The mini-gastric bypass is a bariatric procedure that reduces the size of the stomach and bypasses a portion of the small intestine for the purpose of weight loss. It was developed by Dr. Robert Rutledge in 1997 as an alternative to the Roux-en-Y gastric bypass. The procedure is promoted as a "minimally invasive, short, simple, successful and inexpensive laparoscopic gastric bypass weight loss surgery."

The mini gastric bypass
is a simpler version of
gastric bypass surgery.

Development of Gastric Bypass Surgery

Bariatric surgery is a field of medicine that continues to evolve, as doctors learn more about the body's responses to surgical changes and make use of technological advances. Some bariatric procedures have been abandoned over the years, because the promising results in theory turned to failures in reality. Other procedures, however, have withstood medical scrutiny over time and continue to be used today.

• 1967: Loop Gastric Bypass
• 1967: Open Roux-en-Y Gastric Bypass
• 1993: Laparoscopic Roux-en-Y Gastric Bypass
• 1997: Mini-Gastric Bypass

Loop Gastric Bypass

The first gastric bypass procedure used a loop of the small intestine for bypassing and rerouting a portion of the digestive system. This approach does not involve cutting the small intestine into two segments, but leaves it attached to the pyloric valve at one end and the large intestine at the other end. Instead, the new stomach outlet that is formed in the new smaller stomach pouch is simply reattached further down the small intestine. The outcome is a bypass of a large portion of the stomach, including the pyloric valve (stomach outlet), as well as the first portion of the small intestine.

The initial short term results seemed promising, but the loop gastric bypass was abandoned as a weight loss treatment in the early 1970's, as the later risks of the procedure were not justified for weight loss treatment. The loop reconstruction was simple to create, but it allowed bile and pancreatic enzymes from the small intestine to enter the esophagus, sometimes causing severe inflammation and ulceration of either the stomach or the lower esophagus.

Although the loop gastric bypass is still performed today, it is reserved for reasons other than weight loss, such as ulcer surgery, stomach cancer, and injury to the stomach. With years of medical results, surgeons have also learned that the loop reconstruction is safer when placed low on the stomach and disastrous when placed next to the esophagus.

Roux-en-Y Gastric Bypass

After the loop gastric bypass was abandoned, further experimentation led to the development of a more successful procedure, the Roux-en-Y (RNY) gastric bypass. The RNY is a much more complex operation, but it avoids the long-term risks associated with the loop gastric bypass.

With RNY gastric bypass, the small intestine is divided into two segments. The lower portion is connected to the new stomach outlet, while the upper portion is bypassed. Gastric bypass surgery is commonly performed laparoscopically, although open surgery may be necessary in some patients.

The Roux-en-Y Gastric Bypass surgery involves:

• Creating a small high gastric pouch
• Dividing the small intestine, bypassing 1, 3, or 6 feet, depending on variation
• Connecting new stomach to cut lower end of the small intestine
• Connecting upper portion of small intestine to side of small intestine connected to the stomach, creating the "Y"

While all bariatric procedures involve the possibility of side effects and complications, the RNY gastric bypass continues to be used today and remains the most commonly performed bariatric procedure. Overall, the majority of bariatric surgeons believe that the potential benefits tend to outweigh the associated risks in most morbidly obese patients.

Mini-Gastric Bypass

The field of bariatric surgery has become a very popular and competitive area of medicine, as the incidence of morbid obesity continues to rise and bariatric surgeons respond to the demand for effective treatments. While many doctors prefer to perform the bariatric procedures that have lasted through years of medical scrutiny, other doctors are developing alternatives.

One such development is the mini-gastric bypass (MGB), a variation of gastric bypass surgery, which was developed in 1997 by Dr. Robert Rutledge, a twenty year career professor of surgery at the University of North Carolina at Chapel Hill. The mini-gastric bypass reverts back to the simpler loop reconstruction of earlier gastric bypass procedures, but with some improvements.

In the ten years since it's development, some 4,000 people have chosen the MGB procedure. To put the number in perspective, ten years ago, 20,000 bariatric surgeries were performed annually; today, some 200,000 bariatric procedures are performed each year in the United States.

• In 2005, actor Gil Gerard underwent a mini-gastric bypass operation. His operation and subsequent progress was filmed by Discovery Health channel. The surgery was successful and helped him lose 140 pounds of excess weight.

The Mini-Gastric Bypass surgery involves:

• Creating a long narrow gastric pouch
• Connecting new stomach to the side of the small intestine, bypassing 6 feet

According to Dr. Rutledge, his variation offers the following benefits:

• Lower Cost: his version of gastric bypass costs less - $17,000 versus the $25,000 to $30,000 charged for the standard gastric bypass procedure; some patients may qualify for the same day out-patient procedure which costs $9,500
• Shorter operation: surgery is less than 45 minutes
• Simpler operation: fewer staple lines
• Minimally invasive procedure: surgery is performed laparoscopically
• Shorter hospital stay: usually no more than 24 hours
• Low surgical risks
• Minimal surgical pain
• Less blood loss than in the Roux-en-Y, Open or Laparoscopic
• Can be easily reversed or revised
• Decreases hunger (hunger hormone - Ghrelin)
• Increases satiety (feeling full - Peptide YY)
• Excellent long-term weight loss results

Risks and Side Effects

Although the surgery is considered relatively safe, all major surgery involves some degree of risk. Some of the possible problems are similar to those of RNY, including leak, bowel obstruction, blood clot, and pneumonia. MGB patients must also be monitored for calcium and iron deficiencies as are RNY patients.

Choosing a MGB Bariatric Surgeon

The complete system of pre-operative, intra-operative, and post-operative care that make up the mini-gastric bypass surgery is owned exclusively by Dr Robert Rutledge and his Centers for Laparoscopic Obesity Surgery (CLOS). The "Mini-Gastric Bypass" system is restricted to surgeons and bariatric programs that have completed training and received permission from Dr. Rutledge to do so. The training is specifically designed to "deliver excellent patient care and avoid confusion with other surgery of questionable quality." In turn, Dr. Rutledge receives a portion of the fees for each surgery performed by approved bariatric surgeons.

Controversy and Considerations

Individuals looking into the MGB need to be aware that it is a newer procedure and not widely accepted. Many bariatric surgeons are concerned about the relative safety of the procedure, including the possibility of bile reflux which can lead to severe ulceration of both the stomach and the esophagus. Newer procedures must be considered with caution, as the history of bariatric surgery is full of procedures that seemed promising but were later found to be failures.

Patients must carefully research each procedure and discuss the options with a qualified bariatric surgeon, then decide for themselves which procedure is appropriate for them. Since no bariatric procedure is a perfect operation, the decision process involves comparing benefits to risks.

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