Vol.2, No.8, 935-940 (2010)
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/
Openly accessible at
The Long Magenstrasse with pyloroplasty as functional
gastric bypass: 6-years experience, 308 operations
Carlo Vassallo1*, Giovanni Berbiglia1, Matteo Carena2
1Centro Multidisciplinare per la cura dell’Obesità, Istituto di Cura “Città di Pavia”, Unità operativa di Chirurgia Generale IIa, Pavia,
Italy; *Corresponding Author: carlo.vassallo@grupposandonato.it
2Centro Multidisciplinare per la cura dell’Obesità, Istituto di Cura “Città di Pavia”, Pavia, Italia
Received 8 March 2010; revised 12 April 2010; accepted 13 April 2010.
Background: The Long Magenstrasse with py-
loroplasty as functional Gastric Bypass (briefly
LMGBP) procedure for morbid obesity may re-
duce the incidence of side effects associated
with gastric restrictive and malabsorptive sur-
gery, particularly on quality of life and long-term
nutritional insufficiency. In follow-up to pre-
liminary findings in 34 patients, we report the
results of an additional 274 LMGBPs performed
over the past 3 years. Methods: Between Octo-
ber 2003 and 2009, 308 patients were treated
with the LMGBP. 149 patients underwent open
procedures; 74, hand-assisted laparoscopic sur-
gery (HALS); and 85 were operated laparo-
scopically. 17% had 125 mg/dl glycemia, 43%
sleep apnea, 38% hyperlipidemia, 12% hyperu-
ricemia, and 58% arterial hypertension under
treatment. Results: The mean BMI of 256 pre-
operatively normoglycemic patients at 1 year
was 29 (range 26-31); 27 (25-30) in 45 patients at
3 years; and 27.5 (26-30) in 12 patients at 5 years.
Mean BMI of 53 preoperatively hyperglycemic
patients ( 125 mg/dl) at 1 year (21 patients) was
32 (29-34), and at 3 years (9 patients), 32.5 (30-
33). 15 patients with preoperative type 2 diabe-
tes under oral treatment required no therapy 3-6
months after surgery. Patients reported consid-
erable appetite reduction with rapid satiety but
maintained good nutrition with no supplemen-
tation. There was no mortality. Conclusions:
Safe and effective sustained weight loss, posi-
tive metabolic changes, and appetite diminution
with rapid satiety were seen after LMGBP.
Keywords: Morbid Obesity Bariatric Surgery Partial
Vagotomy Pyloroplasty Magenstrasse and Mill
Gastric Bypass
Relative to the bariatric/metabolic surgical technique
employed, morbidly obese patients may experience
long-term side effects that negatively influence their
metabolism and quality of life; these include vomiting,
diarrhea, osteoporosis, anemia, and malnutrition. Bariat-
ric surgeons have long sought an operation that results in:
steady weight loss that approaches the patient’s goal
weight between 12 and 18 months; technical simplicity
with only moderate risk with laparoscopy; freedom to
consume most foods with reduced hunger and early sati-
ety; and nutritional sufficiency, requiring no supplemen-
In our institute we have performed bariatric surgery
for 32 years. During this time, we have operated with
different techniques, both gastric restrictive and malab-
sorptive, on 2,419 morbidy obese and super-obese pa-
tients [1-6], with an average of 103 patients each year
from 1988 through 2009. During the last 6 years, we
have increasingly performed the Long Magenstrasse
with pyloroplasty as functional Gastric Bypass (briefly
LMGBP) (Figure 1), an operation comprised of 2 out-
moded surgical techniques augmented for use in combi-
nation in the LMGBP. The Magenstrasse and Mill
(M&M) procedure [7-9] originated in 1987 by Johnston
et al., in which a vertical gastric tunnel (the “magen-
strasse,” or street of the stomach) is created from the
angle of His to the antral mill (the “mill”) 6 cm from the
pylorus, is extended in the “Long Magenstrasse” to 3 cm
from the pylorus [10]. A pyloroplasty pneumatic or digi-
toclassic completes the LMGBP.
Our choice to continue performing the LMGBP has
been reinforced by the good results obtained to date, the
relative simplicity of this technique, and patient satisfac-
tion with an improved quality of life. In comparison with
the Roux-en-Y gastric bypass (RYGB) technique, the
LMGBP is performed only on the stomach and involves
no anastomosis to the small intestine, minimizing time in
C. Vassallo et al. / HEALTH 2 (2010) 935-940
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/Openly accessible at
the operating room and surgical risk. Compared to the
sleeve gastrectomy (SG) technique, the LMGBP requires
no destruction of tissues, and no formation of a distal
gastric pouch, thus, reducing the probability of progres-
sive pouch dilatation with could need to be correct with
duodenal swich procedure.
