Magenstrasse and Mill gastroplasty and sleeve gastrectomy as treatment for morbid obesity.

BACKGROUND: Laparoscopic nonbanded restrictive procedures are becoming more popular as staging and primary operations in bariatric surgery. The Magenstrasse and Mill (MM) procedure produces a restrictive gastric tubular pouch based along the lesser curvature; for the most part anatomy and physiology are preserved. In Sleeve Gastrectomy (SG), 80% of normal stomach is resected to produce restriction and to decrease ghrelin levels. METHODS: This is a retrospective nonrandomized study evaluating the medical records of patients who had the laparoscopic MM (LMM) and laparoscopic SG (LSG) between January 2007 and October 2008. One bariatric surgeon performed the LMM and two bariatric surgeons performed the LSG. RESULTS: A total of 20 patients were identified: 13 SG and 7 MM. The mean age was 50 for the MM vs 42.9 for the SG. For the MM, the mean preoperative body mass index (BMI) was 65.4 +/- 11.1 kg/m2, with a mean excess weight of 282 +/- 73.7 kg. For the SG, the mean preoperative body mass index was 47.5 +/- 8.3 kg/m2, with a mean excess weight of 156.1 +/- 52.6 kg. The mean excess weight loss after six and 12 months for the M&M was 35 +/- 10.5% and 20.1 +/- 1.4%, vs 52.4 +/- 17.8% and 49% +/- 15.4% for the SG. Follow-up of one year was achieved in two M&M patients and three SG patients. Median follow-up of all patients was seven months (range 12-1). CONCLUSION: This is a short-term retrospective outcome study. The LMM patients were larger than LSG patients. Total weight loss was greater for the LMM patients. Operative time for the LMM is shorter. The percent excess weight loss in the short-term 12 month period was more in the LSG compared to the LMM. Long-term follow-up is needed.

Cost-effective restrictive bariatric surgery: laparoscopic vertical banded gastroplasty versus laparoscopic adjustable gastric band.

BACKGROUND: Among bariatric restrictive operations, the procedure of choice is still controversial. The aim of this study is to compare the cost of two gastric restrictive procedures: laparoscopic vertical banded gastroplasty (LVBG) and laparoscopic adjustable gastric banding (LAGB). METHODS: This is a prospective nonrandomized study comparing the cost effectiveness of LVBG and LAGB. Fifty-nine LVBG are compared to 83 LAGB performed during the same period, September 2005 and August 2006. Both groups demonstrate similar body mass index range and gender distribution. RESULTS: Cost analysis is evaluated as: preoperative, intraoperative, postoperative, follow-up, and management of complication cost. Both groups have similar preoperative and immediate postoperative cost. The material cost for LVBG is significantly lower than for LAGB ($1,326.42 for LVBG to $3,253.42 for LAGB). This material cost, however, excludes instruments and materials that are used in both procedures. Although both groups have similar postoperative routine visits, LAGB visits require band fills which increase its cost by $28 if fills are by palpation or $179 if by ultrasound. The complications in LAGB were also more severe with four patients returning to the operating room and another one medically managed for pulmonary embolism. These are at a higher cost compared to LVBG where none of the patients require reoperation or readmissions. The rate of percentage excess weight loss in LVBG patients however is more rapid than in LAGB patients. CONCLUSIONS: LVBG required less expensive instruments and materials for the operation and was associated with a higher rate of weight loss and less complications.

Post discharge prophylactic anticoagulation in gastric bypass patient-how safe?

BACKGROUND: It is becoming an increasingly common practice to discharge gastric bypass (GBP) patients on prophylactic anticoagulation. This is because pulmonary embolism (PE) is a common cause of mortality postoperatively. This study was undertaken to: (1) determine the incidence of major bleeding in GBP patients discharged on prophylactic low molecular weight heparin (LMWH)-enoxaparin and, (2) correlate the bleeding risk to the dose used. METHODS: Retrospective chart review of all open GBP operation from June 2004 to August 2005. One hundred and twenty seven patients were sent home on LMWH for 2 weeks. INDICATIONS: Body mass index (BMI) > or =50 kg/m(2) with chronic venous stasis and/or obstructive sleep apnea, previous history of PE or deep vein thrombosis (DVT) or BMI > or =60 kg/m(2). The study group was divided into two subgroups: 40 mg twice daily (bid) and 60 mg bid LMWH. Statistical analysis was done with the chi-square. The primary outcome measure was major bleeding; defined as bleeding during the period of LMWH use associated with symptomatic decrease in hematocrit (HCT), necessitating stopping LMWH administration before the end of the study period (2 weeks), bleeding-related readmission, blood transfusion, or intervention. Excluded were patients on warfarin or treated with therapeutic LMWH. RESULTS: The groups were similarly matched for age, body mass index, and risk factors. No episode of major bleeding after discharge occurred in either group. CONCLUSION: The use of low molecular weight heparin for prophylactic anticoagulation after open gastric bypass is not associated with risk of major bleeding.