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Omega Loop Gastric Bypass (Mini Gastric Bypass)

How is mini gastric bypass performed?

As in other bariatric surgery procedures, mini gastric bypass is also performed laparoscopically, in other words, through 5-6-millimeter holes. The indications for the surgery are the same as for other procedures (click).

Unlike conventional bypass surgery, mini gastric bypass is performed by anastomosing the remaining stomach and the small intestines with a single anastomosis (anastomosis of the stomach and the intestine). First, the stomach is shaped in the form of a tube in the surgery.

This tube of 60-80 cc volume is different from that of the sleeve gastrectomy procedure. While the stomach bypassed is removed in sleeve gastrectomy, this portion continues to remain in the body in mini bypass and conventional bypass.

After the tube form is prepared, the first 2nd meter of the small intestine is found by counting, and this portion is anastomosed to the prepared stomach in the form tube that will be used as the new stomach.

This anastomosis is provided by disposable special equipment, called stapler. By this means, the first 2 meters of the small intestine is closed to food passage. The mean duration of the surgery is between 60-90 min.^

How does gastric bypass help you lose weight?

Food intake is decreased by reducing the volume of the stomach. Patients feel full earlier with smaller portions of food. This effect is similar to that of the sleeve gastrectomy
surgery. The stomach form prepared is smaller than that of the sleeve gastrectomy.

– Since the first 200 cm of the small intestine of patients undergone mini gastric bypass has been closed to food passage, there will be no absorption from this area. This portion holds the bile and pancreatic enzymes required for digestion and the absorption from the small intestine will start after contact of the bile and pancreatic enzymes with foods.

– The absence of food contact with the first portion of the intestine after mini gastric bypass will increase some hormones while reducing other hormones. These hormonal changes are effective in weight loss, especially in the control of diabetes.^

The advantages and disadvantages of mini gastric bypass;

Mini gastric bypass is technically easier and performed faster than conventional bypass surgery. It is more effective in the control of diabetes than the sleeve gastrectomy (tube stomach) procedure.

The most important disadvantage and the most criticized point of the procedure in the medical literature is possible BILE REFLUX complication. In a normal digestive system, the natural valve located in the output of the stomach prevents the passage of bile and pancreatic enzymes through the stomach.

Unlike conventional bypass, it is on the way of bile and pancreas enzymes to the stomach and contacts the inside of the stomach. A number of precautions are taken during the surgery to minimize the contact of the bile with the stomach.

According to our experiences, placing the stomach-small intestine junction on the back surface of the stomach and suspending the small intestine upwards minimize the bile reflux.
Although bile reflux is a cause of complaint in a very few patients, it substantially impair the quality of life the affected patients.

Gastroprotective and bile-binding drugs are used in the treatment. In a small group of patients who do not respond to medical treatment, it should be surgically converted into duodenal switch and Roux-Y gastric bypass procedures. Another controversial issue is whether bile reflux will lead to stomach cancer due to the contact with stomach over the years.

The removal of some portion of the stomach and anastomosis of the remaining stomach with the small intestine surgeries (Billroth II) have been performed for hundreds of thousands of people suffering from gastric ulcer for years. Fisher, MD re-evaluated 1000 patients underwent Billroth II surgery 25 years later and reported that 13 of 522 patients passed away due to stomach cancer.

No stomach cancer has been found in any of surviving and reached patients. In other words, 13 out of 1000 patients have had stomach cancer and this rate is the same as the normal population (Fischer AB, Graem N, Jensen OM. Risk of gastric cancer after Billroth II resection for duodenal ulcer. -4.)
Gastric ulcer (due to bile contact) is another risk of the Dumping syndrome procedure.^

Postoperative period of mini-gastric bypass surgery

Postoperative period is similar to that of the sleeve gastrectomy and RYGBP surgeries. Patients are stood up 4 hours after the surgery.

The next day, liquid foods are started and patients are discharged approximately within 3-4 days. After 1 week the patient returns to his/her normal life. The expected weight loss at the end of one and a half years is 65-80% of the excess weight.