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MGB-OAGB meeting

Report from 5th Annual MGB – OAGB Conference

The next Conference of the MGB-OAGB Society will be in Hamburg, 20-21 June 2018

Under the Chairmanship of Professor Miguel A Carbajo, the 5th Annual MGB – OAGB Conference, Valladolid, Spain, June 28-29, 2018, had 231 attendees from 35 countries – 35% from Latin America, 34% from Europe and 24% from the Middle East and India.

Figure 1:MGB

The MGB was started by Rutledge in USA in 1997 and has become a common operation. It consists of a long conduit (Figure 1) starting below the crow’s foot (which inhibits reflux), and is stapler-divided proximally to the left of the angle of His, followed by an antecolic wide gastro-jejunostomy 180- 200 cm distal to Treitz’ ligament. The channel is non-restrictive. There had been controversy by those experienced in other operations, who suspected bile reflux. However, Tolone and Mion found that the MGB is a low-pressure tube (unlike the sleeve gastrectomy which has high pressure and reflux).

Figure 2: OAGB

The OAGB modification (BAGUA –Bypass Gastrico de Una Anastomosis) was initiated by Carbajo in Spain in 2002. The OAGB (Figure 2) involves: 1. complete measurement of the entire small bowel; 2. dissection of the angle of His; 3. creation of an ‘anti-reflux mechanism’ by a 8–10cm latero-lateral 2.5cm gastro-ileal anastomosis. The OAGB minimises the possibility of reflux. Dr Carbajo reported 3,100 OAGBs performed at his center; perioperative and long-term complications were <3% and 1% respectively. The OAGB has spread widely in Spain and Latin America.

The MGB and OAGB malabsorb fatty foods. They were shown to be simple, relatively safe, have greater resolution of co-morbidities, greater elevation of GLP-1, with generally enduring weight loss, resolve GERD, and improve quality of life. Comparative studies showed superiority of MGB-OAGB over sleeve gastrectomy and RYGB.

This article was authored by Mervyn Deitel (left), Director MGB-OAGB Society and Enrique Luque-de-Leon (right), Scientific Chairman

Bypass length is modifiable with BMI. MGB-OAGB has become the third most common bariatric (and the most common in India, Egypt, Israel, Germany, Mexico, Argentina, the Middle East, Khazakstan and Pakistan). About 800 Canadians of Punjabi descent have undergone MGB in India. Most MGB-OAGB surgeons had previously performed the RYGB.

Dr Weiner’s group found that perioperative morbidity decreased significantly since they adopted the MGB in 2015.

Dr Abass from UAE showed the prevention of anemia by taking iron – most use readily-absorbed Proferrin from the lining of bovine intestine. Chevallier reported excellent results with MGB in 1,585 patients over 10 years.

Rutledge and Kular showed that in 1,142 patients with type 2 diabetes (T2D) with mean follow-up 7.5 years, 95.3% were free of T2D. Mean preoperative HbA1c was 7.5 and postoperative 5.6, with a pharmacy saving of >10 million dollars. Jammu had similar findings.

Cady and co-workers in patients with T2D with lesser overweight showed remarkable resolution of T2D with a bypass length of only 100 cm. Mahdy also showed the superior efficacy in T2D; UAE ranks as the 5th fattest nation in the world, with T2D in 20%; with MGB-OAGB, the resolution of T2D was achieved in 98.5%. Da Silva of Brazil also found remarkable results of insulin-treated T2D 18 years after MGB.

Figure 3

Bhandari of India likewise reported higher remission of T2D and other co-morbidities after MGB than after SG and RYGB. Tovar of Spain found that OAGB achieved superior mid- and long-term weight loss than SG and RYGB and better remission of T2D and hypertension. The sleeve gastrectomy suffers high leaks, reflux (Barrett’s), and weight regain. The RYGB takes longer to perform, is more complex, has a longer learning curve, develops internal hernias and bowel obstruction, more marginal ulcers, has more hypoglycemia, and late weight regain.

A comprehensive textbook - Essentials of Mini – One Anastomosis Gastric Bypass (Figure 3) - by 154 expert authors has been published by MGB-OAGB International Society. This is a complete, well-illustrated textbook with 33 chapters by 154 expert surgeons, covering all aspects, including revision of sleeve gastrectomy and other more complex bariatric operations to MGB or OAGB.

The book retails as an e-book for US$109 (107,09 €, £91.00) OR in Hardcover for US$149.00 (129.99 €, £114.00). It can be obtained via the book’s homepage here

The next Conference of the MGB-OAGB Society will be in Hamburg 20-21 June 2019.

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