This study reviews the etiology, diagnosis, and treatment of MU in the RYGB patient and offers specific recommendations to reduce its occurrence. It also confirms a preliminary impression that NTGB is an effective operation in preventing MU formation.
With an appreciation for the finer anatomy of the proximal stomach and intra-abdominal esophagus, the micropouch can be constructed safely in both primary and redo procedures. The MGB, now in its seventh year, is durable and has, with rare exception, eliminated pouch enlargement, staple-line separation, reflux esophagitis, and marginal ulceration.
Our group has performed the Roux-en-Y gastric bypass (RYGB) in 1450 patients since 1983: 805 patients had primary operations, and 645 were converted from previous gastroplasty procedures, i.e. horizontal gastroplasty, vertical banded gastroplasty, and gastrogastrostomy. Within the last 2 years, 38 patients who failed the RYGB were converted to a modified biliopancreatic diversion (BPD) using a technique that did not require dismantling a major portion of the original gastric exclusion. A 24-month follow-up has demonstrated a significant and sustained weight loss in all patients. In addition, the modified BPD completely eliminated the problem of reflux bile gastritis in those patients with a short Roux-en-Y jejunal limb.
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