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Understanding Objections to One Anastomosis (Mini) Gastric Bypass: A Survey of 417 Surgeons Not Performing this Procedure.BACKGROUND: Despite published experience with thousands of patients, the uptake of One Anastomosis/Mini Gastric Bypass (OAGB/MGB) has been less than enthusiastic and many surgeons still harbour objections to this procedure. The purpose of this study was to understand these objections scientifically. METHODS: Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey on SurveyMonkey®. Surgeons already performing this procedure were excluded. RESULTS: Four hundred seventeen bariatric surgeons (from 42 countries) not currently performing OAGB/MGB took the survey. There were 211/414 (50.97%) and 188/414 (45.41%) respondents who expressed concerns that it will lead to an increased risk of gastric and oesophageal cancers respectively. A total of 62/416 (14.9%) and 201/413 (n = 48.6%) surgeons respectively felt that OAGB/MGB was nassociated with a higher early (30-day) and late complication rate compared to the RYGB. Moreover, 7.8% (n = 32/411) and 16.26% (n = 67/412) of the respondents were concerned that OAGB/MGB carried a higher early (30-day) and late mortality, respectively, in comparison with the RYGB. There were 79/410 (19.27%) and 88/413 (21.3%) respondents who were concerned that OAGB/MGB was not an effective procedure for weight loss and co-morbidity resolution, respectively. A total of 258/411 (62.77%) respondents reported that OAGB/MGB was not approved by their national society as a mainstream bariatric procedure; 51.0% of these surgeons would start performing this procedure if it was. CONCLUSIONS: Surgeons not performing OAGB/MGB cite a number of concerns for not performing this operation. This survey is the first scientific attempt to understand these objections scientifically.
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Outcomes of linear-stapled versus hand-sewn gastrojejunal anastomosis in laparoscopic Roux en-Y gastric bypassBACKGROUND: In laparoscopic Roux en-Y gastric bypass (LRYGB), the gastrojejunal anastomosis (GJA) may be performed using linear-stapled (LS) or completely hand-sewn (HS) techniques. No published study has compared operative and clinical outcomes following LS and HS LRYGB when performed by surgeons beyond the learning curve. This study examined outcomes of both techniques performed by two 'technique-specific' bariatric fellowship-trained surgeons. METHODS: Data on consecutive primary LRYGB undertaken in two university hospitals were prospectively collected over 28-months and included demographics, co-morbidities, postoperative morbidity, mortality, length of stay (LOS), reoperations, and excess weight loss (EWL). Data were presented as mean ± SD. RESULTS: There were 366 LRYGB studied (LS = 144 and HS = 222 patients) with 96 % 12-month follow-up. All procedures were completed laparoscopically with no anastomotic leak or mortality. The LS cohort had a lower body mass index (48.3 ± 5.0 vs 53.8 ± 7.1, P < 0.001), greater incidence of diabetes mellitus (P = 0.009) and sleep apnea (P = 0.007). The HS cohort had more patients in Obesity Surgery Mortality Risk Score classes B and C (P = 0.004 and P = 0.01), and shorter operating time (127 ± 30 vs 172 ± 30 min, P < 0.001). There were no differences in LOS, complications, or reoperations. The HS technique was associated with more GJA stenoses requiring endoscopic dilatation (7.7 vs 0 %, P < 0.001). At 12 months, EWL (%) was comparable between the two techniques (LS 71.0 ± 15.5 vs HS 66.5 ± 13.7, P = 0.09). CONCLUSIONS: When performed by 'technique-specific' surgeons, both LS and HS GJA in LRYGB may be performed safely with no significant differences in morbidity, reoperations, or EWL.
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Mid-Term Remission of Type 2 Diabetes Mellitus After Laparoscopic Roux En-Y Gastric BypassBACKGROUND: Laparoscopic Roux en-Y gastric bypass (LRYGB) is an established therapeutic modality for type 2 diabetes mellitus (T2DM). However, there is paucity of data on the outcomes of LRYGB on T2DM beyond 2 years. This study aimed to examine the medium-term effects of LRYGB on T2DM and determine the predictors of T2DM resolution. METHODS: Prospective data were collected for all consecutive LRYGB performed from September 2009 to November 2010. The American Diabetes Association guidelines were used to define complete (CR) or partial (PR) remission of diabetes. Diabetes status was considered improved when there was >50 % reduction in the dose of medications or when glycaemic control was achieved after stopping insulin. The effects of baseline characteristics, diabetes data and weight loss data at 4 years on T2DM remission were studied. RESULTS: Forty-six patients with T2DM underwent LRYGB with mean ± SD age and body mass index (BMI) of 48.6 ± 9.6 years and 50.4 ± 6.5 kg/m(2), respectively. Median (IQR, interquartile range) duration of T2DM preoperatively was 60 (36-126) months. Median (IQR) follow-up was 52 (50-57) months. T2DM remission was achieved in 64 % of patients (44 % CR, 20 % PR), and a further 28 % of patients had improvement in their diabetes status. Multivariate analyses demonstrated significant excess weight loss (EWL) [P = 0.008] and lower BMI [P = 0.04] at 4 years to be the only independent predictors of T2DM medium-term outcomes. CONCLUSION: The medium-term effects of LRYGB on T2DM remission/improvement were maintained in 92 % of patients. EWL and lower BMI at 4 years were independent predictors of T2DM remission.
