Mini gastric bypass (MGB) is a type of bariatric surgery designed to simplify the traditional gastric bypass procedure while maintaining similar benefits. Developed by Dr. Robert Rutledge in 1997, the MGB has gained popularity due to its minimally invasive nature, shorter operative time, and fewer risks compared to more complex bariatric surgeries.
What is mini gastric bypass?
MGB is a restrictive and malabsorptive procedure. That is, it limits food intake and reduces calorie absorption. Unlike the traditional Roux-en-Y gastric bypass, the operation involves a single connection (single anastomosis) between the stomach and intestines. This reduces the risk of complications and the duration of the operation.
How does mini gastric bypass work?
By reducing the amount of food you can eat at one time, MGB alters the gut hormones that affect appetite and satiety. It combines some features of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy. The surgeon staples the upper part of the stomach to create a long, narrow pouch, similar to the upper three quarters of a sleeve gastrectomy. This pouch is then attached to a loop of small intestine, bypassing part of the small intestine. When you eat, food passes into this small pouch and then directly into the small intestine, bypassing most of the stomach and part of the small intestine, which alters the production of specific gut hormones that control appetite and hunger. This can lead to a decrease in appetite and a reduced craving for fatty, sugary foods.
Who is eligible for mini gastric bypass?
Although it varies depending on the patient’s condition, the following candidates are generally suitable for the operation:
- Those with obesity-related health problems (e.g. diabetes, sleep apnea) and a body mass index (BMI) of 35+
- Those who have previously failed weight loss attempts with diet and exercise
- Those who will be committed to lifelong dietary changes, regular exercise and vitamin supplements
How to prepare for mini gastric bypass?
Although there may be different preparations as your doctor deems appropriate, preparation for surgery generally includes the following steps:
- Patients undergo a number of health assessments, including consultations with a dietitian and surgeon. Mental health assessments may also be recommended to ensure they are ready for lifestyle changes. Routine tests such as blood tests, an ECG or a chest X-ray may also be required to check your suitability for surgery. Your anesthesiologist will examine you to ensure you are suitable for general anesthesia.
- It is important to follow the diet program given to you before surgery. Taking short walks will also help reduce the risk of post-operative complications and help you lose some weight before surgery. If you smoke, you may be asked to quit 6 weeks before your scheduled surgery date.
- You may be asked not to eat or drink anything for 6 hours before surgery.
- If you have any medications that you must take, you should inform your specialist.
- If you are taking blood thinners and/or have any allergies, you should tell your doctor.
What is the first day of the operation like?
On the day of your surgery, your nurses will measure your temperature, blood pressure, and respiratory rate for evaluation purposes. Before surgery, you will be asked to wear special stockings to prevent blood clots from forming in your legs. You may also be given anticoagulant (blood thinner) injections to minimize this risk. Your surgeon will explain the procedure to you in detail.
How is mini gastric bypass surgery performed?
The steps of the operation are briefly as follows:
- The procedure usually takes 2 hours and is performed laparoscopically using small incisions.
- The stomach is divided to create a narrow pouch.
- This pouch is connected directly to a loop of the small intestine.
How is the recovery after the operation?
Recovery varies from person to person, but most patients will spend about 2-6 weeks recovering before returning to a fully active lifestyle.
Post-Surgery:Usually 4 hours after your surgery, your doctor will ask you to stand up and start moving around, and to walk around for 10 minutes every 2 hours.
Hospital Stay: Most patients will stay in the hospital for 1-2 days.
Return Home: When you return home, you may feel a tingling, itching, or numbness at the incision site. This is normal and part of the healing process. However, if you experience a high fever, swelling, pain, drainage, or excessive redness around the wound area, or difficulty swallowing, you should contact your doctor.
First Week After Surgery: The first week usually involves low activity, focusing on rest, fluid intake, and a liquid diet. Pain and discomfort are to be expected, but these usually subside as your recovery progresses.
2-4 Weeks After Surgery: Patients gradually begin soft foods and slowly increase physical activity, focusing on low-impact exercises and walking.
