title: The Magenstrasse and Mill procedure can be combined with a Roux-en-Y gastric bypass to produce greater and sustained weight loss.
abstract: BACKGROUND
  The Magenstrasse and Mill operation (M&M) is effective in producing sustained weight loss and reducing obesity-related co-morbidity. It avoids the implantation of foreign material and is a more physiological procedure by maintaining normal gastric emptying. Side-effects are minimal and operative mortality is low. Satisfactory weight loss is seen at 1 year with 60% of excess weight lost. The present study compared weight loss produced by the combination of a Roux-en-Y gastric bypass (RYGBP) with the standard M&M procedure.
  
  
  METHODS
  Between 1993 and 2001, 118 patients underwent surgery for the treatment of morbid obesity. 70 patients between 1993 and 1998 underwent only a M&M vertical gastric stapling, and 48 patients from 1998 underwent the M&M combined with a RYGBP.
  
  
  RESULTS
  Median follow-up for the M&M procedure was 36 months (range 1 to 72) and for the combined M & M and RYGBP was 30 months (range 1 to 48). At all time points following surgery, patients having a RYGBP performed in addition to the standard M&M procedure demonstrated a significantly greater amount of weight lost (P<0.0001, Mann-Whitney U-test) and overall percentage of excess weight lost (P<0.0001, Mann-Whitney U-test). Both groups had a significant reduction in BMI, although this was greater in the group that underwent the combined procedure at 3 years (P<0.001, sample t-test).
  
  
  CONCLUSIONS
  A more rapid and prolonged weight loss was found when the M&M procedure was performed in combination with a RYGBP. This suggests that this combined procedure may be more beneficial when greater amounts of weight loss are needed in the super-obese.
authors.affiliation: Department of Surgery, Leeds General Infirmary, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Robinson
authors.forename: Henry
authors.initials: H
authors.lastname: Sue-Ling
authors.forename: David
authors.initials: D
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*