  21. 21.
    Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR (2012) Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 55:1577–1596PubMedCrossRefGoogle Scholar
  22. 22.
    Chevallier JM, Trelles N, Arienzo R, Jamal W, Chakhtoura G, Zinzindohoué F (2011) Endoscopic findings after laparoscopic omega loop gastric bypass. Obes Surg 21:956CrossRefGoogle Scholar
  23. 23.
    Caygill CP, Hill MJ, Kirkham JS, Northfield TC (1986) Mortality from gastric cancer following gastric surgery for peptic ulcer. Lancet 1:929–931PubMedCrossRefGoogle Scholar
  24. 24.
    Viste A, Bjørnestad E, Opheim P, Skarstein A, Thunold J, Hartveit F, Eide GE, Eide TJ, Søreide O (1986) Risk of carcinoma following gastric operations for benign disease: a historical cohort study of 3,470 patients. Lancet 2:502–505PubMedCrossRefGoogle Scholar
  25. 25.
    Lundegårdh G, Adami HO, Helmick C, Zack M, Meirik O (1988) Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med 319:195–200PubMedCrossRefGoogle Scholar
  26. 26.
    Fischer AB, Graem N, Jensen OM (1983) Risk of gastric cancer after Billroth II resection for duodenal ulcer. Br J Surg 70:552–554PubMedCrossRefGoogle Scholar
  27. 27.
    Tokudome S, Kono S, Ikeda M, Kuratsune M, Sano C, Inokuchi K, Kodama Y, Ichimiya H, Nakayama F, Kaibara N et al (1984) A prospective study on primary gastric stump cancer following partial gastrectomy for benign gastroduodenal diseases. Cancer Res 44:2208–2212PubMedGoogle Scholar
  28. 28.
    Ito M, Takata S, Tatsugami M et al (2009) Clinical prevention of gastric cancer by Helicobacter pylori eradication therapy: a systematic review. J Gastroenterol 44:365–371PubMedCrossRefGoogle Scholar
  29. 29.
    Tersmette AC, Offerhaus GJ, Tersmette KW, Giardiello FM, Moore GW, Tytgat GN, Vandenbroucke JP (1990) Meta-analysis of the risk of gastric stump cancer: detection of high-risk patient subsets for stomach cancer after remote partial gastrectomy for benign conditions. Cancer Res 50:6486–6489PubMedGoogle Scholar
  30. 30.
    Offerhaus GJ, Tersmette AC, Giardiello FM, Huibregtse K, Vandenbroucke JP, Tytgat GN (1992) Evaluation of endoscopy for early detection of gastric-stump cancer. Lancet 340:33–35PubMedCrossRefGoogle Scholar
  31. 31.
    Bassily R, Smallwood RA, Crotty B (2000) Risk of gastric cancer is not increased after partial gastrectomy. J Gastroenterol Hepatol 15:762–765PubMedCrossRefGoogle Scholar
  32. 32.
    Scozzari G, Trapani R, Toppino M, Morino M (2013) Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis 9:133–142PubMedCrossRefGoogle Scholar
  33. 33.
    Hutter MM, Schirmer BD, Jones DB, Ko CY, Cohen ME, Merkow RP, Nguyen NT (2011) First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 254:410–422PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Padwal R, Klarenbach S, Wiebe N, Birch D, Karmali S, Manns B, Hazel M, Sharma AM, Tonelli M (2011) Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev 12:602–621PubMedCrossRefGoogle Scholar
  35. 35.
    O’Brien PE, MacDonald L, Anderson M, Brennan L, Brown WA (2013) Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg 257:87–94PubMedCrossRefGoogle Scholar
  36. 36.
    Gill RS, Birch DW, Shi X, Sharma AM, Karmali S (2010) Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 6:707–713PubMedCrossRefGoogle Scholar
  37. 37.
    Higa K, Ho T, Tercero F, Yunus T, Boone KB (2011) Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis 7:516–525PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • M. Musella
    • 1
  • A. Susa
    • 2
  • F. Greco
    • 3
  • M. De Luca
    • 4
  • E. Manno
    • 5
  • C. Di Stefano
    • 6
  • M. Milone
    • 1
  • R. Bonfanti
    • 3
  • G. Segato
    • 4
  • A. Antonino
    • 5
  • L. Piazza
    • 6
  1. 1.Advanced Biomedical Sciences Department, General Surgery“Federico II” UniversityNaplesItaly
  2. 2.General SurgeryClinica “S. Maria Maddalena”RovigoItaly
  3. 3.General SurgeryClinica “Castelli”BergamoItaly
  4. 4.General Surgery“S. Bortolo” General HospitalVicenzaItaly
  5. 5.General and Endocrine SurgeryAORN “A. Cardarelli”NaplesItaly
  6. 6.General and Emergency SurgeryAORN “G. Garibaldi”CataniaItaly

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