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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

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Abstract

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RYGB and MGB act on the principle of restriction and malabsorption, but MGB superseded RYGB in its technical ease, efficacy, revisibility, and reversibility.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.

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Acknowledgments

The authors are grateful to Mervyn Deitel, MD, FASMBS, CRCSC, FACN, for review and suggestions with the study.

Conflict of Interest

The authors declare that they have no competing interests.

Informed Consent

Informed consent was obtained from all individual patients in the study before surgery, including follow-up.

A Statement of Human and Animal Rights

All procedures performed in this study involving human participants were in accordance with the ethical standards of our institutional research committee and were indicated as part of ethical patient follow-up of operations done for the benefit of the patient, according to the 1964 Helsinki Declaration and its later amendments. Individual patients are not identifiable. There were no studies on animals performed.

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  1. Jammu Hospital, Near Sports College, Kapurthala Road, Jalandhar, Punjab, India, 144101

    Gurvinder S. Jammu & Rajni Sharma

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  1. Gurvinder S. Jammu
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Correspondence to Gurvinder S. Jammu.

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Jammu, G.S., Sharma, R. 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. OBES SURG 26, 926–932 (2016). https://doi.org/10.1007/s11695-015-1869-2

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