title: Laparoscopic silastic ring mini-gastric bypass: a single centre experience.
abstract: BACKGROUND
  Laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to Roux-en-Y gastric bypass. The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports on the results of a consecutive cohort of patients undergoing SR-MGBP in a single centre.
  
  
  METHODS
  Short- and medium-term outcomes of 156 consecutive patients undergoing surgery between August 2005 and January 2008 were analysed. Weight loss, comorbidity resolution and morbidity/mortality were assessed.
  
  
  RESULTS
  A total of 156 patients (78% female, 22% male) with a mean (range) age of 44 years (18-63), pre-operative weight of 129 kg (83-197) and body mass index of 46 kg/m(2) (35-64) underwent surgery. Eighty-seven percent had pre-operative comorbidities, and median (range) follow-up was 35 months (6-72). Mean (SD) % excess weight loss (EWL) at 6, 12, 24, 36 and 60 months was 74.6 (19.5), 93.4 (21.1), 98.8 (27.6), 93.5 (20.1) and 89 (16.1) respectively. Thirty-seven percent had complete resolution of comorbidities and 67.3% required vitamin/mineral supplementation. Overall, 10.3% patients suffered early complications, of which 7.7% were minor and 2.6% were major. A total of 45.5% patients suffered late complications, of which 34.6% were minor and 10.9% were major. Food intolerance/vomiting, bile reflux and stomal ulcer were seen in 18.6, 10.3 and 7.7% of patients, respectively. Surgical re-intervention was required in 12.8% of patients. There were no deaths.
  
  
  CONCLUSIONS
  Whilst SR-MGBP achieves excellent EWL with low mortality, there is a high incidence of food intolerance/vomiting likely related to the silastic ring. The majority of complications were managed with pharmacological and endoscopic intervention, although 13% required reoperation within 5 years.
authors.affiliation: Department of Bariatric and Upper GI Surgery, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand, mgclarkey@doctors.org.uk.
authors.forename: M G
authors.initials: MG
authors.lastname: Clarke
authors.forename: K
authors.initials: K
authors.lastname: Wong
authors.forename: L
authors.initials: L
authors.lastname: Pearless
authors.forename: M
authors.initials: M
authors.lastname: Booth
mesh_terms: D000328:Adult; D001655:Bile Reflux / Q000209:etiology; D015992:Body Mass Index; D004129:Dimethylpolysiloxanes; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D018579:Patient Selection; D016896:Treatment Outcome; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology*; D015431:Weight Loss
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon