Mini Gastric Bypass Surgery

The Mini Gastric Bypass, first used in the late 1960’s and abandoned in the 1970’s, was recently brought back because this operation can be done through a laparoscope. The mini-gastric bypass is very similar to the Roux en Y gastric bypass. It functions by dividing the stomach into a small, one-ounce or less, upper pouch from the remainder of the stomach.

The upper pouch empties directly into the small bowel. No part of the stomach is removed. The stomach is cut and clipped to form a thin tube, which is reconnected, bypassing about six feet of intestine. The procedure is considered permanent, and would only be changed if a medical problem arises that requires the body to absorb more nutrients. The American Society of Bariatric Surgery does not endorse this procedure because their are other surgeries that are safer and more effective.

How to make a mini gastric bypass

We bring a loop of small bowel up to the stomach, making an opening between them in order for food to move out of the upper stomach and into the bowel. This opening between the stomach and the small bowel is called an “anastomosis.” That is it—you have now done surgery! Experienced surgeons can do this surgery in about twenty minutes. The short surgery time is one of the advantages touted for this surgery.

How to make a Roux en Y

Now compare the mini gastric bypass surgery to the more popular Roux en Y gastric bypass. See the difference? No? There is an extra connection in the RNY that prevents the lower stomach content from going to the upper pouch.

Why that extra anastomosis (connection)? In normal anatomy (that is anatomy which God gave you, before some surgeon decided to mix it up) the end of the stomach is marked by the pylorus—or, a type of one-way valve that helps keep digestive juices out of the stomach.

Food moves from the stomach pouch into the small bowel, (A) which is known as the enteric limb. The digestive juices are carried by the small bowel (B) known as the bilio-pancreatic limb. They join together at C, which is called the “common channel.”

The R.N.Y. gastric bypass separates these components of digestion. The RNY gastric bypasses brings digestive juices away from the stomach pouch, avoiding irritation of the stomach by these juices.

However, as you see in the Mini-gastric bypass, those digestive juices, the bile, the enzymes, all flow back into the upper pouch. Normally they aren’t there. Critics of the mini-gastric bypass state that those juices can cause some erosion of the stomach (bile gastritis) and the esophagus.

The question remains—is the mini-gastric bypass that bad?

It is not supported by The American Society of Bariatric Surgeons, nor by a number of insurance companies, but it is fast and it does have the components of the Roux en Y. The extra connection, the Roux en Y, serves as protection to the stomach, keeping the bile and enzymes away from it. That extra connection takes some extra time to create and is one extra connection that can leak—although it is rare. The most common connections that leak are the ones between the stomach and the small bowel.

In summary, the mini-gastric bypass was the first gastric bypass done

It was largely abandoned because sometimes the bile and pancreatic juices caused damage to the lining of the stomach and esophagus. When bile refluxes back into the stomach it can cause damage, pain, and ulcers. The mini-gastric bypass does work as a weight loss surgery. The question is whether this is a better procedure than the RNY. The answer is that it is not better. The RNY takes a bit longer to do, but not that much longer. Sometimes it is worth spending an hour or so more in the operating room in order to avoid future problems. Proponents of the mini-gastric bypass surgery say that this surgery works as well as the RNY, and that these concerns are minimal.

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