Laparoscopic mini gastric bypass (MGB) or single anastomosis gastric bypass (SAGB)

“When you feel like quitting, think about why you started.”

Morbid obesity or clinically severe obesity has emerged as one of the most dreaded diseases of this century. People who have attempted to lose weight, know how difficult it is to not only lose weight but also to maintain the weight loss. On a daily basis, we see patients who put in their heart and soul into their efforts to lose weight. They have been to every weight loss clinic, celebrity dieticians, gyms, yoga gurus and weight loss retreats. Unfortunately, more often than not, they meet with disappointment and tend to yo-yo between weight loss and weight gain. This entire process is extremely disheartening and demotivating for the patients.

So, if you have tried hard to lose weight without success and the weight is bearing you down, you have come to the right place because bariatric surgery is the only way at the moment that can lead to sustained weight loss in morbidly obese patients.

Laparoscopic mini gastric bypass (MGB) or single anastomosis gastric bypass (SAGB)

Laparoscopic MGB/SAGB is becoming one of the most popular weight loss bariatric procedure in India. It is a technically easier procedure to perform and has good results for super-obese patients.

Am I a right candidate for undergoing laparoscopic Roux-en y gastric bypass

The IFSO- APC (International Federation for Surgery for Obesity and Metabolic Disorders - Asia Pacific Chapter) guidelines for weight loss surgery are as under:

  • Bariatric surgery/obesity surgery/weight loss surgery must be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 Kg/m2 with or without any associated diseases.
  • Bariatric surgery/metabolic surgery must be considered for the treatment of type 2 diabetes or metabolic syndrome for patients who are inadequately controlled by lifestyle alterations and medical treatment for acceptable Asian candidates with BMI ≥ 30 Kg/m2.
  • Bariatric surgery/metabolic surgery may also be considered as a non-primary alternative to treat inadequately controlled type 2 diabetes or metabolic syndrome for suitable Asian candidates with BMI ≥ 27.5 Kg/m2.

Laparoscopic MGB/SAGB has particularly good results for obese patients suffering from type 2 diabetes, high cholesterol etc. It has also shown good results for super-obese patients as a one stage surgery.

 

How is it done

  • As the name suggests, this surgery is performed by laparoscopic technique. In this technique, 4 to 5 tiny 0.5 to 1 cm cuts are made on your tummy and the entire surgery is performed using a camera and instruments. This is minimally invasive and there is no big cut like the surgeries of the past. All the stitches are absorbable and no sutures are to be removed later. Laparoscopy enables the patient to have less pain, recover faster and return to work much earlier. Most patients are discharged from the hospital one day after their operation. Of course, this depend on their clinical status as well.
  • During the surgery, a longitudinal pouch of the stomach is created using surgical staplers. A 150 cm loop of the small intestine called the jejunum is re-routed and attached to this pouch. In this surgery, a major part of stomach, first part of the intestine called duodenum and some length of the second part of small intestine called the jejunum is bypassed.
  • This surgery is more mal-absorptive than Roux-en y gastric bypass and one has to be careful about nutritional supplementation and protein intake.

How does it lead to weight-loss

Following mechanisms lead to weight loss after laparoscopic MGB/SAGB.

  • Narrow longitudina stomach pouch restricts the amount of food that a person can eat. There is significant caloric restriction after this surgery.
  • The re-routing of intestines causes mal-absorption. This means that some part of the food that a patient consumes, will not be absorbed by the body.
  • After this surgery, certain intestinal hormones are activated and these aid in weight loss as well as remission of co-morbidities such as type 2 diabetes etc.
  • There are many other mechanisms and yet unidentified role of bile acids and gut flora that may help in weight loss and remission of co-morbidities after this surgery.

Results of laparoscopic MGB/SAGB

  • Patients lose up to 70 to 80 % of their excess weight over a period of 12 to 18 months after this surgery. This can be better if the patient embraces lifestyle modification and follows a strict diet and exercise program as guided by the bariatric surgery team.
  • This surgery also leads to a significant improvement in associated diseases such as type 2 diabetes, high blood pressure, high cholesterol, heart disease, risk of venous thrombo-embolism, gout and so on.

Long term weight loss goals

  • Bariatric surgery must not be perceived as a short cut to weight loss. The patient and the doctor work as a team to achieve best results in the long term. It is extremely important to be diligent with your follow-up to get optimum results.
  • Long term weight loss goals can be achieved with help of a team that consists of a doctor, an endocrinologist, a nutritionist and a psychologist. This support team of experts will keep you motivated, provide advice and help you to work through weight-loss barriers. 

Who is not eligible for weight loss surgery

  • Pregnant women
  • Patients with severe psychiatric disorders
  • Smokers
  • Patients with inability to take nutritional supplements and protein.
  • Patients who are medically unfit for surgery and anesthesia

Complications

  • Laparoscopic MGB/SAGB surgery is as safe as any other surgery like a knee replacement or a gall bladder surgery. Infact, the complication rate is much lower than cancer surgery or surgery for esophagus, valve replacement etc.
  • It is important to follow the protocols set by the team and to take nutritional supplements as advised. Failure to do so may result into nutritional deficiencies in future.
  • Smokers must strictly stop smoking. Smoking can lead to complications that can be life-threatening. If you are not confident about giving up smoking after this surgery, our advice is that you must not undergo the surgery at all.
  • The team will discuss the pros and cons in detail with you during your consultation.

Dr. Aparna Govil Bhasker believes in quality care and will make it extremely safe for you. You will be in good hands so do not worry. The biggest plus of coming to us for your surgery is our personalized care. Every patient is a VIP for us and we assure you that your smallest queries will be addressed at the earliest.

It is extremely important for the patient to be mentally prepared and be in a positive frame of mind before undergoing any kind of surgery. Positive thoughts go a long way in getting good results after surgery. So, be positive and we wish you all the best for your weight-loss journey to a being a different you.

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