Mini Gastric Bypass vs Gastric Bypass
Are you looking for information on Mini gastric Bypass VS Gastric Bypass surgery? Both these surgeries have their own sets of benefits. However, only a bariatric specialist can best judge your eligibility and the success rate of that procedure.
Find out what our partner Bariatric Surgeon from Cancun- Dr Hectar Perez says about the traditional Gastric Bypass and the trendy Mini Gastric Bypass surgery.
Gastric Bypass Before and After
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Connect nowObese or overweight individuals are at risk of fatal cardiac events, musculoskeletal disorders, and even some cancers. Weight loss surgery is a suitable option for extremely obese people with underlying medical chronic medical conditions such as diabetes and hypertension.
According to the World Health Organization[1]WHO
Obesity and Overweight
“Worldwide obesity has nearly tripled since 1975…”
View in Article, worldwide obesity has tripled since 1975.
What is the difference between a Mini Gastric Bypass and a Gastric Bypass?
| Criteria | Mini-Gastric Bypass | Roux-en-Y Gastric Bypass |
|---|---|---|
| Operating time | Less (~ 2hours) | More
(~2.5 to 3 hrs) |
| Simplicity | Simpler[6]The Journal of Metabolic Surgery and Allied Care Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience “At 5 years after surgery, the mean BMI was lower in LMGB than LRYGB (27.7 vs. 29.2, p < 0.05) and LMGB also had a higher excess weight loss than LRYGB (72.9 vs. 60.1%, p < 0.05)…This study demonstrates that LMGBP can be regarded as a simpler and safer alternative to LRYGB” View in Article |
Complex |
| Safety | Safer | Riskier |
| Hospital stay | Equal | Equal |
| Cost | Cheaper | Expensive |
| Food Tolerance | More | Less |
| Reversal | Easily possible | Possible but complicated |
| Weight loss percentage | Up to 70% | Up to 70% |
| Improvement in comorbidities | Significant | Significant |
| Complications | No major complications | 20% risk of major complications |
| Recovery | Quickest | Progressive |
This article highlights the differences between a mini-gastric bypass and a traditional gastric bypass.
Gastric bypass procedure is nowadays done laparoscopically by making small incisions in the abdomen. However, in some candidates, open Roux-en-Y gastric bypass may be preferred.
Why Gastric Bypass is known as the Gold Standard of Bariatric Surgery?
The gold standard is referred to as something that is considered to be the best and can be used to compare the judge or quality of something similar. Surgery for Obesity and Related Diseases
Laparoscopic sleeve gastrectomy: The rightful gold standard weight loss surgery procedure
“The American Society for Metabolic and Bariatric Surgery (ASMBS) and the National Institute of Health considers Roux-en-Y gastric bypass (RYGB) the “gold standard” of weight loss surgery [ 1 ]. Merriam-Webster defines the gold standard as something that is considered to be the best and that is used to judge the quality or level of other, similar things…”
View in Article
When compared to other bariatric surgery procedures such as sleeve gastrectomy and laparoscopic gastric banding, gastric bypass is known to result in better weight loss results and improvement in metabolic functions.[6]Tucson Newsletter
Gastric bypass called ‘gold standard’
” University of California-San Francisco researchers found that those who had their stomach capacity reduced by a Roux-en-Y bypass, which reduces the stomach’s capacity and bypasses a part of the intestine, lost more weight, required less diabetes medication and were less likely to need further surgery than those who received the Lap-Band…”
View in Article
What Happens During Gastric Bypass?
Both laparoscopic and open RYGB are effective. Reduced postoperative pain, shorter hospital stay, and shorter sick-leave are the benefits of a laparoscopic procedure. But there are 25 per cent chances of a re-operation or a conversion to open procedure [3]The Journal of Metabolic Surgery and Allied Care
Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial
“Reduced postoperative pain, shorter hospital stay and shorter sick-leave are obvious benefits of laparoscopy but conversions and/or reoperations in 1/4 of the patients indicate that Lap-RYGBP at present must be considered an investigational procedure.”
View in Article.
The procedure involves four major steps.
- A small pouch is created by dividing the top of the stomach from the rest of the stomach.
- The small intestine is divided into two parts – the smaller first part and the longer second part.
- The newly created small stomach pouch is connected to the upper end of the lower part of the intestine.
