17 August 2006

CUHK introduces new surgery in treating morbid obesity:
Laparoscopic Mini-Gastric Bypass

Obesity is a chronic devastating disease and is becoming a major global health and socioeconomic issue. It is estimated that 1/3 of adults in Hong Kong are classified as overweight or obese and the demand for treatment is increasing. Surgery is the only proven effective treatment for long-term weight control for morbid obesity and the indications for Asians have been revised recently with the following criteria: age between 18 and 65, and 1) BMI >37; or 2) BMI >32 with diabetes or 2 obesity-related diseases; or 3) unable to lose weight by dietary or medical measures.

One of the traditional types of weight reduction surgery is Roux-en-Y gastric bypass (two-anastomosis gastric bypass), which is considered the gold standard in the USA. In this operation, the proximal part of stomach is divided and connected to proximal small bowel by Roux-en-Y reconstruction (two-anastomosis). It has been proven to be effective in achieving long-term weight loss. However, it is a major operation with considerable risks mainly from anastomotic leakage. Recently, there is a major improvement by modifying the design to one anastomosis. This is called laparoscopic mini-gastric bypass.

The Department of Surgery of the Faculty of Medicine at The Chinese University of Hong Kong has recently introduced this surgical method to treat morbid obese patients in Hong Kong by laparoscopic mini-gastric bypass (one-anastomosis gastric bypass) and the initial results are very promising. It diminishes the absorption of nutrients from food by reducing the volume of stomach and bypassing the proximal part of small intestine with single anastomosis. Mini-gastric bypass has been shown to be much safer with similar efficacy to Roux-en-Y gastric bypass. More importantly, the operative time is shorter and is more easily performed by laparoscope. In addition, leakage is rare with less incidence of postoperative bowel obstruction. Most patients can be discharged from the hospital within 1 week with full recovery of bowel function. Laparoscopic mini-gastric bypass is increasingly popular worldwide especially in Asia–Pacific region because of its safety and efficacy.

CUHK has introduced this new technique at the Prince of Wales Hospital for management of morbid obese patients since January 2005. To date, a total of 7 patients (5 women 2 men; mean age 39) have undergone the procedure. We observed a median weight loss of 41 kg and 67% of excessive body weight loss after treatment. The median body weight (BW) and body mass index (BMI) were 126 (range: 103.1 to 144.8) kg and 42.8 (range 38.3-51.9) kg/m2 respectively. Our initial results are very encouraging. The average waist circumference loss was 23cm. Most obesity-related diseases such as high blood pressure and high cholesterol were alleviated with significant improvement in quality of life. These results confirmed the safety and efficacy of laparoscopic mini-gastric bypass in treating morbid obesity among our population.

The next step of treatment is to restore an acceptable aesthetic appearance in these patients after massive weight reduction. Skin redundancy on the trunk, buttocks, breasts, upper arms and thighs often triggers significant problems after weight reduction surgery. The folding up of redundant skin causes medical diseases (i.e. interigo), functional limitations (i.e. in walking, urinating, and sexual activity), and psychosocial disturbances (i.e. depression). The CUHK also pioneers in Hong Kong to perform body-contouring surgery for these patients, including belt lipectomy, lower body lift, mastopexy and brachioplasty. Since 2004, we have performed 28 procedures in 13 patients. The surgery significantly improves the body shape and image of these patients and most are highly satisfied with the results.