1. 腹腔鏡迷你胃繞道手術 成果分析
林修賢, 吳柏鋼
一般外科, 花蓮慈濟醫院

2. Introduction
Surgical treatment is the most important method for morbid obesity.
Mini gastric bypass (MGB)
 6.6 % bariatric surgery in 2017 in Taiwan TSMBS, 2019
 Gastric tube + ante-colic tension-free gastrojejunostomy
 Equivalent or better weight loss than RYGB and SG
International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)
LAGB= Laparoscopic adjustable gastric banding
Because of longer biliopancreatic limb, LMGB might have better weight loss than RYGB because of malabsorptive effect.
Duodenal bypass (Decreased hormone like Glucogan) and rapid food transit to distal bowel (Increased hormone like GLP-1) , gastric tube restrition
Surgical Endoscopy (2018) 32:3024–3031

3. Study Design and Patients
Hualien Tzu Chi hospital
Laparoscopic MGB (LMGB) from June 2014 to September 2018
 Total 21 patients
Retrospective chart review

4. Procedure Patient in supine position
Mini-laparotomy performed at supraumbilical region  12 mm trocar
Three trocars (12mm at RUQ, 5mm at left subcostal region, 5mm at subxyphoid region)
Left lobe of liver elevated by liver retractor hold by iron intern
Angle of His was dissected.  EG junction exposed
Lesser omentum opened below crow’s foot
Gastric partition was performed by Endopath-GIA along 36 Fr boigie
Greater omentum was splitted.
180cm jejunum  End-to-side gastrojejunostomy
Serosal reinforcement by Lumber suture by 3-0 V-loc
15mm J-vac drain placed at left subhepatic region
Wounds closed by 1-0 Vicryl and 4-0 Nylon

5. GJ by GIA in anterior wall of gastric tube

6. GJ by GIA in posterior wall of gastric tube

7. GJ by hand-sewn in posterior wall of gastric tube

8. Results

11.  50-year-old female, post-OP Y-1
41-year-old male, post-OP D-20 

12. Effect of LMGB on Weight and BMI

14. Effect of LMGB on Glycemic Effects

15. Discussion Data compare  Mortality Marginal ulcer EWL data compare
Effect of glucose metastasis

16. Morbidity and Mortality
0.1 % mortality rate in a systemic review of patients
 0% mortality rate in our experience
% minor morbidity rate
 14.4 % in our experience
 One with IAI
 Two with marginal ulcer
OBES SURG (2018) 28:2956–2967

17. Marginal Ulcer 2.7% in in a systemic review of 12807 patients
Risk factors:
- HP infection
- NSAID consumption
- Alcohol and tobacco consumption
PPI for six months postoperatively for prophylaxis
OBES SURG (2018) 28:2956–2967

18. Obes Surg. 2014 May;24(5):741-6. 

19. OBES SURG (2018) 28:2956–2967

20. Reflection for Lower %EWL
Behavioral management
- Patient education
- Self-monitoring
- Dietary considerations
Physical activity
Psychological considerations
 Incomplete follow-up
Diabetes Metab Syndr Obes. 2015;8:

21. Results Summary
Total 21 patients underwent LMGB from June to September 2018 in our hospital
No mortality was encountered.
14.4% morbidity rate in our experience. Two patients with marginal ulcer and underwent medical treatment.
EWL in 6 and 12 months were 48.0 and 57.4 %.
Significantly decreased mean AC and HbA1c post- OP months 6 were noted.
92.8% patients with HbA1c <6.5 post-OP months 6