title: The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review.
abstract: BACKGROUND
  Due to the failure of the "old Mason loop," the mini-gastric bypass (MGB) has been viewed with skepticism. During the past 12 years, a growing number of authors from around the world have continued to report excellent short- and long-term results with MGB.
  
  
  METHODS
  One university center, three regional hospitals, and two private hospitals participated in this study. From July 2006 to December 2012, 475 men (48.8 %) and 499 women (51.2 %) underwent 974 laparoscopic MGBs. The mean age of these patients was 39.4, and their preoperative body mass index was 48 ± 4.58 kg/m(2). Type 2 diabetes mellitus (T2DM) affected 224 (22.9 %) of the 974 patients, whereas 291 of the 974 patients (29.8 %) presented with hypertension. The preoperative gastrointestinal status was explored in all the patients through esophagogastroduodenoscopia. The major end points of the study were definitions of both MGB safety and efficacy in the long term as well as the endoscopic changes in symptomatic patients eventually produced by surgery.
  
  
  RESULTS
  The rate of conversion to open surgery was 1.2 % (12/974), and the mortality rate was 0.2 % (2/974). The perioperative morbidity rate was 5.5 % (54/974), with 20 (2 %) of the 974 patients requiring an early surgical revision. The mean hospital length of stay was 4.0 ± 1.7 days. At this writing, 818 patients are being followed up. Late complications have affected 74 (9 %) of the 818 patients. The majority of these complications (66/74, 89.1 %) have occurred within 1 year after surgery. Bile reflux gastritis was symptomatic, with endoscopic findings reported for 8 (0.9 %) and acid peptic ulcers for 14 (1.7 %) of the 818 patients. A late revision surgery was required for 7 (0.8 %) of the 818 patients. No patient required revision surgery due to biliary gastritis. At 60 months, the percentage of excess weight loss was 77 ± 5.1 %, the T2DM remission was 84.4 %, and the resolution of hypertension was 87.5 %.
  
  
  CONCLUSIONS
  Despite initial skepticism, this study, together with many other large-scale, long-term similar studies from around the world (e.g., Taiwan, United States, France, Spain, India, Lebanon) demonstrated the MGB to be a short, simple, low-risk, effective, and durable bariatric procedure.
authors: Advanced Biomedical Sciences Department, General Surgery, "Federico II" University, Via S. Pansini, 5 Building 12, 80131, Naples, Italy, mario.musella@unina.it.
authors: M
authors: M
authors: Musella
authors: A
authors: A
authors: Susa
authors: F
authors: F
authors: Greco
authors: M
authors: M
authors: De Luca
authors: E
authors: E
authors: Manno
authors: C
authors: C
authors: Di Stefano
authors: M
authors: M
authors: Milone
authors: R
authors: R
authors: Bonfanti
authors: G
authors: G
authors: Segato
authors: A
authors: A
authors: Antonino
authors: L
authors: L
authors: Piazza
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D061887:Conversion to Open Surgery; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007558:Italy; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss
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