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Laparoscopic Butterfy Gastroplasty 2000 Cases and 10-years’ Experience

International Journal of Diabetes & its Complications - Essam Abdel -Galil, MD -ISSN 2573-8895

Citation: Essam Abdel -Galil. Laparoscopic Butterfy Gastroplasty 2000 Cases and 10-years’ Experience. Int J Diabetes Complications. "Department of surgery, Ahmed MAHER Teaching Hospital,  Cairo, Egypt."

Background: The restrictive bariatric procedures (vertical banded gastroplasty, Gastric band and sleeve
gastrectomy) are efective procedures for the long term control of morbid obesity especially for the bulk
eaters. The cardinal complications after these procedures are weight regain due to pouch dilatation, solid
food intolerance, and refux disease due to the tubular shape of the pouch.
Methods: From Jan 2007 through Jan 2017, laparoscopic Butterfy gastroplasty was attempted in 2000
patients. Median age was 32, with median preoperative BM I48. The Butterfy gastroplasty (micro funell
shaped pouch) was constructed using Two 60 blue endo-cutter cartridges, the frst one placed from angle of
His downward and the second is applied just below the level of the frst branch of the left gastric the outlet
(1.2 cm) is between the ends of the previous Cartridges. The outlet of the pouch was banded with a prolene
Results: Average excess weight loss at one year was 70%, 81% at second year, 85% at third year. 90% at the
fourth and ffth years then 10% start to gain weight (about 50% of the lost weight) at the sixth and seventh
years. While 20% start to gain weight at the eighth & ninth year. While at the tenth years 25% of patients
start to gain weight. The mean operating time was 45 min. The outlet calibration was accurate and easy.
There was complete cure of diabetes type 2 in 92% of cases, and 96% of cases showed cure of hypertension.
Problems of infertility solved in 88% of cases and there was marked decrease of Ghrelin level in all cases.
There was no leak or mortality.
Conclusion: Butterfy gastroplasty, (micropouchfunell shaped pouch) using the gastric cardia only is
an efective way to prevent pouch dilatation and therefore prevent the weight regain occurred in a high
percentage of patients under went the original VBG of Mason. The pouch being micro. Funnel rather than
tubular-shaped prevent solid food intolerance and refux disease. The way of construction of the butterfy
allow easy accurate outlet and less cost. 2000 cases with ten years follow up with such Results, is evidence
that this technique is perfect in morbidly obese patients.

Butterfly Gastric Bypass (BB) Single Anastomosis on Butterfly Gastroplasty, New Laparoscopic Technique Evaluation for Morbidly Obese Patients

International Journal of Diabetes & its Complications - Essam Abdel -Galil, MD -ISSN 2573-8895

Citation: Essam Abdel –Galil. Interferon-Based Antiviral Treatment of Chronic Hepatitis C in Combination with Metformin in Patients with HCV-1 Genotype and Insulin Resistance. Int J Diabetes Complications. 2017; 1(4): 1-3. "Department of surgery, Ahmed MAHER Teaching Hospital,  Cairo, Egypt."

Introduction: The Roux-en y and mini gastric bypass are good operations for morbid obesity- But serious complications and impossible access of traditional endoscopy and ERCP to the bypassed stomach and duodenum and biliary tree are crucial drawbacks. Our new technique (BB) where abanded1cm Outlet is connecting the butterfly gastric pouch with the bypassed stomach and duodenum and allows 25% of the food to pass through the normal pathway which is enough to prevent malabsorptive complications. And allow easy endoscopic and radiological study of the bypassed stomach and duodenum and biliary tree.
Methods: From July 2011 through June 2017 laparoscopic BB was attempted in 400 patients with median age 35 and median BMI 45- The butter fly pouch (25 cm) is constructed by using two blue endocartridges 6cm with a mesh (5.5cmx1cm) around 1.2 cm outlet, then the small intestine (150 cm -200 cm from D/J) is anastomosed to the body of the butterfly above the outlet.

Results: Mean operating time was 60 minutes. Average weight loss was 70% after one year and 82% & 86% in the second & Third year and 88% & 90% in the fourth year & fifth year respectively. Endoscope was done in 3% of cases for dilatation and three anastomotic ulcers were diagnosed. Dye study showed one fourth of dye passed through the butterfly outlet and three fourth through the anastomosis. Only 10% of cases need supplementation while 90% of cases showed normal levels of vitamins and minerals.

Conclusion: BB is one ideal bypass procedure. Weight loss is identical to mini bypass. And only 10% need supplementation. Beside endoscopic and radiological studies are feasible while it is impossible in other types of bypass surgery



Dr. Essam Abd El Galil, President of The Egyptian society for Bariatric surgery during the annual meeting of ESBS


12 Abdel Rahim Sabry St.,
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