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Mini Gastric Bypass

Mini gastric bypass operation is one of the obesity surgeries. It entails making a smaller stomach by separating a small part from the main stomach sac in the form of a tubular structure. This small tubular structure is then connected directly to the small bowel bypassing the main stomach and about 2 meters of first part of the small bowel. Recently there is an international medical interest to perform this procedure which is explained below:

  1. The complications after this operation are relatively fewer than in the full gastric bypass operation for the following reasons:
    • The time required to perform the mini gastric bypass is less than that required to perform the full gastric bypass. Therefore, the chance of having complications like clots in the legs or lungs, and infections are less and this leads to faster recovery.
    • In the mini bypass only one joint in the small bowel is needed compared with 2 joints with the full bypass. This means that in the full bypass surgery higher surgical technical skills are required. This could lead to complications especially in the hands of the less experienced surgeons.
    • The weight loss results and the improvement of the patients’ chronic medical problems after mini gastric bypass are similar to that in the full gastric bypass.
  2. The chance of having bile reflux disease after the 2 operations:
    • The evidence based medicine showed that in some studies there is an increase in the bile reflux while other studies denies this.
    • The bile reflux is a condition that affects large number of population. Bile is the digestive secretions formed by the liver and can be refluxed up into the stomach and oesophagus from the duodenum. Usually when that reflux happens it is accompanied by the acidic secretions of the stomach. This can lead to inflammations and ulcerations of the stomach and the oesophagus. The patient symptoms are heartburn in the chest that might extend to the mouth, bad smelling mouth, vomiting, regurgitations and dry cough sometimes.
  3. The chance of having stomach ulcers is similar in both operations at around 4% and this is in the most published series at date of writing.
  4. The general consensus is that the malabsorption of nutrients in mini gastric bypass happens to a higher extent that that in the full gastric bypass. Therefore, it is observed that the weight reduction is more persistent for the people who had mini gastric bypass in comparison to those who full gastric bypass.
  5. In the event of failure (when the patient puts the weight back on) of both operations, it is more difficult to perform any surgical intervention in the full gastric bypass.  The mini gastric bypass however can be surgically revised relatively easier by decreasing the length of the actively absorbing small bowel, which leads to weight loss.

Lastly, each weight loss surgery procedure has its own pros and cons. The process to choose the suitable operation for the obese patient depends on: patient, surgeon and operation dependent factors. The study of all those factors together by the responsible surgeon and a detailed discussion with the patient will make the best decision for that patient.

References

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

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