Vol:.(1234567890) Surgery Today (2018) 48:558–565 https://doi.org/10.1007/s00595-018-1625-z 1 3 ORIGINAL ARTICLE Laparoscopic subtotal gastrectomy in morbid obese patients: a valid option to laparoscopic gastric bypass in particular circumstances (prospective study) Italo Braghetto 1  · Gustavo Martinez 1  · Owen Korn 1  · Marcelo Zamorano 1  · Enrique Lanzarini 1  · Enrique Narbona 1 Received: 19 September 2017 / Accepted: 5 January 2018 / Published online: 15 February 2018 © Springer Nature Singapore Pte Ltd. 2018 Abstract Background Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) without resection of the distal stomach is largely performed over the world for morbid obesity. Potential risk of gastric remnant carcinoma development has been suggested. Purpose To present the results obtained after LRYGB with resection of distal stomach. Method This prospective study includes 400 consecutive patients. The mean body weight was 105.9 ± 16.8 Kg (range 83–145 kg), and body mass index (BMI) was 38.5 ± 4.4 kg/m 2 (32.9–50.3). Postoperative morbid–mortality and follow-up were analyzed. Results Operative time was 128.5 ± 18.7 min, hospital discharge occurred at 3rd postoperative day, postoperative compli- cations occurred in 9.25%, early surgical complications were observed in 3% and medical complications 4%, late surgical complications occurred 2.25%, no mortality was observed. At 1 year follow-up, BMI was 25.3 ± 2.7 kg/m 2 with % of weight loss (%WL) of 84.6 + 19.1%. At fve years follow-up very similar values were observed. Conclusion The results obtained after LRYGB with resection of distal stomach are similar to results published after non resection LRYGB regarding early and late results and can be indicated in high risk areas of gastric carcinoma. Keywords Laparoscopy · Gastric Bypass · Gastric resection Introduction Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) with- out resection of the distal stomach is the procedure largely performed over the world for morbid obesity [1]. Some late postoperative complications related to the “in situ” gastric remnant have been published. The risk factors of gastric can- cer developing after gastric bypass also have been suggested in spite the reported low rate of gastric carcinoma. Recently more and more cases have appeared in the literature, with very late diagnosis of advances carcinoma associated with very poor prognosis, specially in some areas with high rate of gastric cancer [2–7]. Rarely several postoperative complications related to “in situ” gastric remnant have been published during the last two decades [8–12], that potentially are avoided if resection of distal stomach is performed. In addition, high prevalence of histological pathologic lesions like intestinal metaplasia, lymphoid or atrophic gas- tritis, Gastro Intestinal Stromal Tumor (GIST) or dysplasia in the distal stomach in patients submitted to LRYGB has been described [8, 9]. Objective In this prospective study, we present our early and late results performing gastric bypass with resection of the dis- tal segment of stomach to demonstrate that this procedure does not increase postoperative morbid–mortality, presents similar results of non-resection gastric bypass, and therefore, could be indicated in areas with high risk areas of gastric cancer. * Italo Braghetto ibraghet@hcuch.cl 1 Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile