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Evidence-Based Review of Mini-
Gastric Bypass
Brandon Williams, MD
Assistant Professor of Surgery
Vanderbilt University Medical Center
Nothing to Disclose
What’s in a Name?
• Mini gastric bypass (MGB) since 1997
– Rutledge 2001
• One-anastomosis gastric bypass (OAGB)
– Garcia-Caballero in 2004
• Single-anastomosis gastric bypass (SAGB)
– Lee 2014
• Omega loop gastric bypass (OLGB)
– Himpens 2015
Mini-Gastric Bypass
• Gastric pouch 15 ± 2.5 cm
– Level of the crow’s foot
• Gastrojejunostomy 200 (150-300) cm from ligament of Treitz
• “Larger” G-J
– 1.5 to > 3 cm
One Anastomosis Gastric Bypass
• 31 published articles prior to December 2014
– 16 single-arm case studies
– 15 comparison studies
• LAGB vs MGB (8)
• LSG vs MGB (6)
• LRYGB vs MGB (5)
Outcomes
• Operative time ≈ 50 to 90 min
• Early complications (1 – 2%)
– Bleeding, leak, wound infection
• Late complications (2 – 8%)
– Bile reflux, marginal ulcer, iron deficiency
• Low mortality rate (< 1%)
Versus LAGB Remission of T2DM
Post-op BMI
Versus LSG 1-Year %EWL
Remission of T2DM
Versus LSG
Revision Surgery Rate
Revision Surgery Rate
Versus RYGB
Operative Time
1-Year %EWL
Versus RYGB
Remission of T2DM
• Complete F/U in 126 of 175 (72%)
• Gastric tube over 32 Fr bougie
• Omentum divided
• 200 cm from ligament of Treitz
• End-to-side gastrojejunostomy
• PPIs for 6 months
Early Complications
• Reoperations in 6 (4.8%)
Late Complications
• Reoperation in 6 (4.8%)
• Iron deficiency anemia in 4 (3.2%)
• Severe malnutrion in 2 (1.6%)
Outcomes
• %EMBIL: 71.5 ± 26.5
– Avg 47 → 31 at 5 yr
• Weight regain in 4 (3.2%)
– Pouch revision in 3
Outcomes
• Complete T2DM remission in 82%
• Mean follow-up 11.4 months
• Pre-op BMI 48.1 kg/m2 (34.5 – 73.8)
• OR time: 92.4 min (45 – 150)
• Length of stay: 2.2 days (2 – 17)
Outcomes
• No leaks
• No mortality
• Reoperation
– 1 in first 30 days
• Adhesion to terminal ileum (probably unrelated)
– 3 later
• Perforated marginal ulcer (converted to RYGB)
• Marginal ulcer (realignment of anastomosis)
• Abdominal pain (adhesiolysis, crural closure)
Complications
• Wound infection (1)
• Self-limited GI bleeding (1)
• Marginal ulcer (4)
Weight Loss
Operation LSG (339) RYGB (295) MGB (333)
Mean BMI 35 42.5 56.5
Age 23 38 46.5
Female 45.4% 71.2% 70.4%
T2DM 24.5 32.5 75.9
HTN 26.5 38.3 68.7
Dyslipidemia 23.3 36.3 60.7
Complete F/U 97 (28.6%) 143 (48.5%) 167 (50.2)
Complications
Comorbidity Resolution
Thank you
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