Rafał Mulek

Mini gastric bypass surgery is becoming more and more popular both among bariatric surgeons and patients. This is due to the fact that, despite the greater simplicity and lower degree of complexity, it is a procedure that guarantees treatment results in no way inferior to those after the operation of a more complex and technically more difficult gastric bypass.

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Don't be fooled by the name mini! Mini bypass, it's less work, but not mini results!!! 😉

 

Mini gastric bypass surgery can be presented as a modification of gastric bypass surgery.

The main differences are as follows:

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1) The MGB mini gastric pouch is longer and slightly larger than in gastric bypass surgery. Comparing the 3 most frequently performed bariatric procedures, the gastric pouch is the largest after gastrectomy and the smallest after gastric bypass. After MGB, the size of the stomach is an intermediate value. The situation when we care about the smallest gastric reservoir takes place in patients suffering from gastroesophageal reflux disease. In this group of patients, thanks to gastric bypass surgery, we are able to free patients from this unpleasant ailment. If we do not have to "fight" for the smallest volume of the gastric tank, we gain safety and simplicity of the procedure. The longer gastric pouch allows for tension-free gastrointestinal anastomosis even in very obese patients.

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2) At MGB, we perform one anastomosis instead of two. You don't need to be a scientist to figure out that two anastomoses are potentially twice as many possible problems both before and after surgery. One anastomosis between the gastric pouch and the intestine divides the small intestine in two

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– an enzyme loop (about 160 – 200 cm long) that delivers digestive juices from the distal part of the stomach, pancreas and liver through the duodenum and

– food loop (common), in which food is digested and absorbed. 

 

Dividing the intestine into two parts allows only a part of the intestine to assimilate the ingested food (this affects the strength of mini gastric bypass as a bariatric procedure) and allows the duodenum and the first part of the small intestine to be excluded from contact with food, which is most likely one of the mechanisms allowing cure type 2 diabetes (metabolic effect).

 

3) Due to its design, the MGB operation is associated with a much lower risk of internal hernias in the long term after the operation compared to the gastric bypass operation.

 

4) The biggest disadvantage of mini gastric bypass is the risk of regurgitation of bile from the intestinal (enzymatic) loop into the gastric pouch, which may cause inflammation. In order to reduce this risk, we construct the anastomosis in such a way that the contact of bile with the gastric mucosa is as short as possible. Classic gastric bypass is free from this defect, but at the price of an additional anastomosis between the intestinal loops.​