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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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.
The study is an analysis of a prospectively collected bariatric database of 473 MGBs, 339 LSGs, and 295 RYGBs.
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 %).
RYGB and MGB act on the principle of restriction and malabsorption, but MGB superseded RYGB in its technical ease, efficacy, revisibility, and reversibility.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.
KeywordsLaparoscopic Roux-en-Y gastric bypass (RYGB) Laparoscopic sleeve gastrectomy (LSG) Mini-gastric bypass (MGB) One-anastomosis gastric bypass Type 2 diabetes (T2D) Percent excess weight loss (%EWL)
The authors are grateful to Mervyn Deitel, MD, FASMBS, CRCSC, FACN, for review and suggestions with the study.
Conflict of Interest
The authors declare that they have no competing interests.
Informed consent was obtained from all individual patients in the study before surgery, including follow-up.
A Statement of Human and Animal Rights
All procedures performed in this study involving human participants were in accordance with the ethical standards of our institutional research committee and were indicated as part of ethical patient follow-up of operations done for the benefit of the patient, according to the 1964 Helsinki Declaration and its later amendments. Individual patients are not identifiable. There were no studies on animals performed.
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