Page 28 - World Journal of Laparoscopic Surgery

Abid Ali Karatparambil, C Sidhic
on this both groups have got better outcome as far as simpler and safer procedure than LRYGBP with similar
quality of life is concerned. However, long-terms studies efficacy at the 1 and 2 year follow-up. LMGBP is thus an
are needed to evaluate this hypothesis including endo- acceptable alternative treatment to standard LRYGBP for
scopy. The other adverse effect of LMGB is occurrence morbidly obese patients.
of marginal ulcer here the incidence is more compared
to RYGB. But it can be well-controlled with proton pump REfEREnCES
inhibitors. Main reason for the occurrence is because of 1. NIH conference: gastrointestinal surgery for severe obesity.
volume of gastric tube and ulcerogenic drugs. Ann Intern Med 1991 Dec 15;115(12):959-961.
The effect on BMI and weght loss is more with LMGB 2. Wittgrove A, Clark G. Laparoscopic gastric bypass, Roux-
compared to RYGB this is mainly because of long bypass en-Y: 500 patients: technique and results, with 3-60 month
limb of bowel. That will add nutritional deficiency also follow-up. Obes Surg 2000 June;10(3):233-239.
like folate, iron and vitamin B . But in both group, iron 3. Higa K, Boone K, Ho T, et al. Laparoscopic Roux-en-Y gastric
bypass for morbid obesity. Arch Surg 2000 Sep;135(9):1029-1034.
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deficiency anemia was only detected. 16-18 But the effect of 4. Schauer P, Ikranuddin S, Gourash W, et al. Outcomes after
micronutrient deficiency and bone disease needs regular laparoscopic gastric bypass for morbid obesity. Ann Surg
follow-up and a long-term study. LRYGBP is very effec- 2000 Oct;232(4):515-529.
tive in weight reduction and resolution of the metabolic 5. Westling A, Gustavsson S. Laparoscopic vs open Roux-en-Y
syndrome for morbidly obese patients. Tailoring of the gastric bypass: a prospective, randomized trial. Obes Surg
2001 June;11(3):284-292.
bypass limb in LMGBP according to the BMI may allow 6. Reddy RM, Riker A, Marra D, et al. Open Roux-en-Y gastric
the need for weight reduction to be balanced against bypass for the morbidly obese in the era of laparoscopy. Am
the need to minimize the risk of resulting micronutri- J Surg 2002 Dec;184(6):611-616.
ent deficiencies. The results suggest that use a bypass 7. Rutledge R. The mini-gastric bypass: experience with the
limb of 150 cm in those with BMI below 40, with a 10 first 1272 cases. Obes Surg 2001 June;11(3):276-280.
cm increase in the bypass limb with the every BMI 8. Fisher BL, Buchwald H, Clark W, et al. Mini-gastric bypass
controversy (Letter). Obes Surg 2001 Dec;11(6):773-777.
category related to obesity instead of using a fixed 9. Lomanto D, Wei-Jei L, Goel R, Jen-Mai LJ, et al. Bariatric sur-
200 cm limb for all patients may provide better results. gery in Asia in the last 5 years (2005-2009). Obesity Surgery
In one of the trial 56% of patients had metabolic syn - 2012 Mar;22(3):502-506.
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d rome and 100% were cured at 1 year after gastric bypass. 10. Expert panel on detection, evaluation, and treatment of high
Obesity surgery should therefore be recommended as the blood cholesterol in adults. Executive summary of the third
definitive treatment of morbidly obese patients with meta- report of the National Cholesterol Education Program (NCEP)
expert panel of detection, evaluation, and treatment of high
bolic syndrome. Recent advances in laparoscopic surgery blood cholesterol in adults (Adult Treatment Panel III). JAMA
have made laparoscopic bariatric surgery a minimally 2001 May;285(19):2486-2497.
invasive procedure and have generated renewed interest 11. Espasch E, Williams JL, Wood-Dauphinee S, et al. Gastrointes-
in obesity surgery. The results of this study indicated that tinal quality of life index: development validation and appli-
LMGBP has a better safety profile that LRYGBP and thus cation of new instrument. Br J Surg 1995 Feb;82(2):216-222.
is the preferred gastric bypass treatment of patients with 12. Wei-Jei L, Po-Jui Y, RN, Wang W, Tai-Chi C, Po-Li W, Ming-
Te H. Laparoscopic Roux-en-Y vs mini-gastric bypass for
metabolic syndrome. Current indications for surgery in the treatment of morbid obesity: a prospective randomized
morbidly obese patients include BMI greater than 40 or controlled clinical trial. Ann Surg 2005 July;242(1):20-28.
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greater than 35 if comorbidities are present. However, 13. Welvart K, Warnsinck H. The incidence of carcinoma of the
for patients with moderate obesity (BMI between 30 and gastric remnant. J Surg Oncol 1982 Oct;21(2):104-106.
35) but complicated with metabolic syndrome, the low 14. Schafer LW, Larson DE, Melton LJ III, et al. The risk of gastric
risk of laparoscopic gastric bypass surgery suggests that carcinoma after surgical treatment for benign ulcer disease:
a population-based study in Olmsted County, Minnesota.
it might be included in the choices of treatments. Further N Eng J Med 1983 Nov;309(20):1210-1213.
cost-effectiveness study of laparoscopic gastric bypass 15. Hasson LE, Nyren O, Hsing AW, et al. The risk of stomach
surgery in the treatment of moderate obesity with meta- cancer in patients with gastric and duodenal ulcer disease.
bolic syndrome is needed. N Engl J Med 1996 July;335(4):242-249.
16. Brolin RE, Kenler HA, Gorman JH, et al. Long-limb gastric
bypass in the superobese: a prospective randomized study.
COnCLuSIOn
Ann Surg 1992 Apr;215(4):387-395.
This review article has demonstrated that both LRYGBP 17. Pories WJ, Swanson MS, MacDonld KG, et al. Who whould
and LMGBP are effective treatments for morbid obesity. have thought it? An operation proves to be the most effective
Both procedures can significantly resolve obesity-related therapy for adult-onset diabetes mellitus. Ann Surg 1995
Sep;222(3): 339-350.
metabolic complications and increase quality of life for 18. MacLean LD, Rhode BM, Nohr CW. Late outcome of isolated
morbidly obese patients. LMGBP was shown to be a gastric bypass. Ann Surg 2000 Apr;231(4):524-528.

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