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

Obesity Surgery
Gurvinder S Jammu, Rajni Sharma

Abstract

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. The study is an analysis of a prospectively collected bariatric database of 473 MGBs, 339 LSGs, and 295 RYGBs. 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%). RYGB and MGB act on the principle of restriction and malabsorption, but MGB superseded RYGB in its technical ease, efficacy, revisibility, and reversibility.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 res...Continue Reading

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