Authors: Essam Abdel –Galil, MD
Introduction: The Roux-en y and mini gastric bypass are good operations for morbid obesity- But serious complications and impossible access of traditional endoscopy and ERCP to the bypassed stomach and duodenum and biliary tree are crucial drawbacks. Our new technique (BB) where abanded1cm Outlet is connecting the butterfly gastric pouch with the bypassed stomach and duodenum and allows 25% of the food to pass through the normal pathway which is enough to prevent malabsorptive complications. And allow easy endoscopic and radiological study of the bypassed stomach and duodenum and biliary tree.
Methods: From July 2011 through June 2017 laparoscopic BB was attempted in 400 patients with median age 35 and median BMI 45- The butter fly pouch (25 cm) is constructed by using two blue endocartridges 6cm with a mesh (5.5cmx1cm) around 1.2 cm outlet, then the small intestine (150 cm -200 cm from D/J) is anastomosed to the body of the butterfly above the outlet.
Result: Mean operating time was 60 minutes. Average weight loss was 70% after one year and 82% & 86% in the second & Third year and 88% & 90% in the fourth year &fifth year respectively. Endoscope was done in 3% of cases for dilatation and three anastomotic ulcers were diagnosed. Dye study showed one fourth of dye passed through the butterfly outlet and three fourth through the anastomosis. Only 10% of cases need supplementation while 90% of cases showed normal levels of vitamins and minerals.
Conclusion: BB is one ideal bypass procedure. Weight loss is identical to mini bypass. And only 10% need supplementation. Beside endoscopic and radiological studies are feasible while it is impossible in other types of bypass surgery.
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