This study aimed to confirm, after more than 300
LMGBP operations on morbidly obese and super-obese
patients, what we optimistically observed after the first
34 operations [10]: that safe and effective weight loss
could be achieved with the LMGBP in concert with ex-
cellent reduction or resolution of the comorbidities of
obesity, few and mild complications in the perioperative
period and long term, and an improved quality of life for
2.1. Patients
Between October 2003 and October 2009, 308 morbidly
obese and super-obese patients were operated with the
LMGBP technique (14 to rectify failed gastric restrictive
operations). In a population comprised of 72% females,
patients’ mean preoperative body mass index (BMI,
kg/m2) was 45 and their mean age was 39 years. Seven-
teen percent of the 308 patients before surgery had gly-
cemia 125 mg/dl: Five percent (15 patients) had type 2
diabetes mellitus (T2DM) by standard criteria [12-14]
under oral treatment, 1% (3 patients) had type 1 diabetes
under insulin treatment, and the remaining 11% (35 pa-
tients) had glycemia that fluctuated between 125 mg/dl
and 150 mg/dl, not under any pharmacologic treatment.
During the first year of our experience we excluded as a
precaution the overt T2DM patients, for whom we be-
lieved another kind of operation was preferable. Thus,
for this group, pertinent data are available only for the
last 5 years.
Forty-three percent of all patients had obstructive
sleep apnea, 38% hyperlipidemia, 12% hyperuricemia,
and 58% arterial hypertension under treatment. All pa-
tients underwent presurgical internal screening. Forty-
five percent of patients could not progress directly to
bariatric surgery, requiring prior pneumologic-metabolic
rehabilitation for a period of 6 months to 1 year, some-
times with intermittent hospitalization and use of a con-
tinous positive airway pressure (C-PAP) machine.
2.2. Surgical Technique
The technical features of this operation are the ones de-
scribed in our 2007 study [10]; we summarize them here,
as this procedure has not been widely performed.
The LMGBP is initiated with the performance of a
pyloroplasty. We carried out the pyloroplasty using a
variety of access techniques. In the 74 hand-assisted
laparoscopy (HALS) cases and 149 open operations
performed with median paraxiphoid or left sub costal
mini-laparotomy, a digitoclassic approach (i.e., applica-
tion of external pressure to interrupt the pyloric muscle
by manipulating it between the thumb and index finger)
[15,20] was used to effect the pyloroplasty. In the 85
laparoscopic cases, a pneumatic endoscopic approach
(i.e., pyloric dilatation balloon introduced through the
gastroscope and inflated up to 2 cm in diameter with an
internal pressure of 6 atmospheres) was employed gen-
erally on the day before the surgical procedure. With this
approach you must use a balloon with uniform dilatation
without clepsydra effect.
A 36-Fr. endogastric bougie was introduced to cali-
brate the Long magenstrasse against the lesser curvature
of the stomach. A gastric window was subsequently cre-
ated beside the bougie approximately 9-10 cm proximal
to the pylorus using a 21-mm circular stapler. Gastric
division was accomplished first, distally, from the gastric
window to 3 cm proximal to the pylorus with Echelon-
60 2.0-mm green reloads performing a alimentary way
and a secretory way (Figure 1), and next, proxi- mally,
from the window up to the angle of His with 3-4 addi-
tional Echelon-60 1.8-mm golden reloads.
The gastric division to the angle of His creates a sev-
erance of the left vagus nerve and its innervation of the
greater curvature of the stomach. This, in essence, con-
stitutes a partial vagotomy.
2.3. Experiences and Specific Remarks to
Make the Carrying Out of the
Operating Procedure ‘Long
Magenstrasse’ Simpler.
1) In the open technique the patient should be placed
on the operating table in anti-trendelemburg position,
almost in orthostatic.
2) For a better surgical field and a smaller percentage
of after surgery laparocele (from 6% to 2 %), it is pref-
erable in open surgery to use a left sub-costal laparo-
tomy with section of the rectus muscle instead of the
median xipho-umbilical.