- The lower end of the upper intestine is connected to the small intestine further down. This is done to ensure that the digestive juices from the stomach and upper part of the intestine continue to mix with the food.
Check out this video to understand Gastric bypass better.
Video Courtesy: HCA East Florida
Mini Gastric Bypass Vs traditional Gastric Bypass (RNY): How Do They Work?
The mini-gastric bypass has a lot of differences as compared to traditional gastric bypass surgery. However, both of these procedures work on three primary mechanisms:
1. Restriction
The size of the newly created pouch during both the surgeries is significantly smaller than the original size of the stomach. Therefore, it facilitates smaller meal consumption and therefore, less calorie intake.
2. Malabsorption
There is less absorption of calories and nutrients. The food being eaten now bypasses the larger part of the stomach and upper part of the intestine. However, malabsorption can lead to malnutrition in case of gastric bypass. This is, however, avoided in mini gastric bypass surgery.
3. Changes in the Gut Microbiome
Gastric bypass induces changes in the gut microbiome. Malabsorption status after bariatric surgery and changes in the metabolism of bile acids, gastric pH, and metabolism of hormones lead to gut microbiota changes [4]Bioscience of Microbiota, Food and Health
The effects of bariatric surgery on gut microbiota in patients with obesity: a review of the literature
“Malabsorption status after…bariatric surgery.”
View in Article.
Since changes in microbiota also affect energy homeostasis, weight loss is achieved.
Mini Gastric Bypass VS Gastric Bypass: The Difference?
Traditional gastric bypass is very effective when it comes to weight loss. However, it is technically challenging and also carries a 7 per cent complication risk.[5]Obesity Coverage
Mini-Gastric Bypass – The Good, Bad, And Ugly
“While traditional gastric bypass surgery…7% complication risk”
View in Article
In a bid to make the procedure simpler and reduce complications, Dr Robert Rutledge developed a mini gastric bypass in 1997. Also, known as one-anastomosis bypass, it is a less complicated version of traditional gastric bypass that may lead to similar weight loss.
Some of the key mini-gastric bypass vs traditional gastric bypass (RNY) differences are explained below.
Cost
A mini-gastric bypass is less expensive as compared to traditional laparoscopic or open gastric bypass.
The following table highlights the cost of a mini-gastric bypass and traditional gastric bypass.
| Procedure | Mexico | Australia | US |
|---|---|---|---|
| Mini gastric bypass | $5,500 to $6,500 | $13,000 to $14,500 | $20,000 to $25,000 |
| RNY gastric bypass | $7,500 to $11,000 | $16,000 to $18,000 | $28,000 to $35,000 |
Technique
Mini-gastric bypass involves less re-routing of the intestines. It involves the creation of a long narrow tube of the stomach along the right border with less curvature.
Next, a loop of the small intestine is brought up and hooked to this gastric tube. Because a mini-gastric bypass used low set loop reconstruction, there is only a rare chance of acid reflux.
On the other hand, a gastric pouch is created in the case of a traditional gastric bypass. The reconstruction of the gastrointestinal (GI) tract is then done to connect the small intestine to the lower end of the pouch.
Traditional gastric bypass, therefore, involves greater reconstruction of the GI tract and is more complicated.
Ideal Candidate for surgery
Candidates with gastroesophageal reflux disease (GERD) or bile reflux are NOT a suitable candidate for a mini-gastric bypass. Such patients are recommended to undergo a traditional gastric bypass.
Operating Time
The operating time is significantly shorter for a mini-gastric bypass as compared to traditional gastric bypass (115 versus 159 minutes) [6]The Journal of Metabolic Surgery and Allied Care
Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience
“Surgical time was significantly longer for LRYGB (159.2 vs. 115.3 min for LMGB, p < 0.001)”
View in Article.
Simplicity and Safety
Mini -gastric bypass is considered safer than traditional gastric bypass. The former involves only one connection called anastomosis. On the other hand, the RNY gastric bypass involves multiple rerouting. This is one one the key mini-gastric bypass Vs traditional gastric bypass (RNY) differences.
Moreover, the mini-gastric bypass is a simpler technique for surgeons. It is an effective, relatively low-risk, and low-failure bariatric procedure [7]The Journal of Metabolic Surgery and Allied Care
One thousand consecutive mini-gastric bypass: short- and long-term outcome
“MGB is an effective, relatively low-risk, and low-failure bariatric procedure.”
