Mini-Gastric Bypass Controversy

Autor: Terry Be, Fox, Fisher Bl, Harvey J. Sugerman, Mason Ee, Henry Buchwald, MacDonald Kg, Clark W, Philip R. Schauer, Champion Jk
Rok vydání: 2001
Předmět:
Zdroj: Obesity Surgery. 11:773-773
ISSN: 1708-0428
0960-8923
DOI: 10.1381/09608920160558777
Popis: © FD-Communications Inc. Obesity Surgery, 11, 2001 773 We have seen numerous operations and innovations introduced in past years with fanfare, only to disappear after a few years, because they contributed no additional benefit for the patient, or were found to cause harm when subjected to longterm follow-up. The gastric bypass procedure has undergone development since first introduced by Mason and Ito.1 Among the changes deemed to be an improvement was the Roux-en-Y modification instead of the loop reconstruction of the gastroenterostomy. This was first advocated by Griffen et al2 in 1977; discussing gastric bypass in this article comparing gastric and jejunoileal bypass, they reported “...bilious vomiting was particularly annoying and persistent in the first seven patients and resulted in a change of technique to the Roux-en-Y reconstruction”. A study of several different means of creating the gastroenterostomy, including loop, loop with downstream enteroenterostomy, and Roux-en-Y techniques was published in 1985 by McCarthy et al3 (senior author, H. Buchwald). They performed analyses of the gastric pouch content, and also performed endoscopic biopsies to assess histologic changes following the different methods of establishing intestinal continuity. They observed gastritis in 71% of patients following loop gastric bypass, compared to 13% in patients following Roux-en-Y. They also reported bile acid concentrations of 5,092 μmol/L in gastric pouch aspirates following loop gastric bypass and only 404 μmol/L following Roux-en-Y anastomosis. They concluded that “the Roux-en-Y reconstruction may be preferable in the performance of a gastric bypass operation”.3 Although tension on the anastomosis in performing loop gastroenterostomy with concommitent leak and high mortality in the Mason loop gastric bypass may have played a roll in promoting the move to the Roux-en-Y anastomosis, the incidence of symptoms related to alkaline reflux gastritis and esophagitis significantly enhanced the adoption of Roux-en-Y by the majority of bariatric surgeons performing gastric bypass surgery. It is not surprising that the “mini-gastric bypass” results in weight loss as reported.4 It is a gastric bypass. However, Dr. Rutledge has failed to show a significant benefit to the patient which offsets the risk of alkaline gastritis and esophagitis resulting from this anatomic configuration. Furthermore, the value of conclusions based upon email follow-up falls far short when compared with the endoscopic analysis reported by McCarthy et al.3 We must not forget the dictum “primum, non nocere.” Barry L. Fisher, Las Vegas, NV; Henry Buchwald, Minneapolis, MN; Wesley Clark, San Diego, CA; J. Ken Champion, Marietta, GA; S. Ross Fox, Tacoma, WA; Kenneth G. MacDonald, Greenville, NC; Edward E. Mason, Iowa City, IA; Boyd E. Terry, Columbia, MO; Phillip R. Schauer, Pittsburg, PA; Harvey J. Sugerman, Richmond, VA
Databáze: OpenAIRE
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