4-6 Weeks After Surgery: By this time, most patients have returned to regular activities, including work and light exercise. Dietary adjustments continue with the inclusion of more solid foods.
After 6 Weeks: While full recovery varies from person to person, patients can usually return to all normal activities after 6-8 weeks. However, they should avoid strenuous exercise for several weeks to promote healing.
After 8 Weeks: You may begin eating “normal” foods (solids). However, be careful with foods that don’t fall apart in your hand, such as bread or broccoli, as these can swell in your stomach and cause bloating. Be sure to continue walking for 30 minutes each day.
What can you do to speed up recovery?
To make your post-operative recovery faster and more comfortable, you can:
Follow your doctor’s instructions: Before your surgery, your bariatric surgeon will review the guidelines you will need to follow during your recovery. It is imperative that you follow these guidelines to minimize risks and complications after surgery.
Follow your diet: Following your post-operative diet is important not only for your recovery, but also for your long-term results. Remember that you may not be able to eat solid foods for several months after surgery. You will eat a clear liquid diet for the first week of your recovery, pureed foods for the following weeks, and soft foods for up to two months after that. Your doctor/dietician will work closely with you to design a diet plan that fits your needs.
Drink Plenty of Water: Drinking plenty of water during your recovery will help your body heal quickly and properly. Adequate fluid intake is especially important during the recovery phase when you are starting to lose weight. Remember to drink at least 8 glasses of water per day.
Move Early: Moving as soon as you are physically able after mini gastric bypass surgery can help reduce your risk of developing deep vein thrombosis. Deep vein thrombosis is a blood clot that most often develops in the legs. The clot can break loose and travel through your bloodstream and into your lungs, blocking blood flow and causing serious consequences. Avoid strenuous activity in the days following your surgery, but try to move around the house as much as possible.
Frequently Asked Questions About Mini Gastric Bypass
What are the differences between Mini and Roux-en-Y gastric bypass?
Each operation has its advantages and disadvantages. Your doctor always determines the operation method specifically for you. The main difference between MGB and Roux-en-Y is that it is generally considered a faster and simpler procedure. Since only one anastomosis (joining of the stomach and intestines) is made in MGB, it requires fewer incisions and therefore results in fewer complications and generally faster recovery. For example, while the risk of internal hernia is quite low in MGB, it may be higher in Roux-en-Y gastric bypass patients.
What are the benefits of mini gastric bypass?
Although the superiority of the operations over each other depends on the suitability of the patient, we can list the benefits of MGB as follows:
Effective Weight Loss: You can expect to lose approximately 60%-75% of your excess weight within two years after the operation.
Improvement in Obesity-Related Disorders: Most patients lose a significant portion of their excess weight within a year and observe relief in conditions such as hypertension. It can help with remission in the case of type 2 diabetes. This means that many patients can stop or reduce their medications immediately after the operation.
Shorter Surgery Time: The operation is usually 50 minutes shorter than traditional gastric bypass.
Less Risk of Complications: Risks such as leakage or internal bleeding are less common in this type of operation.
Faster Recovery: Patients return to normal activities sooner.
Are there any risks to mini gastric bypass?
Although safer than traditional methods, MGB still carries risks, including:
Nutritional Deficiencies: May require long-term vitamin and mineral supplements.
Dumping Syndrome: Rapid emptying of stomach contents, which can cause nausea and cramping.
Bile Reflux: Because the pouch is small and closely spaced in the flow of digestive juices, it is possible for these juices to “backflow” into the stomach pouch, causing inflammation and painful ulceration. However, it should be noted that most recent studies do not seem to report this to be a major problem in practice. However, if this problem occurs, the problem can be solved by revising the gastric bypass.
Weight Gain: It occurs when diet and exercise rules are not followed.
What should your lifestyle be like after the surgery?
Although the operations are quite effective in losing weight, making it sustainable requires that you comply with the following conditions:
- Balanced diets consisting of controlled portions
- Regular exercise to maintain weight loss
- Regular follow-up with your doctor, including nutritional counseling