Mini Gastric Bypass Surgery
The Mini Gastric Bypass (MGB), also known as Single-Anastomosis Gastric Bypass or Omega Loop Gastric Bypass, is a powerful weight loss procedure that is similar to the gastric bypass. The original, scientific title for the mini gastric bypass procedure is Billroth II operation or Gastrojejunostomy Intestinal Anastomosis. This weight loss surgery is quickly growing in popularity, as being one of the safest and most effective forms of bariatric surgery.
The mini-gastric bypass surgery uses both restriction and malabsorption to make it extremely effective. Patients can expect to lose 70-80% of excess weight with the mini-gastric bypass procedure. It is boosting in numbers worldwide since it was conceived in the United States 18 years ago by a well-known doctor named Robert Rutledge.
The mini-gastric bypass reduces the stomach size significantly, while also bypassing a large part of the small intestines. This procedure was a modification of the original Billroth II procedure.
Benefits of Mini Gastric Bypass
Above all, the mini gastric bypass has really great benefits for patients. Making it a highly chosen option compared to other bariatric procedures.
- Safe, highly recommended surgery
- Faster recovery time opposed to other procedures like gastric bypass and duodenal switch.
- High amount of success and weight loss
- Strongly requested by past patients
- One of the most effective surgeries to revise and rescue previous bariatric procedures
Mini Gastric Bypass Surgery Explained
Here we explain the single-anastomosis gastric bypass surgery in detail. You will learn why Mini Gastric Bypass Surgery may be the best option for you as a safe and bariatric procedure option in Mexico.
The 5 Steps to Surgery
- Place five trocars in your abdomen
- Create a new stomach pouch
- Measure small intestines to become a bypass point
- Create an anastomosis, connecting the new stomach to the small intestine
- Reinforce the anastomosis with sutures.
First, the abdominal cavity is filled with CO2 in order to have room to comfortably perform the procedure. The mini gastric bypass surgical procedure begins with bariatric surgical trocars that are placed within the abdomen. A trocar is a specialized tool will a hollow tube for surgeons to accurately perform surgery through with surgical equipment needed, including a laparoscopic video camera along with a few other laparoscopic tools. These five trocars are utilized by the surgeon to create a stomach pouch, which is sealed by an endoscopic cutter/stapler.
This makes it possible to perform the procedure with minimal scarring and without fully opening your abdomen. The bypassed section of the small intestines connects to the new stomach. This connection point is called an “anastomosis”. The anastomosis is reinforced with sutures.
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The Mini Gastric Bypass Surgery Details
There are two components created by this laparoscopic operation. The first is that the gastric pouch has less curvature and is thereby more restrictive. The second is a jejunal bypass that is 200 cm or longer and features a single anti-colic gastrojejunostomy anastomosis, leading to a significant reduction in fat absorption.
The surgeon inserts an endoscopic cutter/stapler through the trocars to split the stomach into two sections. The smaller section becomes your “new stomach.” It stays connected to your esophagus and the surgeon reshapes it into a narrow tube, similar to the shape of a vertical sleeve gastrectomy. The new mini bypass stomach will hold between four to six ounces of food, compared to the old stomach holding 40 ounces of food.
The lesser curvature is defined where the body and the antrum meet and the stapler division is created at a right angle from this lesser curvature, and then upwards parallel to it. The surgeon divides the stomach laterally toward the gastroesophageal junction. Unlike when it comes to the sleeve gastrectomy operation, the cardio is avoided explicitly. The larger section of the stomach that was split from your “new stomach” remains intact and alive within your body. It becomes important to produce digestive fluid which will help the digestion process, although will not hold food again.
This digestive fluid travels through the small intestine, connecting to the point at which food is digested through the “new stomach”, therefore breaking down the food as it continues through the intestine.
Then, the bariatric surgeon will examine the length of your small intestine, to measure the amount that will be bypassed. This section of the small intestine will include both the duodenum and a section of the jejunum. It generally is bypassed 5-6 feet from the point at which the larger stomach, or “old stomach”, connects to the small intestine.
When creating the 200 cm long malabsorptive jejunal bypass, the surgeon turns their attention to the left gutter, retracting the omentum medially so that they may identify the Treitz ligament. They run the bowel 200 cm distal to this ligament, at which point the gastric sleeve’s distal tip is anastomosed anti-colic to the jejunum end side.
Your surgeon will determine the length that is bypassed based on lifestyle, habits, health, and physical condition.
Finally, the surgeon begins the connection between the “new mini stomach” to the small intestine that is bypassed, using a stapler. This connection point is called an anastomosis. Once finished, the mini gastric bypass surgeon will reinforce and stabilize the anastomosis with sutures, finishing the procedure with sutures on the trocar insertion parts of your abdomen.
Mini Gastric Bypass Surgeons
The Expected Process of Digestion After Mini Gastric Bypass Surgery
The Normal Digestion Process
In the typical process of digestion, food begins in your mouth, goes down through the esophagus, then reaches your stomach.
For most people, the average stomach holds roughly 40 ounces of food. As the food gathers in your stomach, it combines with acids and enzymes that aid in digestion, by breaking down the food into small particles. The gallbladder and pancreas also create digestion juices to help aid in digestion, which connects to the small intestines through the pylorus.
As food breaks down, the particles get released into the first part of the small intestine (duodenum) and continue to the second part of the small intestine (jejunum). Almost all the calories, nutrients, and important enzymes are absorbed within the duodenum and jejunum while the most of the leftover particles go through the digestive tract and gets wasted.
