The Mini Gastric Bypass (MGB) is a short, simple, successful, reversible laparoscopic gastric bypass weight loss surgery. It has been recently renamed as One Anastomosis Gastric Bypass. The operation usually takes shorter time, with lesser or similar hospital stay as regular bypass.

Indications

As per IFSO-APC Consensus statements 2011.

• Bariatric surgery should be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 with or without co-morbidities.

• Bariatric/GI metabolic surgery should be considered for the treatment of T2DM or metabolic syndrome for patients who are inadequately controlled by lifestyle alternations and medical treatment for acceptable Asian candidates with BMI ≥ 30

• The surgical approach may be considered as a non-primary alternative to treat inadequately controlled T2DM, or metabolic syndrome, for suitable Asian candidates with BMI ≥ 27.5.

Surgery

Mini Gastric bypass surgery is performed under general anaesthesia. Your surgeon makes several small incisions on your abdomen. A laparoscope, a thin instrument with a light and camera on the end, is inserted through one of the incisions, allowing your surgeon to clearly view the internal organs on a monitor. Small surgical instruments are inserted through the other incisions to perform the surgery.

The first step is to reduce the size of the stomach so that it holds less food. The stomach is converted into a long slender pouch up to the antral part by stapling.

The second step of the surgery involves the creation of a bypass for food to flow from the new stomach pouch. A loop of small intestine preferably between 150 and 250 cms is chosen for anastomosis depending upon the surgeon and the metabolic condition of the patient. The middle section of intestine is attached to the opening in the stomach pouch creating what is referred to as the "omega loop". The loop enables food to bypass the lower stomach, duodenum, and a portion of the small intestine. At the end of the procedure, the incisions are closed with sutures.

Post-operative care

After mini gastric bypass surgery, you will have to stay in the hospital for about 1 to 2 days. Your doctor will prescribe pain relieving medications to keep you comfortable. You will be given instructions to follow regarding wound care, diet and activity such as:

• Keep the incision area clean and dry.

• Avoid strenuous exercises and lifting heavy weights

• You may not be able to eat food for the first 1 to 2 days, after which you will be put on a liquid diet followed by pureed or soft foods.

• Sip water throughout the day to prevent dehydration.

• Follow the diet regimen given to you by the dietician.

• Follow an exercise program per your surgeons instructions to maintain the weight loss.

Advantages

• Mini Gastric bypass surgery can help you lose about 5 to 10 kilograms a month in the first year following surgery. You will gradually lose more weight by eating a healthy diet and participating in regular exercise.

• The surgery also helps you resolve obesity-related health conditions more aggressively.

• Unlike the RYGB, it is easily possible to fully reverse the procedure due to the simplicity of the primary procedure.

Disadvantages

• As the malabsorptive segment is more than the regular bypass, more nutritional deficiencies are encountered, which needs to be addressed seriously.

• Lifelong follow up with a physician is required for blood tests to ensure proper health and nutrition.

Risks and Complications

As with any surgery there are potential risks and complications involved. Complications associated with Mini Gastric Bypass include:

• Problems associated with anaesthesia

• Bleeding

• Infection

• Bowel obstruction

• Leaks in your gastrointestinal tract

• Deep vein thrombosis (blood clot in the leg)

• Dumping syndrome leading to diarrhoea and nausea

• Intractable Bile Reflux

• Gallstones

• Malnutrition

• Marginal Ulcers