Essentials of Mini ‒ One Anastomosis Gastric Bypass

371 Pages·2018·15.021 MB·English

by  Mervyn Deitel

Essentials of Mini –
One Anastomosis
Gastric Bypass
Mervyn Deitel
Editor
123
Essentials of Mini One Anastomosis
‒
Gastric Bypass
Mervyn Deitel
Editor
Essentials of Mini One
‒
Anastomosis Gastric
Bypass
Editor
Mervyn Deitel
Obesity Surgery
Toronto
Ontario
Canada
ISBN 978-3-319-76176-3 ISBN 978-3-319-76177-0 (eBook)
https://doi.org/10.1007/978-3-319-76177-0
Library of Congress Control Number: 2018939674
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Introduction
In the late 1960s, after training in GI cancer, head and neck surgery, and intensive
care in New York, I returned to Toronto where I became a surgeon at St. Joseph’s
Health Centre. I found that one of the major problems of GI surgeons was intestinal
fistula, with patients slowly dying of malnutrition. Thus, after further training in
trauma at Parkland Memorial in Dallas, I pioneered total parenteral nutrition (TPN)
in Canada. Immediately, surgeons sent their complications to me, particularly GI
fistulas, in which the patients healed without eating by the use of TPN. Accordingly,
on a trip to Montpelier, France, I met Joel Faintuch of Sao Paulo, who had surgical
nutritional interests in common with me, and we persisted in developing that field.
Because I was managing the starvation cases (which were particularly referred to
me from other hospitals on late Friday afternoons), I began to be referred the oppo-
site extreme—“morbid” obesity. These unfortunate patients, many with end-stage
obesity, suffered their own set of serious medical problems. In 1970, I began per-
forming the jejuno-ileal bypass, which had remarkable results in weight loss and
resolution of co-morbidities. However, the major problem with the JI bypass was
that it tied down the surgeon. Various complications, which could be readily treated
and resolved, were not at all understood by internists and other surgeons.
We moved on to the loop gastric bypass and various forms of horizontal and
vertical gastroplasties. Indeed, the vertical divided gastroplasty with the collar was
similar to the sleeve gastrectomy which is being performed today. I followed this by
>2500 Roux-en-Y gastric bypasses (RYGB), the later ones performed
laparoscopically.
Because of the inability of bariatric surgeons to get their papers published in this
new field, in 1991 I started and became Editor-in-Chief of a new journal published
in Oxford, England, by Rapid Communications—Obesity Surgery. The journal ini-
tially did not do well, and it came under my ownership when it was about to be
discarded. Within a few years, Obesity Surgery had an impact ranking of 17th, 12th,
7th, 6th, 6th and 6th out of 149 surgical journals, and ultimately metabolic surgery
was blossoming. Indeed, we had written papers in the early 1980s concerning the
major success of bariatric surgery in resolution of type 2 diabetes.
In 2001, I received a paper submitted by Robert Rutledge on a new and simpler
operation with very good results—the mini-gastric bypass (MGB). There was preju-
dice by the reviewers who were performing the RYGB that this simpler operation
could not have successful results. Accordingly, I was invited by Dr. Rutledge to
v
vi Introduction
work in his O.R. and pre- and post-operative clinics for 2 weeks, during which I
became convinced that this operation, because of its safety and efficacy, was not to
be discarded. Slowly, the MGB and its 2002 Spanish variant, BAGUA (one-anasto-
mosis gastric bypass) reported in 2004, were both found to be superior operations
for surgeons with open minds. I had found that when surgeons learn to do a complex
procedure well (e.g. RYGB), they are reluctant to accept a simpler effective opera-
tion. I had previously seen that with the bilateral adrenalectomy for metastatic
breast carcinoma (in which I had become a master), when that operation was no
longer required because of the development of the pill Tamoxifen.
The mini-gastric bypass and one-anastomosis gastric bypass have spread widely
and are now a most common form of bypass for bariatric surgery in India, Germany,
France, Egypt, Israel, Mexico, Argentina, Italy and many other nations. Bariatric
surgery for massive obesity and its co-morbidities has found its place. The world
experts in MGB-OAGB have collaborated on this book, in order to manage pitfalls
and contribute to this superlative surgery.
