Mini-gastric bypass in a patient homozygous for Factor V Leiden

Laparoscopic mini-gastric bypass in patients age 60 and older

BACKGROUND

Bariatric surgery in patients over age 60 was previously not considered, due to higher risk. The author presents a study of patients ≥60 years who underwent laparoscopic mini-gastric bypass (LMGB), to evaluate outcomes with follow-up to 6 years.

METHODS

From 2007-2013, a prospectively maintained database was reviewed and patients ≥60 years were identified. Demographics evaluated included age, sex, weight, BMI, comorbidities, operative time, complications, length of stay (LOS) and %EWL up to 72 months.

RESULTS

From 2007-2013, a total of 758 LMGBs were performed by one surgeon (CP). Eighty-eight (12%) were ≥60 years old, with 62% female. Mean age of this cohort at operation was 64 (60-74), and mean weight and BMI were 118 kg (78-171) and 43 kg/m(2) (33-61), respectively. Comorbidities were present in all patients, and one-third had previous abdominal operations. All patients underwent LMGB, without conversion to open. Mean operative time was 70 min (43-173). Only one patient required overnight ICU admission. Average LOS was 1.2 days (1-3). Overall complication rate was 4.5% (all minor); there were no major complications. Readmission rate was 1.2% (one patient). There was no surgical-related mortality. Follow-up to 90 days was 89%, but steadily declined to 42% at 6 years (72 months). The %EWL was 72% at 72 months.

CONCLUSION

LMGB can be safely performed with good weight loss in patients ≥60 years old, despite numerous comorbidities and previous abdominal operations.

Laparoscopic mini-gastric bypass (LMGB) in the super-super obese: outcomes in 16 patients

BACKGROUND

The ideal management of the super-super obese patient (SSO) is unclear and controversy exists as to the choice of procedure as well as the risk for increased morbidity and mortality. I present my experience of laparoscopic mini-gastric bypass (LMGB) in 16 SSO patients with early follow-up results.

METHODS

Review of a prospectively maintained database was performed. All the patients underwent LMGB by a single surgeon (CP). Data collected included demographics, operative time, length of stay, complications, and weight loss. Follow-up data was obtained at office visits in addition to periodic telephone interviews and e-mails. All office follow-up and review of correspondence from Primary Care Physicians (PCP) was managed by the operating surgeon.

RESULTS

Sixteen patients were identified as being SSO and comprise the study group. There were 14 women and two men. Average age was 40 years (27-61). Average weight and BMI were 166 (150-193) and 62.4 (60-73), respectively. All procedures were performed laparoscopically by a single surgeon with no conversion to open. Average operative time was 78 min (41-147 min) and hospital stay was 1.2 days. Intraoperative complications included a liver laceration in one patient and an enterotomy in another. Both were managed laparoscopically. No patients required readmission to the hospital, and there were no major complications or deaths. Weight loss showed a consistent increase over the follow-up period with 2 year results of 72 KG lost or 65% EWL.

CONCLUSION

Laparoscopic mini-gastric bypass (MGB) is a technically simple and safe procedure in SSO patients. LMGB has the advantages of being a single stage procedure, being easily reversible and revisable in a laparoscopic procedure and does not sacrifice portions of the stomach or implant foreign materials. Weight loss appears favorable in the short term; however, information regarding long-term weight loss, durability, and safety profile in this population will require a greater number of patients and longer follow up.