TITLE:
The Long Magenstrasse in the Treatment of Super Obese Patients (Results over 5 Years after Surgery)
AUTHORS:
Giovanni Berbiglia, Mario Martinotti, Gian Matteo Carena, Elena Palamarciuc, Marina Fariseo, Carlo Vassallo
KEYWORDS:
Super Obesity; Bariatric Surgery; Magenstrasse and Mill; Sleeve Gastrectomy; Gastric Partition; Gastric Bypass
JOURNAL NAME:
Surgical Science,
Vol.4 No.10,
October
30,
2013
ABSTRACT: Background: The considerable increase in
Obesity and especially the increase in super obese patients (Body Mass Index—BMI
≥ 50 Kg/m2) who require surgery lead doctors to search for surgery
techniques which give good results in terms of a consistent and stable weight
loss associated with low morbidity and good quality of life. The Long Magenstrasse (LM)
intervention, born from combining two properly modified surgical procedures
(Selective Vagotomy with pyloric divulsion and Mangestrasse & Mill by
Johnston) seems to have these characteristics according to our experience after
operating on 660 patients. Methods: From October 2003 to October 2008 we treated 186 patients with LM. One hundred and sixty-two
patients were regularly present to the annual follow-up, but 24 patients didn’t
turn up, therefore, they were contacted by phone. On average, surgery lasted
approximately 80 minutes (range: 50 - 90 minutes). Thirty patients were super obese
with an average BMI of 57.4 Kg/m2; 156 patients were grade II and
III obese with an average BMI of 40.7 Kg/m2. Results: The average BMI of the 30 super obese patients decreased
from 57.4 Kg/m2 to 35.9 Kg/m2 one year after surgery, to
35.6, 5 years after surgery and it has remained stable until now. In the 156
patients suffering from II and III grade obesity, the average BMI decreased
from 40.7 Kg/m2 to 27.8 Kg/m2 one year after surgery and
it has remained stable until now. Out of all super obese diabetic patients, only one has partially
maintained his/her therapy. Patients have reported a decreased appetite since the very first days of
post-operative period with an early sense of satiety which is unchanged until
today. Conclusions: A consistent and stable weight loss over 5
years after surgery even in Super Obese patients, a decrease in appetite with
an early sense of satiety, a re-equilibrium of the metabolic syndrome in
particular of Diabetes Mellitus, allow to classify LM among those surgical
treatments with a mixed mechanism of action: both restrictive and functional,
in particular, entero-hormonal and gastric neurosecretory.