3) In the H.A.L.S. for the introduction of the hand we
carry out a right sub- costal laparotomy of 6-7 cm and
three left accesses with two trocars of 10-12 mm and one
of 15 mm through which, removing momentarily the
trocar, the 21 circular enters for the making of the gastric
antrum window at 10 cm from the pylorus.
4) In video laparoscopy five accesses are necessary
with two troncars of 5 mm, two of 10-12 mm and one of
15 mm.
PS: If you consider it opportune we can send you the
video tapes of the H.A.L.S. technique (3) and of the
video laparoscopy (4).
C. Vassallo et al. / HEALTH 2 (2010) 935-940
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/Openly accessible at
3.1. Weight Loss and Comorbidity Resolution
The best weight-loss results were seen in the 256 pa-
tients with a mean initial BMI of 45 and normal presur-
gical glycemia. These patients’ BMI dropped under 30
(range 26-30) after 1 year with a sustained effect at 3 and
5 years in those individuals available for follow-up
(Figure 2). In the 53 patients with presurgical hypergly-
cemia ( 125 mg/dl), 21 cases at 1 year and 9 cases at 3
years had a mean BMI of 32 and 32.5, respectively
(Figure 3). All 35 patients with glycemia between 125
mg/dl and 150 mg/dl not under treatment and the 15
patients with overt T2DM experienced normalization of
their glycemia and were able to suspend therapy com-
pletely within 6 months of the operation. The value of
HbA1c in those 15 patients within 6 months of the op-
eration have stabilized at the mean of 5.8 %. The 3 pa-
tients with type 1 diabetes were able to halve their insu-
lin dose within 6 months of surgery (Table 1).
The effects on other comorbidities 1 year after surgery
included complete resolution in 90% of patients of sleep
apnea syndrome, in 68% of those with arterial hyperten-
sion, in 93% of those with hyperlipidemia, in 91% with
hyperuricemia (Table 2), and in 100% of those with
3.2. Nutrition
At 1-, 3-, and 5-year time points, no substantive meta-
bolic-nutritional sequelae, such as anemia, bone disease,
or peptic ulceration, were observed. Iron, calcium, pro-
teins, vitamin B12, and folates remained consistently in
the normal range (Table 2), despite patient reports of
decreased appetite, rapid satiety, and limitation of food
intake. There was also no increase in parathormone at 1,
3, and 5 years following surgery. There has been no need
for mineral or vitamin supplementation in any patient.
3.3. Mortality and Morbidity
There have been no mortalities within the series of
LMGBP patients over the course of our 6-year experi-
ence. No postoperative nasogastric tube was used fol-
lowing the LMGBP procedures. Only 12 patients re-
quired a subhepatic drain.
Two perisurgical complications occurred. The first
complication was a 2-3-cm dehiscence of the suture in
the antrum in 1 of the first operated cases. This patient
required reoperation on postoperative day 4 to incorpo-
rate a manual suture. (Initially, we used a green 45-mm
endoscopic stapler with a double line of staples; today,
mechanical suturers with 3 lines of staples are more re-
liable, even at the antral level, where the gastric wall is
thicker.) The second complication was in a patient with
Table 1 Patients with glycemia 125 mg/dl (17%) operated
with the Long Magenstrasse with pyloroplasty as functional
Gastric Bypass (LMGBP).
N. patients
= 53 (%)
N. pa-
tients =
1 year
N. pa-
tients =
3 years
N. patients
= 9
under oral
15 (5%) 13 sus-
7 sus-
3 sus-
under insulin
3 (1%) 3 halved 2 halved 1 halved
of glucose
not under
35 (11%)
27 gly-
< 110
12 gly-
< 110
5 glyce-
< 110
T2DM, type 2 diabetes; DM1, type 1 diabetes.
Table 2 Comorbidities in 308 patients operated with the
N. pa-
6 months
N. patients
At follow-up
(% resolu-
1 year
N. patients
at follow-up
(% resolu-
3 years
N. patients
at follow-up
(% resolu-
sion 179 145 (62%) 85 (68%) 29 (73%)
Sleep ap-
nea 132 107 (88%) 64 (90%) 19 (94%)
demia 116 93 (82%) 56 (93%) 16 (93%)
ricemia 36 29 (86%) 19 (91%) 7 (80%)
an increasingly severe stenosis of the Long Magen-
strasse (alimentary way) at the third distal that required a
latero-lateral anastomosis with the gastric antrum (sec-
retory way) on day 7, transforming the operation into a
M&M. In the immediate post-surgical period, the patient
had 20% atelectasis at the base of the lungs with moder-
ate hyperthermia; this was resolved on day 3-4 by means
of antibiotic therapy and respiratory care. There was no
thrombophlebitis or pulmonary embolism, probably ow-
ing to the short length of the operation (about 1 hour),
early ambulation to void in the afternoon, and heparin
We had 1 complication at 1 year, due to insufficient
digitoclassic pyloroplasty. In this patient, we had to per-
form a surgical pyloroplasty. Finally, our rate of ventral
hernia in the “open” operations was 9%.