I thank my wife, Frances, and my two sons, Kevin, a spinal surgeon, and Wayne,
a radiologist, for their understanding and support.
Toronto, ON, Canada Mervyn Deitel, MD
Contents
1 A Brief History of Bariatric Surgery to the Present . . . . . . . . . . . . . . 1
Mervyn Deitel
2 Understanding the Technique of MGB: Clearing the Confusion . . . . 17
Robert Rutledge, Kuldeepak S. Kular, Sonja Chiappetta,
and N. Manchanda
3 Physiology of the MGB: How It Works for Long-Term
Weight Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Kuldeepak S. Kular, Naveen Manchanda, and Robert Rutledge
4 Ten Crucial Steps for the MGB Operation . . . . . . . . . . . . . . . . . . . . . . 39
S. Shivakumar, Om Tantia, Tamonas Chaudhuri, Shashi Khanna,
Anmol Ahuja, and Ghanshyam Goyal
5 The Ideal Length of Jejunal Limb in MGB . . . . . . . . . . . . . . . . . . . . . 51
Karl Peter Rheinwalt and Andreas Plamper
6 Perioperative Care in the MGB and Anesthetic Management . . . . . . 61
Jan Apers, Martin Dunkelgrun, Marcel de Quelerij, Serge Verbrugge,
and Ulas Biter
7 Early Complications of the MGB: Prevention and Treatment . . . . . . 75
Mario Musella and Nunzio Velotti
8 Late Complications of MGB: Prevention and Treatment . . . . . . . . . . 81
Mario Musella and Alessio Bocchetti
9 Diet, Supplements and Medications After MGB:
Nutritional Outcomes; Avoidance of Iron Deficiency;
MGB in Vegetarians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Sarfaraz Jalil Baig and Pallawi Priya
10 Patient Contraindications to Undergoing MGB . . . . . . . . . . . . . . . . 101
Rudolf Weiner
11 Understanding the Morbidly Obese Patient . . . . . . . . . . . . . . . . . . . . . 105
David E. Hargroder, Jan Snider Kent, and James R. Clopton
vii
viii Contents
12 Effects of MGB on Obesity-Related Co-Morbidities: Lipids,
Hypertension, Non-Alcoholic Fatty Liver, etc. . . . . . . . . . . . . . . . . . . . 111
Jean-Marc Chevallier
13 Effects of MGB on Type 2 Diabetes in Morbid Obesity,
and Comparison with Other Operations . . . . . . . . . . . . . . . . . . . . . . . 119
Ahmed M. Forieg
14 Effects of MGB on Type 2 Diabetes in Lower BMI Patients . . . . . . . 131
Tarek Mahdy and Waleed Gado
15 Effect of MGB on the Obese Type 1 Diabetic . . . . . . . . . . . . . . . . . . . . 139
Mervyn Deitel
16 The Question of Bile Gastro-Esophageal Reflux . . . . . . . . . . . . . . . . . 143
Nasser Sakran
17 Treatment of Marginal Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Chetan D. Parmar
18 Quality of Life After MGB Compared to Other Operations . . . . . . . 157
Mohamed M. AbouZeid, Mohamed Talaat, and Osama Taha
19 Mini-Gastric Bypass Using Single or Reduced Number of Ports . . . . 163
Mohit Bhandari and Winni Mathur
20 Robotic Mini-Gastric Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Arun Prasad
21 Absence of Gastric and Esophageal Carcinoma
After MGB-OAGB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Mervyn Deitel
22 Revision of Lap-Band to MGB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Antoine Soprani, Sergio Carandina, Imad El Kareh, Laurent Genser,
and Jean Cady
23 Comparison of Results of Mini-Gastric Bypass to Sleeve
Gastrectomy and Roux-en-Y Gastric Bypass. Technique
of Conversion of Failed Sleeve Gastrectomy to MGB . . . . . . . . . . . . . 201
Gurvinder S. Jammu
