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Conference report

Report: 1st Annual Conference of the MGB-OAGB Club

Over the two-day conference, talks, panel discussions and videos on technique and care were presented. It is now common for the LSG to be revised to a MGB

This article was authored by Drs Mervyn Deitel and Kuldeepak S Kular

The Mini-Gastric Bypass – One Anastomosis Gastric Bypass Club (Figures 1 and 2) was formed in August 2015 at the IFSO Vienna Congress. The First Annual MGB-OAGB Scientific Conference, held at London Gatwick-Sofritel Auguust 19–20 2016, was attended by 135 expert MGB-OAGB surgeons (many who had performed >1,000 of these operations) from 31 countries.

Drs Mervyn Deitel and Kuldeepak S Kular

This bariatric operation is rapid, very safe, has a short learning curve, and is very effective for resolving co-morbidities, is associated with durable weight loss, and is easily revised if necessary.

Figure 1: Mini gastric bypass

The MGB was started by Robert Rutledge in USA in 1997, and the OAGB by Miguel Carbajo and the late Manuel Garcia Caballero in Spain in 2002 as the anti-reflux variant BAGUA (bypass gastrico de una anastomosis). The MGB-OAGB has become the third most common bariatric operation, and is the most common bypass in India, Israel, Egypt and other countries. Over the two-day conference, talks, panel discussions and videos on technique and care were presented. It is now common for the sleeve gastrectomy (LSG) to be revised to a MGB.

Figure 2: One Anastomosis Gastric Bypass (The permission for the republication of this image was kindly provided by Arturo Valdes Alvarez

Many surgeons reported that they tailor the length of the bypass on the basis of age, diet, super-obesity and co-morbidities and with nutritional surveiilance. According to a large multi-centre Italian study, mortality has been 0.07 %, 5.6% morbidity, 0.9% re-operation in the post-operative period. Comparative studies showed that the MGB-OAGB provides the greatest resolution of T2D, from 85-95% of diabetics.  Resolution of diabetes with BMI <35 and C-peptide >3 was between 95 and 100%. Compared to the LSG, weight loss and resolution of co-morbidities were superior with the MGB, and also better in comparative studies than the RYGB.

Only one case of carcinoma has been reported after MGB-OAGB, and occurred 9 years post-op in the bypassed stomach (not in the pouch or esophagus) in Taiwan, where carcinoma of the stomach remains prevalent.

In a report of bile reflux scintography, no esophageal bile reflux was observed after MGB. Miguel Carbajo reported that when comparing OAGB with RYGB, LSG and gastric banding with 6 years data from the IFSO European Accreditation Council for Bariatric Surgery, found the greatest efficacy for OAGB with a safe profile. Patients who had undergone LSG had much greater GERD symptoms compared with patients who have had MGB or OAGB. MGB was shown to be highly successful when performed after failure of LSG for weight regain or GERD, due to its much lower pouch pressure with the wide gastrojejunostomy.  Also, in a study of the super-obese, MGB showed significantly better weight loss than the RYGB. The technique using robotics has undisputed technical benefits.

The President of the Club, who had done very extensive work for this conference was Kuldeepak Kular with Director Mervyn Deitel, Honorary President Robert Rutledge, Vice President Mario Musella (who becomes President 1 January 2017), Second Vice President Miguel Carbajo, Treasurer Chetan Parmer, efficient Local Arrangements Peter Small, and Honorary Advisor Pradeep Chowbey. The MGB-OAGB Club now has 299 members.

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