Mini-gastric bypass for revision of failed primary restrictive procedures: a valuable option.

BACKGROUND: Despite the initial success of primary gastric restrictive operations, many patients require revision for weight regain, mechanical complications or intolerance to restriction. The mini-gastric bypass (MGB) for revision of failed primary restrictive procedures was evaluated. METHODS: 33 patients undergoing revisional surgery to a MGB for a failed silastic ring vertical banded gastroplasty (VBG) or a gastric banding (GB) from June 2005 to September 2006, were reviewed at an academic institution. The patients had had a minilaparotomy. Revision of the VBGs was further compared with revision of the GBs. RESULTS: The MGB was completed in all except 2 patients who required Roux-en-Y gastric bypass (RYGBP) because of gastric tube damage. Mean age was 41 years (range 20-64), preoperative BMI was 39.5 kg/m2 (range 28-58), and 20 (65%) were women. The revision was performed after an average of 36.3 months (range 12-84), and was more time-consuming in patients with prior VBG than GB (184 vs 155 min, P=0.007). Postoperative complications occurred in 2 (6.4%) with prior VBG, and length of hospital stay was 4.65 days (range 3-17). Mean BMI at 6 months was 30.6 (range 24.8-50.0, P<0.001) compared with the preoperative BMI. Reflux disease was cured, and all patients noted major improvement in the eating dimension. CONCLUSION: Open MGB through a previous mini-incision is a safe and effective operation for revision of failed gastric restrictive operations. The revision procedure was technically more difficult in patients with prior VBG and hazardous in patients with prior redo VBG.

Mini-gastric bypass by mini-laparotomy: a cost-effective alternative in the laparoscopic era.

BACKGROUND: Laparoscopic mini-gastric bypass (MGB) is being increasingly performed worldwide. Results of MGB by mini-laparotomy (minilap MGB) are hereby reported. METHODS: 126 patients undergoing minilap MGB from October 2004 to October 2006, were reviewed at an academic institution. RESULTS: Mean age was 35 +/- 11.4 years (range 15-72), preoperative BMI was 44 +/- 6.9 kg/m2 (range 35-61.8) and 80 (63.4%) were women. Co-morbidities were present in 42 (33.3%). Operative time was 144 +/- 15.8 minutes (range 120-160) and length of hospital stay was 3.32 +/- 0.62 days (range 2-18). There was no hospital mortality, and the in-hospital complication rate was 4.7%. No anastomotic leakage occurred, and the incidence of wound sepsis was 2.3%. The mean total cost of the procedure was 3408 +/- 547 USD (range 2967-6876). Five patients (3.9%) developed incisional hernias and 3 (2.3%) marginal ulcers. BMI at 6 months was 33.0 +/- 3.1 kg/m2 (range 26.8-43.5, P < 0.001) compared with preoperative value. At 1 year, mean excess weight loss was 68.4% and comorbidities resolved in 85%. CONCLUSION: Minilap MGB is a simple, safe, effective and low-cost gastric bypass. It represents an attractive cost-effective alternative to laparoscopic MGB.