The role of laparoscopic modified antireflux monoanastomotic gastric bypass in the treatment of morbid obesity

Abstract

Aim. Improving the results of surgical treatment for patients with morbid obesity by evaluating the effectiveness and comparing the results of bariatric operations, namely laparoscopic modified monoanastomotic gastric bypass (LMMGB) and laparoscopic standard Roux-en-Y.
Materials and methods. The work analyzed the results of treatment of 41 patients with morbid obesity. All patients were divided into two groups. LMMGB surgery was performed for 30 patients (the main group). The control group consisted of 11 patients after the standard technique of laparoscopic standard Roux-en-Y. Inclusion criteria were: persons of both sexes aged 18–60 years with morbid obesity and body mass index of 40 kg/m2 or more, as well as 35 kg/m2 or more in the presence of comorbid diseases (type 2 diabetes, hypertension, dyslipidemia, sleep apnea syndrome). Body weight of the patients ranged from 83 kg to 173 kg. The average body mass index was 42.5 kg/m2 in the main group before the operation. Violation of carbohydrate metabolism, which is included in the criteria of metabolic syndrome, was detected in 28 (93.33 %) of 30 studied patients of the main group and in 10 (90.90 %) of 11 studied patients of the control group. Comorbid pathology was found in 76.67 % of the main group and 72.72 % of the control group.
Statistical processing was carried out via the Statistica 13.0 software package using parametric and non-parametric statistical methods.
Results. There were no deaths, anastomosis failures, conversions, and intraoperative complications. The duration of LMMGB operation ranged from 120 to 290 minutes. The postoperative period was 5 days in the main group and 7 days in the control group, that is, a statistically significant reduction in the postoperative period duration was observed. In both groups, a decrease in body weight ranged from 12 kg to 81 kg within 6 months. In the main group, the median weight loss was 26.0 kg after 6 months and 38.5 kg after 12 months. BMI was 31.25 kg/m2 after 6 months, 26.88 kg/m2 after 12 months. In the control group, this indicator was 28.0 kg after 6 months and 42.0 kg after 12 months. Median BMI after 6 months – 31.64 kg/m2, after 12 months – 26.03 kg/m2, respectively. After the operation, there was a tendency towards an increase in all indicators of quality of life, both in the group of patients who underwent gastric bypass according to the classic Roux technique and in the group of patients after LMMGB. Clinical manifestations of the enterogastric biliary reflex were detected in both groups, in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. No statistically significant difference was found in these parameters.
Conclusions. Monoanastomotic gastric bypass in the modification of the clinic has the same positive properties as the standard Roux-en-Y technique, allowing to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone a mini-gastric bypass surgery need a thorough examination with fibrogastroscopy in combination with pH-impedance measurement at least once a year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stump of the stomach. The quality of life level does not significantly differ after surgery between patients of the control group and the main group based on the results of the GERG-Questionnaire indicating the effectiveness of the laparoscopic monoanastomotic gastric bypass technique modified in the clinic.