Mini-gastric bypass versus single-anastomosis sleeve ileal bypass as revisional surgery after laparoscopic sleeve gastrectomy for gastroesophageal reflux disease management

Introduction
Bariatric surgeries are currently the only effective treatment for morbid obesity and its associated comorbidities, including type-2 diabetes mellitus, hypertension, and dyslipidemia. Laparoscopic sleeve gastrectomy (LSG) is nowadays the most performed bariatric procedure accounting for 46% of all bariatric procedures, according to 2018 IFSO global registry report. However, gastroesophageal reflux disease (GERD) remained a common complication of LSG. Studies had showed the effect of mini-gastric bypass (MGB) or single-anastomosis sleeve ileal bypass (SASI) on GERD either as primary procedures of revisional surgeries. Our study aims to compare MGB with SASI as revisional surgeries after LSG for GERD management.
Patients and methods
A prospective cohort study for patients undergoing revision surgery, MGB, or SASI, after LSG at Bariatric Surgery Department at Ain Shams University Hospital, is done. We included all patients above 18 years old, and we excluded those who were below 18 years or over 60, had previous bariatric surgery other than LSG, had previous gastrointestinal surgery, psychiatric contraindications, pregnancy, and other medical conditions for denying laparoscopy. Patients were followed 1 year later at clinics.
Results
A total of 50 patients, 25 MGB versus 25 SASI, were included in our study. No significant difference is detected between both groups regarding the resolution of GERD symptoms, 64% had complete resolution in MGB versus 56% had complete resolution in SASI. After 12 months of follow-up, no significant difference is detected between MGB and SASI in postoperative BMI with value of 0.45. MGB and SASI procedures had significantly reduced BMI in each group during 12 months of follow-up, value of 0.0001.
Conclusion
Our study shows that both MGB and SASI are equally effective in BMI loss after 1 year of follow-up and that both procedures result in remission of GERD symptoms comparably with slight improvement in GERD symptoms after MGB than SASI. We recommend large multicenter RCTs to compare MGB with SASI with long-term follow-up period.