Laparoscopic Mini Gastric Bypass

Overview:

Laparoscopic Mini Gastric Bypass (LMGB) surgery is a safe, effective, and simple bariatric surgery done for weight loss. Bariatric surgery is done for shedding of pounds (weight loss) and is of two types. One is the restrictive type, and the other is the restrictive and malabsorptive type. It is a simplification of the Roux-en-Y bypass, which is a restrictive and malabsorptive surgery. It is performed by a single anastomosis, which significantly reduces technical complexity, has a shorter operative time, and potentially reduces complications. 

Advantages of LMGB:

This procedure has several benefits, comprising weight loss, decreased comorbidities like diabetes, hypertension, lipid parameters, and liver functions, and an increased quality of life. The other advantages include fewer anastomoses, relatively shorter operative time, lower risk of leakage, and lesser herniation from tissues. 

Indications:

LMGB is a bariatric surgery indicated when an individual is suffering from health conditions like obesity. Obesity is a global pandemic and severely affects the quality of life of suffering individuals. The presence of obesity for more than five years without any change indicates surgery. Body mass index (BMI) serves as a measure of obesity. Individuals with BMI ≥ 40 are suitable for LMGB. Also, a BMI ≥ 35 with comorbidities like cardiovascular diseases, diabetes, and hypertension is ideal for surgery. 

Attempts at weight loss with unsuccessful results in the past three years are also an indication of LMGB. 

Before the procedure:

Before undergoing an LMGB, one should get a surgical profile done. It includes blood tests, urine tests, an Electrocardiogram (ECG), and the physical examination and imaging tests for the abdomen. Healthcare professionals (HCPs) can understand the functioning of other organs, get information about the current general health status, and help them identify any factors that may interfere with healing, like diabetes or any infections. An electrocardiogram is done to check the heart's (cardiac) electrical activity as well as a chest x-ray is done to check the functioning of the lungs. 

Sometimes, one might need to attend a bariatric surgery educational program, nutritional counseling, and a psychological evaluation before undergoing the surgery. Certain medications like blood thinners and over-the-counter medications should be stopped. At the same time, surgeons might prescribe some other drugs that can prepare one for surgery. Smoking and alcohol consumption should be stopped. LMGB is done on an empty stomach. Hence, stopping eating or drinking 8-12 hours before the procedure is better. 

During the LMGB:

LMGB is done in a hospital under general anaesthesia, with the patient sleeping throughout the procedure. Post-cleaning the surgical site with an antiseptic solution, several cuts or incisions are made on the abdomen. Using the laparoscopic instruments, a miniature pouch is created on the upper portion of the tummy. The pouch is designed to hold about 30 ml of food. 

The remaining part of the stomach is kept intact and connected to the lower part of the small intestine. A part of the small intestine is rerouted to the new stomach pouch. One end of the small intestine is connected to the new pouch, while the other is connected to the small intestine. This is done to bypass the lower part of the stomach and a part of the small intestine. Such rerouting reduces the amount of nutrients that are absorbed by the body. After rerouting, careful inspection of the surgical site is done to check for any potential leakages. Then, the area is closed with surgical sutures or staples. 

After LMGB: 

Individuals will be closely monitored in the recovery room till the anesthesia wears off and the vitals are stabilized. Individuals may be prescribed certain antibiotics and painkillers to reduce infection. The individual is advised to be on sugar-free, non-carbonated liquids for a week. Pureed foods follow this for the next three weeks. One can have average solids about four weeks after surgery. 

An individual is to avoid strenuous activities for about six weeks. Patients are advised to have at least 1-2 liters of fluids, protein for strength, vitamin, and mineral supplements to avoid deficiencies, and foods with concentrated sugars and starches. 

Recovery from LMGB:

LMGB takes about one to two hours to be finished. The significant advantage of LMGB is its shorter recovery times, where an individual can return to their daily activities in two weeks. 

The success of LMGB:

LMGB is considered successful when there is consistent and significant weight loss, reduced life-threatening conditions, and improved quality of life. Patients lose 60-80% of weight within two years of surgery. 

Risks and complications:

LMGB is associated with certain risks and complications that include potential bleeding and infections, nutritional deficiencies due to bypassing of the stomach, which leads to lessened absorption of nutrients from the body, dumping syndrome, which causes vomiting and diarrhea, stretching of the stomach, and leakages from the surgical sites which can lead to further complications. Other complications include gallstone formations due to rapid weight loss, blood clots due to surgery, the development of strictures between the stomach and intestine, and the development of gastroesophageal reflux disease. 

Conclusion:

LMGB is a safe, minimally invasive, and effective bariatric surgery for weight loss that restricts food intake and absorption of calories. With its advantages like a simplified approach, shorter operative time, and quicker recovery compared to traditional procedures, it is one of the practical approaches for weight loss.