A 7-Year Clinical Audit of 1107 Cases Comparing Sleeve Gastrectomy, Roux-En-Y Gastric Bypass, and Mini-Gastric Bypass, to Determine an Effective and Safe Bariatric and Metabolic Procedure.
BACKGROUND
The epidemic of obesity is engulfing developed as well as developing countries like India. We present our 7-year experience with laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) to determine an effective and safe bariatric and metabolic procedure.


METHODS
The study is an analysis of a prospectively collected bariatric database of 473 MGBs, 339 LSGs, and 295 RYGBs.


RESULTS
Mortality rate was 2.1% in LSG, 0.3% in RYGB, and 0% in MGB. Leaks were highest in LSG (1.5%), followed by RYGB (0.3%), and zero in MGB. Bile reflux was seen in <1% in the MGB series. Persistent vomiting was seen only in LSG. Weight regain was 14.2% in LSG, 8.5% in RYGB, but 0% in MGB. Hypoalbuminemia was minimal in LSG, 2.0% in RYGB, and 13.1% in MGB (in earlier patients where bypass was >250 cm). The following resolution of comorbidities: dyslipidemia, type 2 diabetes (T2D), hypertension, and percent excess weight loss (%EWL) was maximum in MGB. GERD was maximum in LSG (9.8%), followed by RYGB (1.7%), and minimal in MGB (0.6%).


CONCLUSIONS
RYGB and MGB act on the principle of restriction and malabsorption, but MGB superseded RYGB in its technical ease, efficacy, revisibility, and reversibility. Mortality was zero in MGB. %EWL and resolution of comorbidities were highly significant in MGB. Based on this audit, we suggest that MGB is the effective and safe procedure for patients who are compliant in taking their supplements. LSG may be done in non-compliant patients and those ready to accept weight regain.
Jammu Hospital, Near Sports College, Kapurthala Road, Jalandhar, Punjab, India, 144101. drgsjammu@gmail.com.
Gurvinder S
GS
Jammu
Jammu Hospital, Near Sports College, Kapurthala Road, Jalandhar, Punjab, India, 144101.
Rajni
R
Sharma
D000328:Adult; D001655:Bile Reflux / Q000209:etiology; D054869:Clinical Audit; D016208:Databases, Factual; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
Laparoscopic; Laparoscopic sleeve gastrectomy (LSG); Mini-gastric bypass (MGB); One-anastomosis gastric bypass; Percent excess weight loss (%EWL); Roux-en-Y gastric bypass (RYGB); Type 2 diabetes (T2D)