Letter to the Editor Regarding the Mini Gastric Bypass-One Anastomosis Gastric Bypass (MGB-OAGB) IFSO Position Statement
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LETTER TO THE EDITOR
Letter to the Editor Regarding the Mini Gastric Bypass-One Anastomosis Gastric Bypass (MGB-OAGB) IFSO Position Statement Eduardo Lemos de Souza Bastos 1 Received: 21 July 2020 / Revised: 13 August 2020 / Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor, The Brazilian Society of Bariatric and Metabolic Surgery is working on the new Brazilian Guideline for Bariatric and Metabolic Surgery, which should be launched soon. Thus, I have thoroughly analyzed the literature about one anastomosis gastric bypass (OAGB) to join forces in the elaboration of the final version of the aforementioned document. Therefore, I recently reviewed the article entitled “Mini Gastric BypassOne Anastomosis Gastric Bypass (MGB-OAGB) IFSO Position Statement”, which was published in this prestigious journal approximately 2 years ago [1]. Unquestionably, valuable scientific information were gathered in the article mentioned above, although two information provided by the authors were not clear to me; in my point-of-view, they should be better explained. First, the authors of the herein referred article literally wrote that Rutledge introduced a different version of one anastomosis gastric bypass in 1997 and named it “mini gastric bypass” (MGB) because the procedure had been initially described as “mini-laparotomy”, in analogy to “minilaparotomy cholecystectomy.” Although there is no quote at the end of the sentence, I believe that this statement was based on the original publication by Robert Rutledge, in 2001, also in Obes Surg [2], which, in fact, was quoted at the end of the following sentence. However, the careful reading of the original MGB description by Professor Rutledge reveals that the procedure started with the placement of five ports, as clearly expressed in the chapter “Methods - Operative Technique”. Therefore, it is reasonable inferring that the original technique described in that publication was based on laparoscopy rather
* Eduardo Lemos de Souza Bastos [email protected] 1
Division of Gastrointestinal Surgery, Marilia Medicine School, Marilia, Brazil
than on a single short abdominal incision, i.e., on mini-laparotomy. Accordingly, Mervyn Dietel has published an interesting article last year about the historical development of MGB-OAGB and provided an explanation for the source of the name “MGB”. According to Professor Dietel, mini gastric bypass was the name chosen to describe the technical simplification of the traditional Roux-en-Y gastric bypass (RYGB), but it was not related to surgical access through “mini-laparotomy” [3]. The other dubious issue emerged right after the first one. According to the authors of the herein referred manuscript, Carbajo et al. have suggested two fundamental technical changes in Rutledge’s MGB and named the surgery one anastomosis gastric bypass (in Spanish, Bypass Gastrico de Una Anastomosis-BaGUA). The first change referred to gastrojejunostomy with a built-in anti-reflux mechanism, whereas the secon
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