Laparoscopic Mini Gastric Bypass as a Revisional Procedure After Failed Primary Restrictive Bariatric Surgery

Abstract

Background: Restrictive bariatric procedures are commonly performed to induce weight reduction, however, some patients may require a second surgery due to inadequate weight loss, weight regain or late complications. Laparoscopic mini gastric bypass (LMGB) is a promising bariatric procedure, which provides an effective long-term weight loss and resolution of primary procedure related complications. Aim of the Work: To assess laparoscopic Mini Gastric Bypass as a bariatric surgical technique for revision after failed primary restrictive bariatric procedure. Cause of revision, weight loss, resolution of primary procedure related co-morbidities and complication rates will be assessed. Patients and Methods: This study included 60 patients with failed primary restrictive bariatric procedures (20 patients with failed sleeve gastrectomy, 20 patients with failed vertical banded gastroplasty and 20 patients with failed adjustable gastric banding) that were converted to laparoscopic MGB with minimal follow-up of 1 year. Results: Among all patient samples (60 patients) , there was significant decrease in mean body mass index after conversion to MGB. The mean BMI before revision was 42.80 ± 3.43 kg/m2 (range, 36-48.9) that decreased to 32.51 ± 3.31 kg/m2 one year after revision. A significant improvement of obesity related co-morbidities was observed after one year, the incidence of remission of diabetes mellitus was 91.6%, while it was 64.7% for hypertension and it was 70.5% for dyslipidemia. Reflux symptoms improved in about 80% of affected cases. Complications occurred only in 5% of cases and they were successfully managed. Conclusion: Mini gastric bypass is a safe and effective revisional procedure after failed primary restrictive bariatric surgery that adequate weight loss and satisfactory improvement of the primary procedure related complications.

Five-year outcomes of one anastomosis gastric bypass as conversional surgery following sleeve gastrectomy for weight loss failure

“…In another study by Bhandari et al, the rate of remission was 100% for DM and HTN at 1 and 2-year follow-ups 5 . Another study showed remission of DM, HTN, DLP and GERD in 91.6%, 64.7%, 70.5% and 80% of patients at 1-year follow-up respectively 11 . Debs et al, showed the improvement/remission of DM, OSA and HTN in 76.9%, 81.8% and 82.6% of patients in 1–5 years follow-ups after conversion of SG to OAGB 23 .…”

“…Some studies have shown controversial outcomes for related variables with different SG conversion procedures. There are limited published study about conversional OAGB following failed SG and most of them has reported the short to mid-term outcomes 9 – 11 that should be assess in long term.…”

One Anastomosis Gastric Bypass Versus Roux-en-y Gastric Bypass Surgery as Revisional Surgery after Restrictive Bariatric Operations

“…25 A study by Chiappetta (2019) and her colleagues that compared between MGB and RYGB as a second step operation after SG showed that the causes of revision to MGB in 34 patients were inadequate weight loss in 64.7%, weight regain in 20.5% and GERD in 14.7%. 21 A study done by Sabry et al, (2020) that assessed the effect of MGB as a revisional procedure after failed primary restrictive bariatric surgery 23 Khoursheed, et al, (2013) published results revealed the mean operative time in r-RYGB was 161.2 min and the median hospital stay was 3 days. 24 Salama and Sabry (2016) published results on 60 patients that showed that the mean operative time of r-MGB after VBG was 145.41 minutes compared to 185.16 min with r-RYGB.…”