The New Digestion Process
After the mini gastric bypass surgery, weight loss begins. For starters, the new stomach will hold significantly less food which creates the feeling of being full, while eating less food to reach fullness. Next, as the food exits the new stomach, it reroutes so it does not go through the duodenum and avoids most of the jejunum. Because of this, fewer calories and nutrients are absorbed. While also having most of the same digestive fluid the breaks down the food particles, from the old stomach. The old stomach is vital in digestion, using enzymes and acids to break up food at the point at which it bypasses a portion of the small intestine.
Hormones that have previously regulated your hunger and appetite, don’t effect mini gastric bypass patients the same. By eating less with a significantly smaller stomach, certain hormone levels are diminished and weight loss is achieved.
The mini gastric bypass surgery has shown itself to be quite useful in resolving Gastro-Esophageal Reflux Disease or GERD. Surgeons believe this is because it addresses obesity in the patient as well as creating traction reducing cardia in the abdomen.
Expected Excess Weight Loss (%EWL)
How the Mini-Gastric Bypass Evolved
In the early stages of the mini gastric bypass surgery, there were high prejudices by surgeons who had been performing longer procedures with greater difficulty. Doctors all over the world who are performing the mini gastric bypass operation, however, are finding that they are receiving the same results like these other operations. The attendees of the MGB conferences are finding that this procedure is technically straightforward, rapid, efficient and safe. The process also offers a single anti-colic anastomosis that is in prevailing view, the absence of any leaking issues and a bypassed length that can be modified based on the BMI of the patient. This procedure processes patients with durable weight loss that can be reversed or revised as needed.
- Surgery Duration – 2 to 3 hours
- Nights in Hospital – 3 nights
- Nights in Hotel – 2 nights (1 pre-op, 1 post-op)
- Back to Work – 3 to 4 weeks
Compared to Other Bariatric Procedures
The mini gastric bypass is similar to the gastric bypass, or Roux en Y, and the gastric sleeve, or vertical sleeve gastrectomy (VSG). The gastric sleeve uses restriction only, by removing 80% of the stomach, ultimately having the same “full feeling” and “eating less” like the mini gastric bypass. Although, the gastric sleeve procedure completely removes 80% of the stomach, instead of keeping it in place like the mini gastric bypass. The gastric bypass creates a small pouch, and actually forms a new stomach, while also bypassing the small intestines. The gastric bypass has two anastomoses, while the mini gastric bypass only has one while having a “new stomach” along the lesser curvature of the patient’s stomach. The mini gastric bypass is also less likely to stretch because of the new stomach along the lesser curvature. In comparison to gastric bypass surgery (RNY), the mini bypass has concerns related to high rates and prevalence of marginal ulceration (MU). Ulcers may cause risks and complications after mini-gastric bypass surgery.
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Some of the surgeons who engage in the mini gastric bypass surgery vary the actual length of the bypass. In people who are very tall or especially obese, the surgeon may opt for 250 cm or more rather than the traditional 200 cm distal to the Treitz ligament. A group in Italy has performed this surgery with 600 cm and more depending on the patient. Different modifications of this surgery have had different results, and it was found that placing the GJ between 200 cm and 300 cm proximal to the body’s ileocecal valve would be ideal for maintaining an adequate level of nutrition.
A Spanish technique has been developed, which was prevented by Flores hailing from Mexico. In this technique, they constructed an antireflux valve on the GJ’s afferent side. They place sutures along the afferent limb and the sleeve to inhibit the possibility of reflex. More than 80 percent of all attendees of the conference said that they used the Rutledge method and Rutledge measurements, whereas 10 percent used the Carbajo method presented by Mexico, and 5 percent utilized the Tacchino method involving the 300 cm standard limb.
Should it become necessary, it is possible for the MGB operation to be modified if there is inadequate weight loss or an excess amount of weight loss. This involves only moving the anastomosis either proximally or distally. There is a physician in India, Bhandari, who constructs a sleeve in a much longer length. Prasad, a physician in India, uses robotics in order to perform this operation.
Discussion on Survey Findings
Before the conference, a questionnaire was provided by SurveyMonkey. The results of the survey yielded the following information, that was based on carefully recorded data; especially necessary since the MGB had been met with heavy skepticism in the past. The average BMI before the operation was 46.1, and the average hospital stay was only 3.2 days. In 91.4 percent of patients, diabetes had resolved itself within one year.
There was evidence of preoperative GE reflux found in 15.3 ±14.2% and then postoperatively in only 4.7 ±14.2%. This led the experts to the opinion that GERD is improved by MGB. Surgery to revise the MGB has only been necessary to 3.2% of that 0.4% for bile reflux. Braun entero-enterostomy was rarely needed. In a small 1.4 ±1.8% (range 0-5) ulcers occurred; a number less than those after RYGB. There have been nearly no postoperative ulcers occurring in Spain and India.
The %EWL was: one year at 75.8, two years at 85.0, three years at 78.0, four years at 75.0, five years at 70.2, longer 70.0. In 14.2 ±25.1%, there was a failure to lose less than 50% of excess weight in 5 years. There has been a 0.2% effective 30-day mortality rate translating to 33 deaths.
A surgeon from Taiwan, Wei-Jei Lee, described a comparison that he made over ten years between the RYGB and the MGB surgeries. He believed that MGB was safer and simpler and that it produced better results when it came to diabetes reduction, GLP-1 elevation, and long-term weight loss.
Last Updated: Feb 13, 2018, by Ron Elli, Ph.D.
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