Advertisement

Obesity Surgery

, Volume 23, Issue 11, pp 1852–1857 | Cite as

Laparoscopic Silastic Ring Mini-gastric Bypass: a Single Centre Experience

  • M. G. Clarke
  • K. Wong
  • L. Pearless
  • M. Booth
Original Contributions

Abstract

Background

Laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to Roux-en-Y gastric bypass. The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports on the results of a consecutive cohort of patients undergoing SR-MGBP in a single centre.

Methods

Short- and medium-term outcomes of 156 consecutive patients undergoing surgery between August 2005 and January 2008 were analysed. Weight loss, comorbidity resolution and morbidity/mortality were assessed.

Results

A total of 156 patients (78% female, 22% male) with a mean (range) age of 44 years (18–63), pre-operative weight of 129 kg (83–197) and body mass index of 46 kg/m2 (35–64) underwent surgery. Eighty-seven percent had pre-operative comorbidities, and median (range) follow-up was 35 months (6–72). Mean (SD) % excess weight loss (EWL) at 6, 12, 24, 36 and 60 months was 74.6 (19.5), 93.4 (21.1), 98.8 (27.6), 93.5 (20.1) and 89 (16.1) respectively. Thirty-seven percent had complete resolution of comorbidities and 67.3% required vitamin/mineral supplementation. Overall, 10.3% patients suffered early complications, of which 7.7% were minor and 2.6% were major. A total of 45.5% patients suffered late complications, of which 34.6% were minor and 10.9% were major. Food intolerance/vomiting, bile reflux and stomal ulcer were seen in 18.6, 10.3 and 7.7% of patients, respectively. Surgical re-intervention was required in 12.8% of patients. There were no deaths.

Conclusions

Whilst SR-MGBP achieves excellent EWL with low mortality, there is a high incidence of food intolerance/vomiting likely related to the silastic ring. The majority of complications were managed with pharmacological and endoscopic intervention, although 13% required reoperation within 5 years.

Keywords

Mini-gastric bypass Gastric bypass Excess weight loss Silastic ring 

Notes

Conflicts of Interest

None.

References

  1. 1.
    Sjostrom L, Narbro K, Sjostrom D, et al. Effect of bariatric surgery on mortality in Swedish obese subjects. NEJM. 2007;357:741–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  3. 3.
    Sjostrom L, Peltonen M, Jacobsen P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Rutledge R. The mini-gastric bypass: experience with the first 1272 cases. Obes Surg. 2001;11:276–80.PubMedCrossRefGoogle Scholar
  5. 5.
    Wang W, Wei PL, Lee WJ, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15:648–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Carbajo M, Garcia-Callabero M, Toledano M, et al. One anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg. 2005;15:398–404.PubMedCrossRefGoogle Scholar
  7. 7.
    Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15:1304–8.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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;22:1827–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Lee WJ, Lee YC, Ser KH. Revisional surgery for laparoscopic minigastric bypass. SOARD. 2011;7(4):486–91.Google Scholar
  11. 11.
    Johnson WH, Fernandez 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. SOARD. 2007;3:37–41.Google Scholar
  12. 12.
    Fobi MA, Lee H, Holness R, et al. Gastric bypass operation for obesity. World J Surg. 1998;22:925–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Salinas A, Salinas H, Santiago E, et al. Silastic ring vertical gastric bypass: cohort study with 83% rate of 5-year follow-up. Surg Obes Relat Dis. 2009;5:455–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Awad W, Garay A, Martinez C. Ten years experience of banded gastric bypass: does it make a difference? Obes Surg. 2012;22(2):271–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Bessler M, Daud A, Kim T, et al. Prospective randomized trial of banded versus non-banded gastric bypass for the super obese: early results. Surg Obes Relat Dis. 2007;3:480–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Arceo-Olaiz R, Nayvi Espana-Gomez M, Montalvo-Hernandez J, et al. Maximal weight loss after banded and unbanded laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial. SOARD. 2008;5:455–8.Google Scholar
  17. 17.
    Fobi MA. Placement of the GaBP ring system in the banded gastric bypass operation. Obes Surg. 2005 Sep;15(8):1196–201.Google Scholar
  18. 18.
    Crampton NA, Izvornikov V, Stubbs RS. Silastic ring gastric bypass: a comparison of two ring sizes: a preliminary report. Obes Surg. 1997 Dec;7(6):495–9.Google Scholar
  19. 19.
    Conference NIH. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115(12):959–61.Google Scholar
  20. 20.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.PubMedCrossRefGoogle Scholar
  21. 21.
    Fobi M, Lee H, Igwe D, et al. Band erosion: incidence, etiology, management and outcome after banded vertical gastric bypass. Obes Surg. 2001 Dec;11(6):699–707.Google Scholar
  22. 22.
    Fisher BL, Buchwald H, Clark W, et al. Mini-gastric bypass controversy (letter). Obes Surg. 2001;11:773–7.PubMedCrossRefGoogle Scholar
  23. 23.
    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;249:189–94.PubMedCrossRefGoogle Scholar
  24. 24.
    Scozzari G, Trapani R, Toppino M, et al. Esophagogastric cancer after bariatric surgery: systematic review of the literature. SOARD. 2013;9(1):133–42.Google Scholar
  25. 25.
    Ovrebo KK, Hatlebakk JG, Viste A, et al. Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastroplasty. Ann Surg. 1998;228(1):51–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Miguel GP, Azevedo JL, de Souza PH, et al. Erosive esophagitis after bariatric surgery: banded vertical gastrectomy versus banded Roux-en-Y gastric bypass. Obes Surg. 2011 Feb;21(2):167–72.Google Scholar
  27. 27.
    Reis GM, Savassi-Rocha PR, Noguiera AM, et al. Histological esophagitis before and after surgical treatment of morbid obesity (Capella technique): a prospective study. Obes Surg. 2008;18:367–70.PubMedCrossRefGoogle Scholar
  28. 28.
    Sapala JA, Wood MH, Sapala MA, et al. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg. 1998;8:505–16.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • M. G. Clarke
    • 1
  • K. Wong
    • 2
  • L. Pearless
    • 3
  • M. Booth
    • 1
    • 3
  1. 1.Department of Bariatric and Upper GI SurgeryNorth Shore HospitalTakapunaNew Zealand
  2. 2.Gosford Private HospitalNorth GosfordAustralia
  3. 3.Waitemata Specialist CentreWestlakeNew Zealand

Personalised recommendations