Laparoscopic gastric plication versus mini-gastric bypass surgery in the treatment of morbid obesity: A randomized clinical trial

BackgroundLaparoscopic gastric plication (LGP) is emerging as a safe and effective bariatric procedure. However, there are no reports on the comparison between the efficacy and complications of LGP and laparoscopic mini-gastric bypass (LMGB), which is still an investigational bariatric procedure. The objective of this study was to compare safety and efficacy of LGP and LMGB in the treatment of morbid obesity in a one-year follow-up study.MethodsForty patients met the National Institutes of Health criteria and were randomly assigned to receive either LGP (n = 20) or LMGB (n = 20) by a block randomization method. Early and late complications, body mass index (BMI), excess weight loss, and obesity-related co-morbidities were determined at the 1-year follow-up.ResultsOperative time and mean length of hospitalization were shorter in the LGP group (71.0 minutes versus 125.0 minutes, P<.001, and 1.6 days versus 5.2 days; P<.001, respectively). The mean percentage of excess weight loss (%EWL) at 12 months follow-up was 66.9% in the LMGB group and 60.8% in the LGP group (P = .34). Improvement was observed in all co-morbidities in both groups, with the exception of hyperlipidemia, which remained unresolved in 4 patients. Lower incidence of iron deficiency occurred in the LGP group (P = .035). Rehospitalization and reoperation were not required in any cases. Considering the cost of instruments used in the LMGB procedure and operative time, LGP saved approximately $2,500 per case compared with LMGB.ConclusionBoth LGP and LMGB are effective weight loss procedures. LGP proved to be a simpler and less costly procedure compared with LMGB with a lower risk of iron deficiency during a 1-year follow-up study.     

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目的 报告成功实施腹腔镜迷你胃旁路术治疗单纯性肥胖并2型糖尿病病人1例。方法 第二军医大学附属长海医院微创外科于2007年11月对1例伴有2型糖尿病的单纯性肥胖症病人行腹腔镜迷你胃旁路术。结果 病人手术顺利，手术时间135min，术中出血20mL。术后30d内无手术并发症，随访30d，体重下降15kg，体重指数（BMI）减少4．9。术后第8天停用一切降糖药物，各项糖尿病检查指标均正常。结论 腹腔镜迷你胃旁路术是相对安全、简单的术式，近期减重效果良好，对2型糖尿病具有很好的治疗效果。     

Laparoscopic mini-gastric bypass: an effective option for the treatment of morbid obesity

OBJECTIVE: To evaluate laparoscopic Mini-Gastric Bypass in the treatment of morbid obesity. PATIENTS AND METHODS: Thirty patients with a mean BMI of 41.84.5 Kg/M2 underwent a laparoscopic Mini-Gastric Bypass between March 2005 and February 2006. A laparoscopic approach with five trocar incisions was used to create a long narrow gastric tube; this was then anastomosed ante-colically to a loop of jejunum 200 cm. distal to the ligament of Treitz Peri-operative and short-term follow-up results up to May 2006 are reported. RESULTS: Conversion to open mini-gastric bypass was necessary in one case (3.3%). Mean operative time was 135 45 minutes. There were no deaths. There were no anastomotic leakages. Two patients developed obstruction at the gastrojejunostomy requiring laparoscopic correction in one case and accounting for an overall morbidity of 6.6%. Mean hospital stay was 3 0.25 days. One patient developed marginal ulcer which resolved with medical treatment; no patients developed symptoms of reflux esophagitis. Mean loss of excess weight was 67.6% at one year and was accompanied by resolution of obesity-associated medical illness in 85% of patients. CONCLUSION: Laparoscopic Mini-Gastric Bypass is a technically simple, safe, and effective procedure in the treatment of morbid obesity and its associated medical illnesses. Moreover, the procedure is easily reversible laparoscopically when post-operative complication occurs.     

Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study

OBJECTIVE: The objective of the study was to compare the results of open versus laparoscopic gastric bypass in the treatment of morbid obesity. SUMMARY BACKGROUND DATA: Gastric bypass is one of the most commonly acknowledged surgical techniques for the management of morbid obesity. It is usually performed as an open surgery procedure, although now some groups perform it via the laparoscopic approach. PATIENTS AND METHODS: Between June 1999 and January 2002 we conducted a randomized prospective study in 104 patients diagnosed with morbid obesity. The patients were divided into 2 groups: 1 group with gastric bypass via the open approach (OGBP) comprising 51 patients, and 1 group with gastric bypass via the laparoscopic approach (LGBP) comprising 53 patients. The parameters compared were as follows: operating time, intraoperative complications, early (<30 days) and late (>30 days) postoperative complications, hospital stay, and short-term evolution of body mass index. RESULTS: Mean operating time was 186.4 minutes (125-290) in the LGBP group and 201.7 minutes (129-310) in the OGBP group (P < 0.05). Conversion to laparotomy was necessary in 8% of the LGBP patients. Early postoperative complications (<30 days) occurred in 22.6% of the LGBP group compared with 29.4% of the OGBP group, with no significant differences. Late complications (>30 days) occurred in 11% of the LGBP group compared with 24% of the OGBP group (P < 0.05). The differences observed between the 2 groups are the result of a high incidence of abdominal wall hernias in the OGBP group. Mean hospital stay was 5.2 days (1-13) in the LGBP group and 7.9 days (2-28) in the OGBP group (P < 0.05). Evolution of body mass index during a mean follow-up of 23 months was similar in both groups. CONCLUSIONS: LGBP is a good surgical technique for the management of morbid obesity and has clear advantages over OGBP, such as a reduction in abdominal wall complications and a shorter hospital stay. The midterm weight loss is similar with both techniques. One inconvenience is that LGBP has a more complex learning curve than other advanced laparoscopic techniques, which may be associated with an increase in postoperative complications.     

Randomized clinical trial of hand-assisted laparoscopic versus open Roux-en-Y gastric bypass for the treatment of morbid obesity

BACKGROUND:: Roux-en-Y gastric bypass (RYGBP) has increased in popularity since the introduction of the laparoscopic procedure, but this approach requires extensive surgical skill and the learning curve is steep. The present study examined the suitability of hand-assisted laparoscopy for RYGBP. METHODS: In a prospective trial, 50 patients (median age 38 years, body mass index 45 kg/m(2)) were randomized to either hand-assisted (n = 25) or open (n = 25) RYGBP. The hand-assisted device was introduced through a right subcostal incision. Laparoscopic staplers were also used in the open group, allowing a short upper midline incision. The gastrojejunostomy was made by means of a circular stapler and the Roux limb placed behind the colon and excluded stomach. RESULTS: The postoperative outcome, with respect to morphine consumption, complications, hospital stay (6 days) and weight loss, was similar in the two groups. The operating time was significantly longer in the hand-assisted group (150 versus 85 min; P < 0.001) but there was no conversion to open operation. One patient in the hand-assisted group was reoperated owing to leakage and one patient developed an incisional hernia after open RYGBP. CONCLUSION: The hand-assisted technique was feasible and allowed good working conditions in all patients. However, the postoperative outcome was excellent in both groups and there was no advantage to the hand-assisted technique.     

Laparoscopic Roux-en-Y gastric bypass for morbid obesity.

Surgery is currently the only effective treatment for morbid obesity. The two most commonly accepted operations are the Roux-en-Y gastric bypass and vertical banded gastroplasty. Although multiple authors have reported on a laparoscopic approach to gastric banding, the Roux-en-Y gastric bypass is a complex operation to be replicated using laparoscopic techniques. In this article, we describe our technique of the Roux-en-Y gastric bypass using a laparoscopic approach in four cases.     

Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 10-year results of a prospective,randomized trial

BackgroundThere are few studies of long-term outcomes for either laparoscopic adjustable gastric banding (LAGB) or laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to compare outcomes of patients randomly assigned to undergo LAGB or LRYGB at 10 years.MethodsLAGB, using the pars flaccida technique, and standard LRYGB were performed. From January 2000 to November 2000, 51 patients (mean age 34.0 ± 8.9 years; range 20–49) were randomly allocated to undergo either LAGB (n = 27, 5 men and 22 women; mean age 33.3 years; mean weight 120 kg; mean body mass index [BMI] 43.4 kg/m²) or LRYGB (n = 24, 4 men and 20 women; mean age 34.7; mean weight 120 kg; mean BMI 43.8 kg/m²). Data on complications, reoperations, weight, BMI, percentage of excess weight loss, and co-morbidities were collected yearly. The data were analyzed using Student’s t test and Fisher’s exact test, with P<.05 considered significant.ResultsFive patients in the LAGB group and 3 patients in the LRYGB group were lost to follow-up. No patient died. Conversion to laparotomy was performed in 1 (4.2%) of 24 LRYGB patients. Reoperations were required in 9 (40.9%) of 22 LAGB patients and in 6 (28.6%) of the 21 LRYGB patients. At 10-year follow-up, the LRYGB patients had a greater percentage of mean excess weight loss than did the LAGB patients (69±29% versus 46±27%; P = .03).ConclusionLRYGB was superior to LAGB in term of excess weight loss results (76.2% versus 46.2%) at 10 years. However, LRYGB exposes patients to higher early complication rates than LAGB (8.3% versus 0%) and potentially lethal long-term surgical complications (internal hernia and bowel obstruction rate: 4.7%).     

Banded Roux-en-Y gastric bypass for the treatment of morbid obesity

BackgroundLaparoscopic Roux-en-Y gastric bypass (LRYGB) is the most effective treatment for morbid obesity. The additional benefit of placing a nonadjustable band around the pouch remains to be determined. The objective of this study was to compare outcomes between banded and nonbanded LRYGB patients in a single bariatric center.MethodsA matched cohort analysis was performed between patients who had undergone banded and nonbanded (standard) LRYGB. In the banded bypass cohort, an 8 F, 6.5 cm silastic ring was placed around the proximal gastric pouch. Both cohorts were matched for age, body mass index (BMI), and anastomotic technique. Endpoints included percentage excess weight loss (%EWL), postoperative morbidity, and band-related complications.ResultsBetween January 2007 and July 2010, 134 banded LRYGB were performed (55% female, mean age 45 years). They were compared with a matched cohort of 134 concurrent nonbanded LRYGB patients (67% female, mean age 45.4 years). Mean preoperative BMI was 54.6 and 52.8 kg/m², respectively (P = .084). At 24 months postoperatively, the average %EWL was 58.6% in banded bypass patients and 51.4% in the nonbanded group (P = .015). The difference in EWL was more pronounced in super-obese patients than in those with BMI<50 (among super-obese, 57.5% versus 47.6%, P = .003; among those with BMI<50, 62.9% versus 57.9%, P = .406]. There was no difference in early (19.4% versus 19.4%) or late complications (10.4% versus 13.4%, P = .451) between banded and nonbanded LRYGB patients.ConclusionBanding the pouch during LRYGB can be performed safely and may provide better weight loss, particularly in super-obese patients. Further prospective and long-term comparative studies of this technique are warranted.     

Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial.

