Magenstrasse and Mill gastroplasty and sleeve gastrectomy as treatment for morbid obesity.

BACKGROUND: Laparoscopic nonbanded restrictive procedures are becoming more popular as staging and primary operations in bariatric surgery. The Magenstrasse and Mill (MM) procedure produces a restrictive gastric tubular pouch based along the lesser curvature; for the most part anatomy and physiology are preserved. In Sleeve Gastrectomy (SG), 80% of normal stomach is resected to produce restriction and to decrease ghrelin levels.

METHODS: This is a retrospective nonrandomized study evaluating the medical records of patients who had the laparoscopic MM (LMM) and laparoscopic SG (LSG) between January 2007 and October 2008. One bariatric surgeon performed the LMM and two bariatric surgeons performed the LSG.

RESULTS: A total of 20 patients were identified: 13 SG and 7 MM. The mean age was 50 for the MM vs 42.9 for the SG. For the MM, the mean preoperative body mass index (BMI) was 65.4 +/- 11.1 kg/m2, with a mean excess weight of 282 +/- 73.7 kg. For the SG, the mean preoperative body mass index was 47.5 +/- 8.3 kg/m2, with a mean excess weight of 156.1 +/- 52.6 kg. The mean excess weight loss after six and 12 months for the M&M was 35 +/- 10.5% and 20.1 +/- 1.4%, vs 52.4 +/- 17.8% and 49% +/- 15.4% for the SG. Follow-up of one year was achieved in two M&M patients and three SG patients. Median follow-up of all patients was seven months (range 12-1).

CONCLUSION: This is a short-term retrospective outcome study. The LMM patients were larger than LSG patients. Total weight loss was greater for the LMM patients. Operative time for the LMM is shorter. The percent excess weight loss in the short-term 12 month period was more in the LSG compared to the LMM. Long-term follow-up is needed.