A BMI reduction from 45 to approximately 30 at 1 year
C. Vassallo et al. / HEALTH 2 (2010) 935-940
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/
Figure. 1. The Long Magenstrasse Gastric Bypass (LMGBP).
Figure 2. Mean BMI before LMGBP surgery and at follow-up in patients with normoglycemia
Figure 3. Mean BMI before LMGBP surgery and at follow-up in patients with hyperglycemia.
Openly accessible at
C. Vassallo et al. / HEALTH 2 (2010) 935-940
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/Openly accessible at
Table 3. Average nutritional levels before and after LMGBP.
years 5 years
N. patients 308 251 147 55 12
Iron (µg/dl) 74.81 76.27 74.75 81.83 78.24
Ca (mg/dl) 8.98 9.42 9.24 9.25 8.91
Vit. B12
(pg/ml) 414.12 405.75345.13 304.25321.36
Folic acid
ng/ml) 5.94 5.70 4.18 5.15 4.90
Total pro-
teins (g/dl) 7.3 6.8 7.6 7.1 6.9
following LMGBP surgery in both normoglycemic and
hyperglycemic patients was achieved; this is comparable
to the weight reduction attained with other primary bari-
atric/metabolic procedures. In patients who were avail-
able for follow-up, weight loss appeared to be sustained
at 3 and 5 years, while established T2DM was resolved
(i.e., requiring no medication) in all cases. LMGBP was
associated with resolution of 68% to 100% of all other
comorbid disease.
Significant weight loss with LMGBP, coupled with its
moderate surgical risk, very low complication profile,
and the satisfaction of patients, suggests a viable ad-
vance in bariatric surgical technique. This procedure can
be employed to advantage and perhaps may be prefer-
able to the technically more complex RYGBP, which is
not without nutritional-metabolic side effects, or the SG
[21,22], which, though conferring the benefit of restric-
tion without a foreign body, involves tissue destruction
and creation of a distal gastric pouch subject to possible
dilatation. In its most radical and effective form, the SG
is a real sub-total gastrectomy that, in the instance of
intercurrent illnesses requiring added nourishment,
makes restoration impossible.
The LMGBP technique may not be readily embraced
by surgeons due to its incorporation of the pyloroplasty,
particularly digitoclassic pyloroplasty, a procedure in-
volving manipulations of the pyloric muscle that are
difficult to calibrate and that require the introduction of a
hand into the abdomen. Since acquiring the technology
to perform endoscopic pneumatic pyloroplasty, inde-
pendent of the primary surgery, it is no longer necessary
to perform pyloroplasty manually. We have had to repeat
the pneumatic pyloroplasty procedure in only 3 patients
6 months after the operation.
An effective pyloroplasty is essential for the LMGBP
to work. It is the digitoclassic or pneumatic pyloroplasty
in an antrum subjected to vagotomy to 3 cm from the
pylorus that enables partially digested food to freely pass
through the duodenum in a modulated way, without the
exaggerated movement induced by some surgical py-
loroplasties that can result in the dumping syndrome. A
smoother transit of food prevents reflux of the alimen-
tary bolus into the gastric corpus/fundus, effecting a true
bypassing of the stomach and reduction of the secretion
of ghrelin [23-26]. Moreover, recent studies seem to
show that the increased speed of food transit through the
jejunum induces an increased peptide YY (PYY) secre-
tion [27], an early feeling of satiety, and stimulation of
increased secretion of glucagon-like peptide (GLP-1) at
the ileal level [13,28], lessening insulin resistance. Duo0
denal biliary reflux into the stomach is nonexistent be-
cause of the narrowness of alimentary and secretory way
wich convly in the prepyloric mill (Figure 1). One year
after the surgery the gastroscopy routine do not show
bile o phlogosis in the praepiloric “Mill”.
