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Invited Critique
October 1, 2007

Gastric Bypass: Why Roux-en-Y? A Review of Experimental Data—Invited Critique

Arch Surg. 2007;142(10):1004. doi:10.1001/archsurg.142.10.1004

This is a thoughtful, thorough analysis of the actual and potential risks of loop gastric bypass, also known as mini–gastric bypass. As stated in the article, several of these patients required revision to a Roux-en-Y procedure because of severe bile reflux gastritis or esophagitis symptoms.1 There is 1 reference to constructing a jejunojejunostomy below the loop gastrojejunostomy to relieve bile reflux symptoms, also known as the Braun procedure.2 Some surgeons have been performing loop gastric bypass in combination with a Braun procedure as their primary operation to prevent this complication. This obviates the potential advantage of loop gastric bypass because it entails 2 operations and does not eliminate bile reflux, since the afferent limb still brings bile through peristalsis into the stomach. This procedure has also been used to treat efferent jejunal limb obstruction after a mini–gastric bypass.3 However, as pointed out in this study, the real concern is with the increased risk of gastric carcinoma, and that will take many years to develop. Have these patients been informed of this potential risk? I doubt it.