Long-term follow-up of proximal versus distal laparoscopic gastric bypass for morbid obesity

Abstract

Background: Laparoscopic gastric bypass is the 'gold standard' for treatment of morbidly obese patients in many centres. There is debate regarding the optimal length for small bowel limbs. This study aimed to determine whether the proximal or distal approach is better.Methods: Twenty-five patients undergoing primary distal gastric bypass in 2000-2002 were randomly matched for age, sex and preoperative body mass index (BMI) with 25 patients having a primary proximal bypass. All distal operations were performed laparoscopically; one proximal procedure was converted to open surgery. Results: Mean operating time was 170 min for proximal and 242 min for distal bypasses (P = 0·004); median hospital stay was similar in the two groups. There were no deaths and the overall complication rate was similar, as was weight loss at 4 years: BMI decreased from 45·9 to 31·7 kg/m 2 for the proximal and from 45·8 to 33·1 kg/m 2 for the distal approach. Co-morbidities decreased after surgery in both groups; the prevalence of diabetes, arterial hypertension and dyslipidaemia at all time points was similar in the two groups.Conclusion: Proximal and distal laparoscopic gastric bypass operations are feasible and safe, with no differences in weight loss or reduction of co-morbidity in unselected morbidly obese patients.

Vagal Sparing Surgical Technique but Not Stoma Size Affects Body Weight Loss in Rodent Model of Gastric Bypass

“…An increasing body of evidence in humans indicates that up to certain limits the size of the gastric pouch and length of the different limbs is of less importance for the outcome of gastric bypass [28]. In support of this observation, we demonstrated that the level of restriction measured by the size of the gastro-jejunostomy has no impact on different levels of weight loss and food intake after gastric bypass in rats.…”

Petersen’s hernia after laparoscopic distal gastrectomy with Roux-en-Y reconstruction for gastric cancer

“…In our study, the reduction after distal gastrectomy was 11.4 % on average (data not shown), which was also slightly larger than in other studies [13,14]. Weight loss is considered a risk factor for internal hernia in RYGBP [15,16]. The large decrease in mesenteric fat after distal gastrectomy is a major cause of weight loss after surgery [17,18].…”

Two Important Criteria for Reducing the Risk of Postoperative Ulcers at the Gastrojejunostomy Site after Gastric Bypass: Patient Compliance and Type of Gastric Bypass

“…An ideal management of super-obese patients does not exist, but gastric bypass is one of the most common procedures with the best results concerning efficacy, morbidity and mortality [1][2][3][4][5][6][7]. If a decision for gastric bypass is made after the relevant preoperative diagnostics (body mass index, comorbidities, diabetes mellitus), the surgeon has a choice between Roux-en-Y and B-II gastric bypass.…”