Page 27 - World Journal of Laparoscopic Surgery

WJOLS

A Review of Comparing Laparoscopic Roux-en-Y vs Minigastric bypass for the Morbid Obesity
placed low on the stomach, but can be a disaster when dISCuSSIOn
placed adjacent to the esophagus. Today thousands of Although a growing number of adjustable gastric band-
‘loops’ are used for surgical procedures to treat gastric ing operations have been reported NIH approved bariatric
problems, such as ulcers, stomach cancer, and injury to surgical operations are currently only VBG and Roux-en-Y
the stomach. The minigastric bypass uses the low set loop gastric bypass. RYGBP is considered as the gold standard
reconstruction and thus has rare chances of bile reflux. surgery in us as the weight reduction is more with this
The MGB has been suggested as an alternative to the than VBG. As per the 1999 survey, RYGB is considered
Roux-en-Y procedure due to the simplicity of its construc- as the most commonly performed bariatric surgery. As
tion, which reduces the challenges of bariatric surgery. the perioperative complications are high this techniques
The surgery is becoming more and more popular because needs more experience. The reported major compli -
of low risk of complications and good sustained weight cation rate of LRYGBP varied from 3.3 to 15%, and the late
loss. It has been estimated that 15.4% of weight loss sur- complication rate from 2.2 to 27% conversion rate from
gery in Asia is now performed via the MGB technique. 9
0.8 to 11.8%. Leakage ranged from 1.5 to 5.8% and is one
12
RESuLTS of the most common complication.
Technical difficulty of RYGB is mainly due to high
Preoperative Parameters anastomosis near gastroesophageal junction. Earlier
As far as the preoperative parameters like age, sex, BMI, retrocolic approach was used that itself added the tech-
10
metabolic syndromes (as defined by ATPIII criteria) nical difficulty.But some surgeons now prefer antecolic
concerned no specific advantage of one procedure over approach with bivalving of the omentum to reduce
other or both are equally effective in all the groups. tension on mesentery.Theoretically, LMGB is low ante-
colic and one less anastomosis makes it more easier
Operation Time compared to RYGB and provides better blood supply
thereby reducing the chance of leakage. The technical
As far as LMGB is considered operation time, postopera-
tive stay, analgesic used are minimal compared to LRYGB. difficulty and postoperative complications in terms of
Conversion rate is also nil in case of LMGB. But the opera- leakage, hospital stay, pain and time taken are more for
tive blood loss and passage of flatus both are comparable. RYGB compared to LMGB. Operative time for RYGB is
No mortality detected in both the procedures. 27.8% more than LMGB even though five port technique
is used for both more dissection and anastomosis make
Operative Morbidities its more time consuming procedure.
All most all the studies are of shorter postoperative
Postoperative major complication in terms of anastomotic follow-up and the postoperative criteria for discharge is
leak and minor complication like wound infection, GI also standardized in order to avoid bias. None of the stu-
blee ding, ileus, is more with LRYGB. There is also mini- dies included extremely obese patient that is BMI more
mal increase in reoperation rate with LRYGB. But with than 60 in order to avoid technical difficulty.
LMGB major complication are nil but minor leakage is Studies have shown that major and minor complications
there but less chance compared to LRYGB. are less for LMGB compared to RYGB and in the range of

follow-up 0 and 7.5% comparing with 5 and 15%. But one of the
limiting factor may be the learning curve. Because RYGB
As far as the BMI, weight loss, morbidities related to learning curve is very steep. Hence, the incidence may
obesity are concerned all were improved with surgery vary in highly specialized centers. The major complication
without a significant difference between two except for of LMGB is mainly anastomotic bleeding because of high
the weight loss its more for LMGB in the first year after blood supply to stomach tube some time makes reoperation.
that both are same. As per Reinholds classification excess Hence, it is advisable to check the anastomotic line after
weight loss is more for patient in LMGB. clipping and if needed seromuscular sutures can be put.
One of the drawback of LMGB is bile reflux gastritis
Quality of Life Assessment
and the carcinogenic effect which is still controversial. 13-15
There were significant improvement in the domains of High incidence of biliary gastritis is mainly because of
gene ral life including physical, social and emotional Roux-en-Y loop anastomosis but it is technically lower
functions equally in both the groups. But there were GI in LMGB because of its low anastomosis. But for all this
symptoms like belching, gurgling sound in the abdomen, needs long-term follow-up with endoscopy but most
distension are same in both the groups in spite of great of the studies are of short-term and endoscopy has not
improvement in eating and relief of acid peptic disorder. adviced in regular follow-up. Most of the results are based
These are assessed by gastrointestinal quality of life index. 11 on the gastrointestinal quality of life assessment. Based
World Journal of Laparoscopic Surgery, September-December 2014;7(3):125-128 127