BACKGROUND: To perform a prospective, randomized comparison of laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: LAGB, using the pars flaccida technique, and standard LRYGB were performed. From January 2000 to November 2000, 51 patients (mean age 34.0 +/- 8.9 years, range 20-49) were randomly allocated to undergo either LAGB (n = 27, 5 men and 22 women, mean age 33.3 years, mean weight 120 kg, mean body mass index [BMI] 43.4 kg/m(2); percentage of excess weight loss 83.8%) or LRYGB (n = 24, 4 men and 20 women, mean age 34.7, mean weight 120 kg, mean BMI 43.8 kg/m(2), percentage of excess weight loss 83.3). Data on the operative time, complications, reoperations with hospital stay, weight, BMI, percentage of excess weight loss, and co-morbidities were collected yearly. Failure was considered a BMI of >35 at 5 years postoperatively. The data were analyzed using Student's t test and Fisher's exact test, with P <.05 considered significant. RESULTS: The mean operative time was 60 +/- 20 minutes for the LAGB group and 220 +/- 100 minutes for the LRYGB group (P <.001). One patient in the LAGB group was lost to follow-up. No patient died. Conversion to laparotomy was performed in 1 (4.2%) of 24 LRYGB patients because of a posterior leak of the gastrojejunal anastomosis. Reoperations were required in 4 (15.2%) of 26 LAGB patients, 2 because of gastric pouch dilation and 2 because of unsatisfactory weight loss. One of these patients required conversion to biliopancreatic diversion; the remaining 3 patients were on the waiting list for LRYGB. Reoperations were required in 3 (12.5%) of the 24 LRYGB patients, and each was because of a potentially lethal complication. No LAGB patient required reoperation because of an early complication. Of the 27 LAGB patients, 3 had hypertension and 1 had sleep apnea. Of the 24 LRYGB patients, 2 had hyperlipemia, 1 had hypertension, and 1 had type 2 diabetes. Five years after surgery, the diabetes, sleep apnea, and hyperlipemia had resolved. At the 5-year (range 60-66 months) follow-up visit, the LRYGB patients had significantly lower weight and BMI and a greater percentage of excess weight loss than did the LAGB patients. Weight loss failure (BMI >35 kg/m(2) at 5 yr) was observed in 9 (34.6%) of 26 LAGB patients and in 1 (4.2%) of 24 LRYGB patients (P <.001). Of the 26 patients in the LAGB group and 24 in the LRYGB group, 3 (11.5%) and 15 (62.5%) had a BMI of <30 kg/m(2), respectively (P <.001). CONCLUSION: The results of our study have shown that LRYGB results in better weight loss and a reduced number of failures compared with LAGB, despite the significantly longer operative time and life-threatening complications.     

Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass

Over the past 20 years bariatric surgery proved to be a valid treatment for reduction and elimination of obesity-related diseases and long-term sustainable weight loss. Minimally invasive or laparoscopic techniques such as laparoscopic Roux-en-Y (LRNY) have replaced open procedures. Many factors play important roles in the small intricacies and variations of the procedure, chief of which is the creation and size of the gastrojejunostomy. Regardless of the variations in technique, the LRNY remains the gold standard for the surgical treatment of clinically severe or morbid obesity, with relatively low morbidity and mortality.     

Long-term outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: Results from a meta-analysis of randomized controlled trials

BackgroundLaparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (LRYGB) are 2 widely used procedures performed in bariatric surgery. However, their long-term weight loss effects have not been well compared.ObjectivesTo evaluate the long-term outcome of 2 procedures for treating morbid obesity.SettingThe gastrointestinal surgery center, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital.MethodsThree electronic databases, PubMed, CNKI, and EMBASE, were searched ending in September 2018. Eligible studies were prospective randomized controlled trials.ResultsOf 15 randomized controlled trials studies, 1381 cases were included, 697 were randomly divided into the laparoscopic sleeve gastrectomy group and 684 to the LRYGB group. A statistically significant percent excess weight loss reduction in weighted mean difference was observed in LRYGB group at 5 years (weighted mean difference = −8.9, 95% confidence interval [CI] = −13.08 to −4.73, P < .0001), and at 3 years (weighted mean difference = −11.96, 95% CI = −17.62 to −6.30, P < .0001). However, there was not any statistically difference between the 2 procedures in <3 years. The total complication of the LSC group were less than that of the LRYGB groups (odds ratio = .52, 95%CI = .35–.76, P = .0007). This meta-analysis showed that the LRYGB procedure could reduce gastrointestinal reflux disease (odds ratio = .26, 95%CI = .11–.61, P = .002); however, no statistically significant differences were found in type 2 diabetes, hypertension, dyslipidemia, and sleep apnea.ConclusionsThis meta-analysis showed that significantly greater in percent excess weight loss after 5 years of LRYGB treatment; however, it seems to have a higher incidence of total complications.     

121例腹腔镜Roux-en-Y胃空肠吻合术后随访结果

目的探讨腹腔镜Roux-en-Y胃空肠吻合术(laparoscopicRoux-en-Ygastricbypass,LRYGBP)治疗病态肥胖的术后营养和代谢方面的变化。方法121例LRYGBP,男40例,女81例。分别测定术前1个月及术后6个月的体重指数(bodymassindex,BMI)。对比分析6个月、12个月,24个月血清铁(Fe)、钙(Ca)、锌(Zn)、硒(Se)及维生素A(VitA)、维生素D(VitD)、维生素B12(VitB12)和甲状旁腺素(parathyroidhormone,PTH)的水平变化。结果术前1个月BMI(47.00±7.15)kg/m2,术后6个月BMI(33.79±6.06)kg/m2,BMI下降(13.21±5.47)kg/m2(t=26·103,P=0·000)。术后血清Fe、Ca、Zn、Se及VitA、VitD、VitB12均在正常范围,其中术后6个月血清Zn、Se和VitA水平虽然在正常范围内,但分别有19.5%(17/87)、22.7%(20/88)和33.7%(28/83)的患者低于正常水平,但术后2年仅有6·7%(2/30)、11·5%(3/26)和17·2%(5/29)的患者低于正常水平。血清PTH术后6个月11~161pg/ml,(66±34)pg/ml、1年24~154pg/ml,(72±34)pg/ml、2年21~194pg/ml,(75±40)pg/ml(正常值9~44pg/ml)。结论LRYGBP治疗病态肥胖是有效、安全的。术后2年血清Fe、Ca及VitD、VitB12均正常;血清锌、硒及维生素A经术后6个月给予补充剂大多接近正常;血清PTH水平明显高于正常。建议患者术后长期服用复合维生素、矿物质补充剂,定期到医院随访。     

Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity

Background: We reviewed our experience with complications following laparoscopic Roux-en-Y gastric bypass (LRYGB) that were managed laparoscopically. Methods: A total of 246 consecutive morbidly obese patients (mean body mass index, 50.9 kg/m2) underwent LRYGB by three surgeons at two institutions. All patients met National Institutes of Health criteria for surgical treatment of morbid obesity. Patients were followed prospectively. Results: A total of 62 patients (25.2%) developed 64 complications, 34 of which (13.8%) required a surgical intervention. Twenty-seven of the 34 procedures were performed laparoscopically. Gastrojejunostomy stricture was the most common complication (8.9%), followed by intestinal obstruction (7.3%) and gastrointestinal bleeding (4%). The intestinal obstruction was secondary to adhesions (n = 6), internal hernia at the level of the transverse mesocolon (n = 3), jejunojejunostomy stricture (n = 3), and cicatrix around the Roux limb at the level of the transverse mesocolon (n = 3). Other complications included gastrojejunostomy leak (1.6%), symptomatic gallstone disease (2.8%), and gastric remnant perforation (0.8%). One patient underwent a negative laparoscopy to rule out anastomotic leak. There were 3 deaths in this series of patients, 2 attributable to anastomotic leak. Conclusions: A variety of complications can present after LRYGB. Laparoscopy is an excellent technique to treat these complications.     

腹腔镜胃旁路术结肠前与结肠后胃空肠吻合术的前瞻性比较研究

目的比较腹腔镜Roux-en—Y胃旁路术（LRYGB）治疗肥胖症术中结肠前与结肠后两种胃空肠吻合术式的疗效差异。方法前瞻性地将2008年3月至2010年7月暨南大学附属第一医院收治的40例肥胖症患者按随机数字表法分为结肠前组（20例）和结肠后组（20例）。比较两种术式术中、术后恢复情况及短期消化道症状。结果所有病例均顺利完成手术。两组术中失血量、术后排气时间、进食半流时间及术后住院时间方面的差异均无统计学意义（均P〉0．05）;但结肠后组手术时间明显长于结肠前组[（163．4±28．1）min比（131．8±22．7）min,P〈0．05]。两组均未出现腹内疝及吻合口瘘等并发症;术后3个月,两组患者消化道症状的差异亦无统计学意义（P〉0．05）。结论尽管LRYGB结肠后胃空肠吻合更加符合生理结构．但在术后短期疗效上结肠前与结肠后吻合术相当．其远期效果有待进一步研究证实。