Long-Term Outcomes and Consequences of Distal Gastric Bypass (D-GB) In Severe Clinical Obesity

Sugerman et.al.-Surgery, Virginia Commonwealth University, Richmond, VA

This study was conducted to measure longterm weight loss and metabolic results in Distal Gastric Bypass (D-GB) patients within a 24 year time span. Through a bariatric database and office visits statistics were inquired about a 3 year cliental list of 40 super – obese and 6 morbidly obese cases that had the D-GB done with the Roux-En-Y bypass. Preoperative BMI in patients was 59 kg/m2 (80% being women) and the average age was around 36 years old. In addition, approximately 40% of the patients required limb-lengthening revision as a result of protein-calorie malnutrition, and thirteen patients required another surgery. Unfortunately, six to nineteen years later after the D-GB surgery was performed, eight patients died. As a followup, patients who did not have revision surgery showed some weight loss, resulting in a BMI of 34 kg/m2 and an initial excess weight loss of 67%. Patients did have beneficial results in terms of weight loss; however, the protein-calorie malnutrition was too high and some patients’ levels of iron and vitamin D dropped. Distal-GB isn’t the best primary operation for morbid or super obese patients.

Editorial: There has been a resurgence of the distal gastric bypass as a salvage operation for failed proximal gastric bypass operation. The distal gastric bypass operation is a tested procedure, with is known complication rates. The number of distal procedures had gone down significantly, till recently when some centers and surgeons started offering is a revision to other restrictive procedures. It is my opinion that the distal gastric bypass has significant metabolic and nutritional sequel that do not justify its superior weight loss. It is also important to remember that distal gastric bypass is not the same as the duodenal switch or the BPD operation.
Ara Keshishian, MD

Short Term Outcomes Comparing Roux-En-Y Gastric Bypass vs. Sleeve Gastrectomy as Treatment for Failed or Complicated Gastric Banding

Lieb et.al. Cleveland Clinic Florida, Weston, FL

Laparoscopic adjustable gastric band (LAGB) is a commonly performed bariatric operation; however, when major problems take place or weight loss disappoints a revision surgery may take place; Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) and Laparoscopic Sleeve Gastrectomy (LSG) are the most popular options. This study was conducted to compare the efficiency of LRYGB and LSG from 2003 until 2008 analyzing weight loss in terms of the body mass index (BMI). A total of 25 conversions were performed, 13 from LAGB to LRYGB (patients losing 10 BMI points) and 12 from LAGB to LSG (8 points lost in BMI). Hence, after a year the LAGB to LRYGB portrayed more weight loss in comparison to the LAGB to LSG.

Editorial: A common patient presented to our office is a gastric bypass or a lap band that has had less than desirable weight loss. More so, some patients are presenting with complications, such as dumping syndrome, weight regain, nutritional deficiencies, slipped band, dilation of the esophagus and other. There are solutions that are being offered, and most are nothing more than a band aid. I believe that the best reversional operation for failed gastric bypass and the adjustable gastric banding is the duodenal switch operation. This issue was discussed at length last in July 2009 newsletter.
Ara Keshishian, MD