RESUMO
BACKGROUND: Our strategy for performing various types of bariatric operations in order to make them suitable for the individual morbidly obese patient, has led us to take into account the original Magenstrasse and Mill (M&M) operation and modify it. This resulted in the so-called Super-Magenstrasse and Mill with pyloroplasty (SM&M-P). METHODS: In the past 3 years, 34 patients with mean BMI 48 and mean age 43 years underwent the SM&MP operation for morbid obesity. A digitoclasic pyloroplasty was performed and a 36-Fr bougie was used to calibrate the Magenstrasse. A 21-mm circular stapler was used to create a gastric window 10 cm proximal to the pylorus. The stapled division of the stomach to 3-4 cm from the pylorus and to the angle of His was performed first distally via the gastric window and then proximally from the window. RESULTS: 2 patients have reached 3 years since the operation: one could not be assessed due to the development of rectal cancer 1 year after surgery, and the other one has had an excellent outcome with 3-year BMI 26 kg/m2. 8 patients who underwent the surgery 2 years ago have a mean percent excess BMI loss (%EBL) of 69, and 19 patients who have reached 1 year have %EBL 64. All patients have experienced a clear reduction of appetite, with vomiting absent or rare. CONCLUSIONS: The SM&M-P procedure confers to this restrictive intervention some characteristics similar to gastric bypass, including rapid transit of the alimentary contents in the prepyloric "mill", scarse reflux into the gastric fundus, possible entero-endocrine effects and loss of interest in food.