The correct functioning of the LMGBP also relies
upon extension of the partial vagotomy from the angle of
His to 3 cm from the pylorus. This added length, we
believe, secures a dramatic decrease of 60% to 80% in
hydrochloric peptic secretion [15-20]. The small per-
centage of residual hydrochloric peptic secretion main-
tains digestive activity, mixing ingested food at the level
of the prepyloric mill. Patients report that their interest in
food is diminished.
A limitation of this study was its loss to follow-up of a
number of patients. In addition, few patients in our series
have been followed yet for more than 3 years. Continued
study is required on a meaningful number of patients
over the long term, the results of which should be com-
pared with those of other primary bariatric/metabolic
After 6 years of experience performing the LMGBP
and following patients, some out to 3 and 5 years, we
can confirm that the technique has some very definite
assets: For the surgeon, LMGBP is relatively straight-
forward to perform open or laparoscopically, no foreign
bodies need to be introduced, and there is no potentially
dilatable gastric pouch. For the anesthetist, LMGBP is
an efficient procedure (50-90 minutes), and it rarely re-
quires post-surgical intensive care. For the follow-up
team, LMGBP produces a patient who is uncomplicated
to care for. And, most important, for the patient, LMGBP
is a relatively positive experience; he or she achieves a
weight loss that is satisfactory and sustainable with easy
food compliance, no observable metabolic and nutri-
tional imbalance, and no need for supplementation [29].
In conclusion, the patient operated with a LMGBP
does not become a formerly morbidly obese patient, but
rather, a person whose metabolism functions more like
that of a normal-weight individual. This form of func-
tional gastric bypass appears to achieve and maintain
weight loss safely without marked nutritional perturba-
tion, and without the psychological and behavioral strain
C. Vassallo et al. / HEALTH 2 (2010) 935-940
Copyright © 2010 SciRes. http://www.scirp.org/journal/HEALTH/
Openly accessible at
of treating the nutritional imbalances that often accom-
pany restrictive or malabsorptive surgery.
[1] Baltazar, A., Bou, R., Cipagauta, L.A., et al. (1995) “Hy-
brid” bariatric surgery: Biliopancreatic diversion and
duodenal swich-preliminary experience. Obesity Surgery,
5(4), 419-423.
[2] Bastaroli, E., Della Valle, A., Vassallo, C., et al. (1993)
Reflections on 4 years’ activity of an interdisciplinary
center for the treatment of obese patients. Obesity
Surgery, 3(3), 285-288.
[3] Marceau, P., Biron, S., Bourque, R.A., et al. (1992)
Biliopancreatic diversion with a new type of gastrectomy.
Obesity Surgery, 3(1), 29-35.
[4] Vassallo, C., Andreoli, M., La Manna, A., et al. (2001) 60
reoperations on 890 patients after gastric restrictive sur-
gery. Obesity Surgery, 11(6), 752-756.
[5] Vassallo, C., Negri, L., Della Valle, A., et al. (1999) Di-
vided vertical banded gastroplasty either for correction or
as a first-choice operation. Obesity Surgery, 9(2), 177-
[6] Vassallo, C., Negri, L, Berbiglia, G., et al. (2004) Bilio-
pancreatic diversion with transitory gastric restriction
and duodenal bulb preservation: 88 patients since 1992.
Obesity Surgery, 14(6), 773-776.
[7] Johnston, D., Dachtler, J., Sue-Ling, H., et al. (2003) The
Magenstrasse and Mill operation for morbid obesity.
Obesity Surgery, 13(1), 10-16.
[8] Johnston, D. and Sue-Ling, H. (1995) Surgical treatment
of morbid obesity. In: Cushieri, A., Moosa, A.R., Giles,
G.R., Eds., Essential Surgical Practice. Butterworth-
Heinemann, London, 1036-1044.
[9] Robinson, J., Sue-Ling, H. and Johnston, D. (2006) The
Magenstrasse and Mill procedure can be combined with
a Roux-en-Y gastric bypass to produce greater and sus-
tained weight loss. Obesity Surgery, 16(7), 891-896.
[10] Vassallo, C., Berbiglia, G., et al. (2007) The Long Ma-
genstrasse and Mill operation with pyloroplasty: Pre-
liminary results. Obesity Surgery, 17(8), 1080-1083.
[11] Carmichael, A.R., Sue-Ling, H.M. and Johnston, D.
