The mini gastric bypass is a minimally invasive surgical procedure that is both restrictive and malabsorptive. It is also known as single anastomosis gastric bypass and is a simple operation that combines the characteristics of both gastric sleeve and Roux-en-Y Gastric Bypass. Apart from reducing the size of the stomach and restricting the amount of food eaten, this procedure also reduces the absorption of the ingested food by bypassing approximately 6 feet of intestines.
The stomach is divided with the help of a laparoscopic stapler such that a hockey-stick shaped sleeve along the lesser curve is created, while the baggy part is disconnected from the esophagus (food pipe). The native/remnant stomach henceforth will not receive food once this is done (since the esophagus now leads to the new sleeve). Approximately 150-200 cm of the upper small bowel is bypassed. This means that this part of the small bowel will not come in contact with the food that comes down from the new stomach. The food directly enters the small bowel (jejunum) around 150-200 cm from its starting point, as this point is where the stomach and jejunum are connected together. The food therefore enters into the new stomach and bypasses approximately 6 feet of intestine where it then continues with the normal digestive stream.
There are 3 ways by which the mini gastric bypass helps you:
•The portion size is reduced like in a sleeve operation, as the new stomach has around 200-250 ml capacity.
•As a result of bypassing approximately 5 to 6 feet of the upper part of the small intestines, the amount of food absorbed is reduced.
•There is a major hormonal change that occurs after the procedure. 200 or more hormones have been identified to be released from the intestinal tract and impact weight loss and metabolic remission of diabetes. These have been grouped and named as incretins. Some of these are so powerful that they have been isolated and are now manufactured as anti-diabetes medications!
The MGB is a powerful operation. It combines the power of the sleeve and the bypass together. In fact, it may be as powerful as the most potent bariatric procedure, the BPD (biliopancreatic diversion). The benefits of the MGB are:
• Patient can swallow food comfortably
• Patient can eat decent volumes of food
• No reflux or acidity symptoms (in the majority of patients)
• Allows cheat meals
• Stomach pouch does not dilate later in life (something that leads to weight gain)
• Is reversible
• Can be revised easily
• It is accumulating favorable reviews in scientific studies
• Patient satisfaction seems to be very high
• Pain scores and discharge times are the best amongst all procedures (personal data)
• Virtually no leaks, compared to the sleeve and bypass.
• No internal hernias later (though stray cases are reported)
There is a very good chance that your answer is YES. In some situations, we would not consider the MGB. For example, in cirrhosis of liver, renal transplant recipients and in large, symptomatic hiatus hernias, the other procedures would get preference, not the MGB. Likewise, in the younger generation of patients, the MGB may not be the first choice.