The Long Magenstrasse in the Treatment of Super Obese Patients (Results over 5 Years after Surgery)


Background: The considerable increase in Obesity and especially the increase in super obese patients (Body Mass Index—BMI ≥ 50 Kg/m2) who require surgery lead doctors to search for surgery techniques which give good results in terms of a consistent and stable weight loss associated with low morbidity and good quality of life. The Long Magenstrasse (LM) intervention, born from combining two properly modified surgical procedures (Selective Vagotomy with pyloric divulsion and Mangestrasse & Mill by Johnston) seems to have these characteristics according to our experience after operating on 660 patients. Methods: From October 2003 to October 2008 we treated 186 patients with LM. One hundred and sixty-two patients were regularly present to the annual follow-up, but 24 patients didn’t turn up, therefore, they were contacted by phone. On average, surgery lasted approximately 80 minutes (range: 50 - 90 minutes). Thirty patients were super obese with an average BMI of 57.4 Kg/m2; 156 patients were grade II and III obese with an average BMI of 40.7 Kg/m2. Results: The average BMI of the 30 super obese patients decreased from 57.4 Kg/m2 to 35.9 Kg/m2 one year after surgery, to 35.6, 5 years after surgery and it has remained stable until now. In the 156 patients suffering from II and III grade obesity, the average BMI decreased from 40.7 Kg/m2 to 27.8 Kg/m2 one year after surgery and it has remained stable until now. Out of all super obese diabetic patients, only one has partially maintained his/her therapy. Patients have reported a decreased appetite since the very first days of post-operative period with an early sense of satiety which is unchanged until today. Conclusions: A consistent and stable weight loss over 5 years after surgery even in Super Obese patients, a decrease in appetite with an early sense of satiety, a re-equilibrium of the metabolic syndrome in particular of Diabetes Mellitus, allow to classify LM among those surgical treatments with a mixed mechanism of action: both restrictive and functional, in particular, entero-hormonal and gastric neurosecretory.

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G. Berbiglia, M. Martinotti, G. Carena, E. Palamarciuc, M. Fariseo and C. Vassallo, "The Long Magenstrasse in the Treatment of Super Obese Patients (Results over 5 Years after Surgery)," Surgical Science, Vol. 4 No. 10, 2013, pp. 469-473. doi: 10.4236/ss.2013.410092.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. A. Gumbs, M. Gagner, G. Dakin and A. Pomp, “Sleeve Gastrectomy for Morbid Obesity,” Obesity Surgery, Vol. 17, No. 7, 2007, pp. 962-969.
[2] M. Deitel, M. Gagner, A. L. Erickson and R. D. Crosby, “Third International Summit: Current Status of Sleeve Gastrectomy,” Surgery for Obesity and Related Diseases, Vol. 7, No. 6, 2011, pp. 749-759.
[3] C. Vassallo, G. Berbiglia, A. Pessina, M. Carena, A. Firullo, A. Griziotti, F. Ramajoli, E. Palamarciuc and M. Fariseo, “The Super-Magenstrasse and Mill Operation with Pyloroplasty: Preliminary Results,” Obesity Surgery, Vol. 17, No. 8, 2007, pp. 1080-1083.
[4] C. Vassallo, G. Berbiglia, M. Carena, “The Long Magenstrasse with Pyloroplasty as Functional Gastric Bypass: 6-Years Experience, 308 Operations,” Health, Vol. 2, No. 8, 2010, pp. 935-940.
[5] M. Allg?wer, F. Harder, L. F. Hollender, H. J. Peiper and J. R. Siewert, “Trattato di Gastroenterologia Chirurgica,” Delfino Antonio, Frosinone, 1984.
[6] K. Tymitz, A. Engel, S. McDonough, M. P. Hendy and G. Kerlakian, “Changes in Ghrelin Levels Following Bariatric Surgery: Review of the Literature,” Obesity Surgery, Vol. 21, No. 1, 2011, pp. 125-130.
[7] A. Bohdjalian, F. B. Langer, S. Shakeri-Leidenmühler, et al., “Sleeve Gastrectomy as Sole and Definitive Bariatric Procedure: 5-Year Results for Weight Loss and Ghrelin,” Obesity Surgery, Vol. 20, No. 5, 2010, pp. 535-540.
[8] D. L. Drazen, T. P. Vahl, D. A. D’Alessio, “Effects of a Fixed Meal Pattern on Ghrelin Secretion: Evidence for a Learned Response Independent of Nutrient Status,” Endocrinology, Vol. 147, No. 1, 2006, pp. 23-30.
[9] T. Reinehr, C. L. Roth, G. H. Schernthaner, H. P. Kopp, S. Kriwanek and G. Schernthaner, “Peptide YY and Glucagon-Like Peptide-1 in Morbidly Obese Patients before and after Surgically Induced Weight Loss,” Obesity Surgery, Vol. 17, No. 12, 2007, pp. 1571-1577.
[10] J. P. Valderas, V. Irribarra, C. Boza, R. de la Cruz, Y. Liberona, A. M. Acosta, M. Yolito and A. Maiz, “Medical and Surgical Treatments for Obesity Have Opposite Effects on Peptide YY and Appetite: A Prospective Study Controlled for Weight Loss,” The Journal of Clinical Endocrinology and Metabolism, Vol. 95, No. 3, 2010, pp. 1069-1075.

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