Mini Gastric Bypass

Mini Gastric Bypass

What is a Mini Gastric Bypass?


The Mini Gastric Bypass Surgery (MGBP) is also referred to as Single Anastomosis Gastric Bypass (SAGB) surgery.


The Mini Gastric Bypass is a relatively new procedure, which combines some of the properties of a Gastric Sleeve with a Gastric Bypass.


The Mini Gastric Bypass procedure is performed with a Laparoscopic (keyhole) technique under general anaesthesia.


The upper part of the stomach is divided into a tube, similar to the top three-quarters of a sleeve and then joined to a loop of intestine.

Five small incisions (between 5 and 12mm in length) are made for the insertion of keyhole surgery instruments.


Using these instruments, the top of the stomach is stapled to form a thin tube (30ml to 50ml in size). The thin tube becomes the new, smaller stomach and is completely separate to the rest of the stomach.

This stomach is then sewn to a loop of the small intestine, bypassing the first part of the intestine called the duodenum and approximately 150-200cm of the bowel. The rest of the stomach and upper part of the small intestine remains in the body but is no longer used for food digestion.


It is an operation that combines restriction with some malabsorption, and the result is that it provides good weight loss with great quality of life.



How Does the Mini Gastric Bypass Work?


The Mini Gastric Bypass helps you to lose weight in two ways:

  • Restricting the amount of food that can be eaten at any one time, thereby reducing meals to healthy portion size, and
  • Decreasing the number of calories your body absorbs during digestion as food bypasses about 200cm of your upper small intestine


What are the Advantages of the Mini Gastric Bypass?


  • It is particularly effective for patients with a larger BMI as the procedure has more predictable weight loss outcomes.
  • Most patients have an almost immediate reduction in their need for diabetic medication and some are able to completely stop diabetic medication altogether.
  • It does not require any on-going adjustments which are required with other procedures, such as the gastric band. Regular follow up is however necessary to ensure weight loss is appropriate and intake is nutritionally adequate.
  • It is effective for those people who tend towards high sugar or high-fat foods. Dumping syndrome is directly linked to a high-sugar, or high-fat intake. Symptoms of dumping are unpleasant and therefore discourage the intake of high-calorie sweet foods.
  • How Much Weight Will I lose with the Mini Bypass?
  • Most people can expect to lose up 70% of their excess body weight over a 12 to 18 month period.


Who is a Candidate for the Mini Bypass?


You may be eligible for a Mini Gastric Bypass if you have a Body Mass Index (BMI) that is greater than 40 (or greater than 35 with weight-related illnesses) and you have tried all other types of diets without long-term success. In certain circumstances, patients with lower BMI may be candidates.



What are the Disadvantages of the Mini Gastric Bypass?


The disadvantages of the Mini Bypass are generally related to the magnitude of the surgery:

  • Complications, although rare, are generally more serious than with other weight loss procedures, such as the gastric band.
  • There is a higher risk of nutritional deficiency due to the reduced absorption of vitamins and nutrients. Life-long vitamin and mineral supplementation is essential to prevent deficiency following surgery. Long term follow-ups with the surgeon and dietitian to monitor nutritional status is also very important.


What are the Risks of a Mini Gastric Bypass?


As with any surgical procedure, the MINI GASTRIC BYPASS operation has risks which are important to clearly understand before proceeding.
The following is a comprehensive list of issues which can occur. Most of these complications are very rare and 90-95% of patients have no issues.


Dr Hatzifotis takes measures directly aimed at reducing these risks, but if complications occur, additional treatment may be necessary.

Precautions are taken in all patients to reduce any risks to the absolute minimum. The following complications are uncommon & unusual, and may occur following any surgical procedure:


Possible Acute Complications may include (but are not limited to):


  • Bleeding - This occurs in less than 1 in 100 patients after the procedure. This may require blood transfusion or rarely re-operation.


  • Infections –Infections in abdomen, chest or wounds may develop. An infection may require treatment with antibiotics and can occasionally require re-operation.


  • Leak - A leak of fluid can occur through the new join between the stomach and intestines if it does not heal well. This can happen in the first few days after surgery and may require reoperation. If these leaks persist they can leak to the skin or wound (known as a fistula) or cause a persistent fluid infection in the area (abscess). If this happens, length of hospital stay may be extended to weeks or even months after surgery, and it may be a life-threatening problem. This occurs in less than 1% of cases.


  • Ulcers - Just like ulcers can occur in a normal stomach, they can also occur in the new stomach pouch after a Mini Gastric Bypass. For this reason, patients need to take anti-ulcer medication for 6 months after surgery. Sometimes ulcers can still develop and require additional therapy to manage.


  • Damage to Organs – Any Laparoscopic or keyhole procedure can be complicated by unintentional injury to the organs near the area of operation. This may require a repeat operation to repair the damaged organs.


  • Blood Clots – Deep Venous Thromboses (clots in the veins) and pulmonary embolus (clots in the lungs)



 

Are there any Long Term Complications of the Mini Gastric Bypass? 


There are some long term problems following the MINI GASTRIC BYPASS that have been reported to date.

 

Possible Long Term Complications may include (but are not limited to):


  • Wound Hernia any wound of the abdominal wall has a chance, anytime in future, of developing a hernia (some of the bowel or fat from inside the abdomen can get stuck underneath the skin). If this happens it needs to be assessed, and if it is red, hot and painful it should be seen to quickly as it may be an emergency.


  • Anastomotic Stricture – It is important to keep the new connection between the stomach and the intestines small so as to achieve the right amount of weight loss. Sometimes this means the connection is too tight (1% patients). If this occurs it may require stretching under endoscopy (camera into the stomach) or re-operation.


  • Internal Hernia – Occasionally the loops of bowel in the abdomen can become entangled and get stuck. If this occurs, a re-operation is required to fix the problem. If there are any unexpected abdominal complaints it is important to be assessed quickly by the surgeon.


  • Adhesions – Any procedure in the abdomen can cause adhesions (scar tissue). This can occur any time after the operation and can sometimes cause problems with the bowel getting stuck or twisted. This may require hospitalization and may even require re-operation.


  • Gastro-Oesophageal Reflux – If reflux occurs post-operatively some patients can require acid-suppressing medication. This operation should be avoided for those people with severe symptoms of reflux prior to surgery.


  • Weight Re-gain or Failure of Weight Loss – This usually occurs when dietary advice is not followed. If you eat too much food at once, this can stretch the small stomach pouch making it easier to take larger volumes at meal times in the future.


  • Other - As this surgery affects the function of the gut, some patients are unable to tolerate adequate intakes of food which can result in the requirement of long-term nutritional support via intravenous methods, called TPN (total parenteral nutrition).


  • Dumping Syndrome - Dumping is a group of signs and symptoms that usually occurs due to poor food choices. It is the result of high sugar or high-fat foods passing too quickly into the small intestine. Symptoms can include cramping, nausea, dizziness, weakness and fatigue. More information about dietary advice to avoid dumping will be provided during your visit to the dietitian.


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