View in Article.
Efficacy (Percentage of Postoperative Weight Loss)
Excess weight loss is significantly greater in mini-gastric bypass candidates in the first year of follow-up. However, the difference is not significant at 2 years of follow-up [8]Annals of Surgery
Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity
“Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.”
View in Article.
Both the procedures are, therefore, effective treatments for morbid obesity.
Hospital Stay
The average hospital stay for both the types of surgeries is the same, about two to 3 days. In the case of open gastric bypass, the duration of hospital stay can be up to 6 days.
Use of Medications
Gastric bypass patients typically required a higher dose of analgesics during the hospital stay. This is because, during traditional gastric bypass surgery, the small intestine is shortened. This leads to the loss of a great part of active drug carriers located in that area. [6]International Journal of General Medicine
The use of drugs in patients who have undergone bariatric surgery
“Surgical procedures, such as RYGB, shorten the small intestine and lead to the loss of a great part of active drug carriers located in that area, thus affecting its absorption…”
View in Article
Therefore heavier doses are needed for effective results.
Improvement in Obesity-related Parameters
Both the groups of patients experience a significant improvement in obesity-related comorbidities such as hypertension, diabetes, high uric acid, reduced liver function, and high lipid levels.[8]Annals of Surgery
Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity
“Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.”
View in Article
Recovery Time
Recovery is quicker for both the groups of patients since the procedure is performed laparoscopically. However, since mini gastric bypass is a less complicated procedure, recovery is quicker for such patients and the downtime is less.
Postoperative Complication Rate
The rate of major complications in the case of a mini-gastric bypass is negligible. On the other hand, it is about 5 per cent in the patients who undergo traditional gastric bypass.
The rate of minor complications in mini-gastric bypass is about 7.5 per cent, as compared to 15 per cent in the other patients.[8]Annals of Surgery
Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity
“The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05).”
View in Article
The most common major complication in the case of gastric bypass is anastomotic leakage. Gastrointestinal bleeding and leakage from drainage tubes are minor complications. It can be observed in both the category of patients.
Possibility of Revision Surgery
Mini-gastric bypass, being less complicated, can be easily revised, converted, or reversed. However, that is not generally preferred in the case of gastric bypass as the procedure is complicated and risky.
Traditional gastric bypass reversal can be done on a carefully selected patient population if there are no alternative strategies available. [9]Surgery for Obesity and Related Diseases
Gastric bypass reversal: a 7-year experience
“In a carefully selected patient population, gastric bypass reversal should be considered if conservative approaches to adverse conditions fail.”
View in Article
Food Tolerance
Food tolerance is better in patients who undergo a mini-gastric bypass as compared to traditional gastric bypass.
Both approaches result in equal weight loss over a period of two years. However, due to less complexity and lower cost, the mini-gastric bypass is now emerging as the preferred choice of procedure.
Check these links to know the clinical outcome of both procedures: Gastric bypass and mini-gastric bypass success rates
The candidates should, however, discuss their eligibility with the specialists before making a decision. To observe significant weight loss, it is important in the case of both surgeries to follow the dietary guidelines and take supplements.
Read about some common bariatric surgery procedures here:
- Sleeve gastrectomy
- RNY Gastric bypass
- Adjustable gastric band
- Biliopancreatic diversion with duodenal switch
References:
- WHO: Obesity and Overweight
- American Society for Metabolic and Bariatric Surgery: Bariatric Surgery Procedures
- The Journal of Metabolic Surgery and Allied Care: Laparoscopic vs open Roux-en-Y gastric bypass: a prospective, randomized trial
- Bioscience of Microbiota, Food and Health: The effects of bariatric surgery on gut microbiota in patients with obesity: a review of the literature
- Obesity Coverage: Mini-Gastric Bypass – The Good, Bad, And Ugly
- The Journal of Metabolic Surgery and Allied Care: Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience.
- The Journal of Metabolic Surgery and Allied Care: One thousand consecutive mini-gastric bypass: short- and long-term outcome.
- Annals of Surgery: Laparoscopic Roux-en-Y Versus Mini-Gastric Bypass for the Treatment of Morbid Obesity
- Surgery for Obesity and Related Diseases: Gastric bypass reversal: a 7-year experience
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