24 Anti-Reflux One-Anastomosis Gastric Bypass (OAGB)—(Spanish
BAGUA): Step-By-Step Technique, Rationale and Bowel Lengths . . 215
Miguel A. Carbajo, Enrique Luque-de-León,
Juan F. Valdez-Hashimoto, and Jaime Ruiz-Tovar
25 Results of the One-Anastomosis Gastric Bypass (OAGB):
Safety, Nutritional Considerations and Effects on Weight,
Co-Morbidities, Diabetes and Quality of Life . . . . . . . . . . . . . . . . . . . 245
Enrique Luque-de-León and Miguel A. Carbajo
Contents ix
26 Results of the OAGB in Adolescents . . . . . . . . . . . . . . . . . . . . . . . . . 273
Miguel Flores de la Torre, Raúl Vázquez Pelcastre,
Juan Francisco Valdez Hashimoto,
and Zanndor Jacob del Real Romo
27 Physical Principles Applied to the OAGB . . . . . . . . . . . . . . . . . . . . . . . 285
Omar Fonseca, Ricardo Ramos-Kelly, José Olivares, Arturo Valdez,
Efraín Ruiz, and Miguel A. Carbajo
28 Method of Revision of Sleeve Gastrectomy to OAGB . . . . . . . . . . . . . 297
José Sergio Verboonen Sotelo and Vicente Lopez Kavanagh
29 The Ileal Food Diversion Operation: Technique, Rationale
and Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Francesco Greco, Laura Pedretti, Antonio Vilardi, Giulia Deretti,
and Edoardo Matteo Rosso
30 Diverted MGB: A New Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Rui Ribeiro, Anabela Guerra, and Octávio Viveiros
31 Comparison of MGB with SADI-S: Revision of Sleeve
Gastrectomy to MGB or Single Anastomosis
Duodeno-Ileostomy (SADI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Arun Prasad
32 Single Anastomosis Gastro-Ileal Bypass (SAGI) . . . . . . . . . . . . . . . . . 351
Chetan D. Parmar
33 The MGB-OAGB International Club® . . . . . . . . . . . . . . . . . . . . . . . . . 355
Roger C. Luciani
Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
List of Editor and Contributors
Editor
Mervyn Deitel, MD, SFASMBS, FACN, CRCSC, FICS Founder and Director
MGB-OAGB Club; Editor-in-Chief Emeritus and Founding Editor Obesity Surgery;
ASMBS Founding Member (1983), Past President (1994–1995); IFSO Founding
and Honourary Life Member and 1st Executive Director; Past Professor Surgery
and Nutritional Sciences, Toronto, Canada
Contributors
Mohamed M. AbouZeid, MD, MRCS Assistant Professor, Bariatric Surgery,
Ain Shams University, Cairo, Egypt
Anmol Ahuja, DNB (Gen Surg), FMAS Fellow of National Board (Minimal
Access Surgery), Department of Minimal Access and Bariatric Surgery, ILS
Hospitals, Salt Lake City, Kolkata, West Bengal, India
Jan  Apers, MD Department of Bariatric and Metabolic Surgery, Franciscus
Gasthuis, Rotterdam, The Netherlands
Sarfaraz Jalil Baig, MS, FRCS, FIAGES, FALS Senior Consultant, Director
Digestive Surgery Clinic, Belle Vue, Kolkata, India
Mohit  Bhandari, MD Consultant Robotic, Bariatric and Metabolic Surgeon,
Founder and Director Mohak Bariatrics and Robotics, Indore, Madhya Pradesh, India
Chief Bariatric/Metabolic Surgeon, Apollo Hospital, Ahmedabad, Gujarat, India
Chief Bariatric/Metabolic Surgeon, Galaxy Hospital, Pune, India
Ulas  Biter, MD Department of Bariatric and Metabolic Surgery, Franciscus
Gasthuis, Rotterdam, The Netherlands
Alessio Bocchetti, MD Resident in General Surgery, “Federico II” University,
Naples, Italy
Jean Cady, MD Department of Digestive and Metabolic Surgery, Geoffroy Saint
Hilaire Clinic, Ramsay Générale de Santé (Ramsay GDS), Paris, France
xi