The Gastric Bypass and Fundoplication in Bariatric Surgery: the Comments on Published Papers and Our Classification of Combination Procedures.

TRIAL REGISTRATION: NCT04834635 (https://clinicaltrials.gov/ct2/show/NCT04834635).

Surgical technique of laparoscopic mini-gastric bypass with obstructive stapleless pouch creation: A case series.

BACKGROUND: Laparoscopic mini-gastric bypass (MGB) is a bariatric procedure which is gaining popularity worldwide. The original Rutledge technique is known to have good outcomes, but this and other surgical procedures that involve the use of staplers are very expensive for use in low-income countries. For this reason, the laparoscopic band-separated gastric bypass was developed. This paper aimed to describe a modified MGB technique without the use of staplers. METHODS: We present a modification of the MGB with the use of an obstructive stapleless pouch and anastomosis (MGB-Ospanov procedure). The technique is based on our experience in 32 patients who underwent the procedure involving this technique between January 2016 and December 2018. RESULTS: As in the original Rutledge version that uses staples, a long conduit is created below the crow's foot, extending up to the angle of His. The main differences between the MGB-Ospanov procedure and the stapler technique are as follows: creation of a gastric pouch from the anterior wall of the stomach; non-use of staplers; non-intersection of the stomach; use of semi-absorbable (or absorbable) strips of mesh; use of gastroplication to obstruct the communication between the gastric pouch and the bypassed greater part of the stomach. Gastrojejunostomy is performed using a hand-sewn suture at 150-200 cm distal from the ligament of Treitz. The body mass index (kg/m2) was 26.36 ±â€¯4.0 after surgery vs 41.6 ±â€¯6.1 before surgery (P < 0.0001). CONCLUSION: The MGB-Ospanov procedure with an obstructive stapleless pouch and hand-sewn anastomosis is more feasible and cheaper than the stapler technique. Not using staplers could potentially help in avoiding bleeding and leakage along the stapler line when creating a gastric pouch. However, further research is warranted to confirm these results.

Laparoscopic Band-Separated One Anastomosis Gastric Bypass.

BACKGROUND: This video demonstrates laparoscopic band-separated one anastomosis gastric bypass-combining the advantages of banding and gastric bypass without stapler and cutter use. This is basically a gastrojejunal loop bypass above an obstructive band in the upper stomach. MATERIALS AND SURGICAL TECHNIQUE: An adjustable low pressure "Medsil" gastric band was introduced in the abdomen and retracted through the retrogastric tunnel. The front wall of the stomach below the band was displaced in the upward direction through the ring band, increasing the size of the anterior portion of the stomach pouch so that a gastroenteroanastomosis could be created at this point. Gastro-gastric sutures were placed to create a gastro-gastric plication around the band and hold it in position. The band tubing was exteriorized and connected to a special port, which was secured to the abdominal wall fascia. A jejunal loop was created about 200 cm from the ligament of Treitz and anastomosed to the gastric pouch by hand using Vicryl 2/0 sutures. RESULTS: Between November 2015 and February 2016, the study was performed on 10 patients. The average operating time for all cases was 75 min (range 63-87). There was no morbidity or mortality. No complications were observed, including band erosion and band infection. Operation costs were about $2000 lower with this method than with standard gastric bypass surgery. Postop the patients lost weight by 3-4 kg per month. CONCLUSION: Preliminary results show that laparoscopic band-separated one anastomosis gastric bypass have feasibility, safety, efficacy, and reduced operating costs.