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.