Evidence-Based Review of Mini- Gastric Bypass - Duke · PDF fileEvidence-Based Review of Mini-Gastric Bypass Brandon Williams, MD Assistant Professor of Surgery Vanderbilt University

Evidence-Based Review of Mini-

Gastric Bypass

Brandon Williams, MD

Assistant Professor of Surgery

Vanderbilt University Medical Center

Nothing to Disclose

What’s in a Name?

• Mini gastric bypass (MGB) since 1997

– Rutledge 2001

• One-anastomosis gastric bypass (OAGB)

– Garcia-Caballero in 2004

• Single-anastomosis gastric bypass (SAGB)

– Lee 2014

• Omega loop gastric bypass (OLGB)

– Himpens 2015

Mini-Gastric Bypass

• Gastric pouch 15 ± 2.5 cm

– Level of the crow’s foot

• Gastrojejunostomy 200 (150-300) cm from ligament of Treitz

• “Larger” G-J

– 1.5 to > 3 cm

One Anastomosis Gastric Bypass

• 31 published articles prior to December 2014

– 16 single-arm case studies

– 15 comparison studies

• LAGB vs MGB (8)

• LSG vs MGB (6)

• LRYGB vs MGB (5)

Outcomes

• Operative time ≈ 50 to 90 min

• Early complications (1 – 2%)

– Bleeding, leak, wound infection

• Late complications (2 – 8%)

– Bile reflux, marginal ulcer, iron deficiency

• Low mortality rate (< 1%)

Versus LAGB Remission of T2DM

Post-op BMI

Versus LSG 1-Year %EWL

Remission of T2DM

Versus LSG

Revision Surgery Rate

Revision Surgery Rate

Versus RYGB

Operative Time

1-Year %EWL

Versus RYGB

Remission of T2DM

• Complete F/U in 126 of 175 (72%)

• Gastric tube over 32 Fr bougie

• Omentum divided

• 200 cm from ligament of Treitz

• End-to-side gastrojejunostomy

• PPIs for 6 months

Early Complications

• Reoperations in 6 (4.8%)

Late Complications

• Reoperation in 6 (4.8%)

• Iron deficiency anemia in 4 (3.2%)

• Severe malnutrion in 2 (1.6%)

Outcomes

• %EMBIL: 71.5 ± 26.5

– Avg 47 → 31 at 5 yr

• Weight regain in 4 (3.2%)

– Pouch revision in 3

Outcomes

• Complete T2DM remission in 82%

• Mean follow-up 11.4 months

• Pre-op BMI 48.1 kg/m2 (34.5 – 73.8)

• OR time: 92.4 min (45 – 150)

• Length of stay: 2.2 days (2 – 17)

Outcomes

• No leaks

• No mortality

• Reoperation

– 1 in first 30 days

• Adhesion to terminal ileum (probably unrelated)

– 3 later

• Perforated marginal ulcer (converted to RYGB)

• Marginal ulcer (realignment of anastomosis)

• Abdominal pain (adhesiolysis, crural closure)

Complications

• Wound infection (1)

• Self-limited GI bleeding (1)

• Marginal ulcer (4)

Weight Loss

Operation LSG (339) RYGB (295) MGB (333)

Mean BMI 35 42.5 56.5

Age 23 38 46.5

Female 45.4% 71.2% 70.4%

T2DM 24.5 32.5 75.9

HTN 26.5 38.3 68.7

Dyslipidemia 23.3 36.3 60.7

Complete F/U 97 (28.6%) 143 (48.5%) 167 (50.2)

Complications

Comorbidity Resolution

Thank you