(2001) Quality of life after the Magenstrasse and Mill
procedure for morbid obesity. Obesity Surgery, 11(6),
[12] Mason, E.E. (2005) The mechanisms of surgical treat-
ment of type 2 diabetes. Obesity Surgery, 15(4), 459-461.
[13] Rubino, F., Forgione, A., Cummings, D.E., et al. (2006)
The mechanism of diabetes control after gastrointestinal
bypass surgery reveals a role of the proximal small intes-
tine in the pathophysiology of type 2 diabetes. Annals of
Surgery, 244(5), 741-749.
[14] Scopinaro, N., Papadia, F., et al. (2008) A comparison of
a personal series of biliopancreatic diversion and litera-
ture data and gastric bypass help to explain the mecha-
nisms of resolution of type 2 diabetes by the two opera-
tions. Obesity Surgery, 18(8), 1035-1038.
[15] Siewert, J.R. and Muller, C.. (1983) Terapia chirurgica
dell’ulcera duodenale non complicata. In: Allgöwer, M.,
Harder, F., Hollender, L.F., Peiper, H.J. and Siewert, J.R.,
Eds. Trattato di Gastroenterologia Chirurgica. Antonio
Delfino Editore, Rome, 2, 463-466.
[16] Amdrup, E. and Jensen, H.E. (1973) One hundred pa-
tients five years after selective gastric vagotomy and
drainage for duodenal ulcer. Surgery, 74, 321-325.
[17] Goligher, J.C., Pulvertaft, C.N., et al. (1972) Five to
eight years results of truncal vagotomy and pyloroplasty
for duodenal ulcer. British Medical Journal, 1(5791),
[18] Johnston, D., Humphrey, C.S., et al. (1970) Should the
gastric antrum be vagally denervated if it is well drained
and in the acid stream? British Journal of Surgery,
58(10), 725-731.
[19] Thompson, J.D. and Galloway, J.B.W. (1979) Vagotomy
and pyloric dilatation in chronic duodenal ulceration.
British Medical Journal, 1(6176), 1453-1455.
[20] Taylor, T.V., Lythgoe, J.P., et al. (1990) Anterior lesser
curve seromyotomy and posterior truncal vagotomy versus
truncal vagotomy and pyloroplasty in the treatment of
chronic duodenal ulcer. British Journal of Surgery, 77,
[21] Almogy, G. Crookes, P.F., Anthone, G.I., et al. (2004)
Longitudinal gastrectomy as a treatment for the high-risk
super-obese patient. Obesity Surgery, 14(4), 492-497.
[22] Morínigo, R., Lacy, A.M., et al. (2006) GLP-1 and
changes in glucose tolerance following gastric bypass
surgery in morbidly obese subjects. Obesity Surgery,
16(12), 1594-1601.
[23] Conce, M.E., Cottam, D. and Esplen, J. (2006) Is ghrelin
the culprit for weight loss after gastric bypass surgery? A
negative answer. Obesity Surgery, 16(7), 870-878.
[24] Frühbeck, G., Diaz-Caballero, A., Gil, M.J., et al. (2004)
The decrease in plasma ghrelin concentrations following
surgery depends on the functional integrity of the fundus.
Obesity Surgery, 14(5), 606-612.
[25] Garcia-Fuentes, E., Garrido-Sanchez, L., et al. (2008)
Different effect of laparoscopic Roux-en-Y gastric by-
pass and open biliopancreatic diversion of Scopinaro on
serum PYY and ghrelin levels. Obesity Surgery, 18,
[26] Roth, C.L., Reinehr, T., et al. (2009) Ghrelin and obes-
tatin levels in severely obese women before and after
weight loss after Roux-en-Y gastric bypass surgery.
Obesity Surgery, 19(1), 29-35.
[27] Reinehr, T., Roth, C.L., et al. (2007) Peptide YY and
glucagon-like peptide-1 in morbidly obese patients be-
fore and after surgically induced weight loss. Obesity
Surgery, 17(12), 1571-1577.
[28] Reavis, K.M., Hinojosa, M.W., et al. (2008) Single lapar-
oscopic incision transabdominal surgery sleeve gastrec-
tomy. Obesity Surgery, 18(11), 1492-1494.
[29] Schweitzer, D.H. and Posthuma, E.F. (2008) Prevention
of vitamin and mineral deficiencies after bariatric surgery:
Evidence and algorithms. Obesity Surgery, 18(11), 1485-