MINI GASTRIC BYPASS SURGERY IN TIJUANA, MEXICO
gained popularity as technically less challenging procedure with lower complication risk
Also known as Laparoscopic Mini Gastric Bypass (LMGBP), “Loop Gastric Bypass”, Gastric Mini Bypass, this surgery was originally developed by Dr. Robert Rutledge in 1997 and has gained popularity in recent years.
PROS:
- Only one intestinal connection in Mini Bypass vs 2 intestinal connections in RNY bypass results in potentially lower complication risk;
- Technically a more simple procedure that results in less time in the OR and a slightly faster recovery;
- Good option for patients with mild heartburn, it resolves with Mini bypass in the vast majority of patients;
- Good option for patients with Type 1 and Type 2 diabetes, malabsorption helps to control and even eliminate these health conditions (Diabetes Type 2 in particular).
CONS:
- Mini bypass (unlike RNY bypass) carries a small risk of causing bile reflux due to its specific anatomy. Learn more about Bile Reflux after MINI Bypass;
- In Mini bypass, the stomach pouch is a little longer (2 to 4 oz in volume) than in RNY bypass (1 to 2 oz in volume), resulting in slightly bigger food portions the patient will be able to consume;
- In Mini bypass the connection between the stomach pouch and the small intestine (called stoma or anastomosis) is made a little wider compared to RNY bypass, which results in less restriction. Learn more at Restriction after gastric sleeve vs restriction after Mini or RNY bypass.
WHY WAS MINI BYPASS DEVELOPED?
While traditional gastric bypass (RNY surgery) results in excellent weight loss, the procedure is technically more challenging and potentially carries a higher complication risk. The mini gastric bypass surgery was developed to reduce operating time and possible complications, as well as simplify the procedure in general. The MGBP is a both restrictive and malabsorptive procedure. This means that it reduces the size of your stomach, restricting the amount you can eat; it also reduces absorption of food by bypassing up to 5-7 feet of the small intestine. Studies show that mini-bypass leads to similar weight loss as full bypass, and slightly reduces overall complication rates compared to RNY gastric bypass surgery.
To learn about how Mini Bypass compares to RNY Bypass and other weight loss surgery types, pros and cons of each procedure, please go to Compare Bariatric Surgeries.
SURGICAL METHOD
Our bariatric surgeons Dr. Cynthia Hernandez and Dr.Francisco Zavalza perform mini gastric bypass surgery laparoscopically, making several small 1/4- to 1/2-inch abdominal incisions. After you receive general anesthesia, our medical team will:
- Inflate the abdomen with CO2 gas to create working space around the stomach and intestines. The abdomen will be deflated at the end of surgery, but some traces of gas will remain and cause pain and discomfort. Walking as much as possible after surgery will help to reduce pain and remove gas much faster. Learn more at Pain. Left side stabbing pain or left shoulder pain, early recovery stage.
- Perform an endoscopy to check on the stomach condition. Learn more about the pre-op and post-op endoscopy here >>
- If the liver is large, a special instrument called liver separator will be inserted to keep the liver in an uplifted position throughout surgery to allow surgeons better access to the stomach.
- Hiatus (an opening in the diaphragm where the esophagus connects to the stomach) will be examined to rule out hiatal hernia. If a hiatal hernia is diagnosed, it will be repaired during surgery by suturing the opening in the diaphragm. The stomach will be pulled into its correct natural position and if need be anchored by a so-called anchor stitch (it is important to understand that a hiatal hernia may develop again in the future).
- With the help of a laparoscopic stapler, the surgeon separates a tube-shaped chamber from the stomach at the base of the esophagus and connects it about six to seven feet down the small intestine. The remaining part of the stomach is no longer attached to the esophagus and will no longer receive food. It does remain in your body in its original position and continues producing stomach acid that flows into the small intestine and helps to digest food. The volume of your new stomach pouch is much smaller, about 2 to 4 oz, and the pouch has the shape of a small tube.
- In certain cases the surgeon removes the Fundus portion of the stomach that is located in the upper part of the stomach. This may be necessary in case of a higher complication risk, if stomach polyps are diagnosed in the Fundus, or due to the scar tissue after previous abdominal surgeries that complicate access to the stomach, due to a very large liver and other factors. Removing the fundal portion of the stomach makes a bypass surgery slightly easier for the surgeon and reduces the risk of post-op stomach ulcers (the larger the stomach pouch, the more possibilities for ulcers to develop), it does however increase the risk of the post-op bleeding (the more cutting is done, the more blood vessels may bleed). Whether removing the Fundus area (where the hunger hormone Ghrelin is produced) affects the hunger levels in patients requires further research. Many among our patients report less hunger within the first few months post-op regardless of having this portion of the stomach removed or not.
- Separate the small intestine from the surrounding visceral fat tissue that is attached to our internal organs. This is the reason why a good pre-op diet is so important for any type of bypass surgery: the better the diet, the less internal fat tissue (visceral fat) is attached to the intestines, the less cutting needs to be done, which results in less blood loss during surgery, less risks and faster recovery.
- Between 5 and 7 feet of the small intestine are bypassed (the length is adjusted based on the patient`s BMI, the higher the more is bypassed in order to increase malabsorption). The bypassed portion is called Duodenum, this is the part of the small intestine where most of the calories and nutrients are absorbed. The malabsorption along with restriction due to the small stomach pouch promote further weight loss. The surgeon will attach the remainder of the small intestine to the new stomach pouch using very small titanium staples and non dissolvable suturing. Food now flows into your small tube-like stomach and then bypasses between 5 to 7 feet of intestines where it resumes the normal digestive process in the remaining intestine.
- A second endoscopy is performed to check for potential staple or suturing line disruptions, bleedings, etc.
- Drain tube is placed (will be removed on the day of the hospital discharge).
- All the incisions are closed with 100% dissolvable stitches except for one incision that is sutured internally with non dissolvable material and externally with dissolvable suturing. This particular incision that is normally located toward the right side of the abdomen above the belly button is closed in this special way in order to prevent incisional hernia, since this incision is used more than others during surgery and thus is more traumatized. More surgical instruments are inserted and removed through this incision, if a portion of the stomach is removed, it is pulled through this incision also. Pain in this incision is expected to be a little stronger and longer-lasting compared to others. Fibrous tissue that feels like a ball or a lump when pressing on the area around that incision is normal during the first few months post-op and will reduce with time.
For a better understanding of the anatomy of MINI bypass, we invite you to watch the video below, courtesy of Ethicon, our trusted provider of bariatric titanium staples and staplers.
HOW YOU LOSE WEIGHT?
Restriction:
Mini gastric bypass surgery restricts the amount of food you can eat due to a small stomach pouch; for many patients, it reduces hunger (at least for the first few months post-op);
Malabsorption:
Mini gastric bypass reduces the number of calories your body will absorb from the food you consume due to a large portion of the small intestine being bypassed.
WEIGHT LOSS IS RAPID:
As with all bariatric surgery procedures, weight regain does occur (most of the time due to the patients` incomplete adherence to the post-operatory guidance or slow return to the old eating habits), but most patients are able to keep at least half of the excess weight off over a long term.
SURGERY TIME
On average, Dr. Cynthia Hernandez and Dr. Francisco Zavalza take less than 1 hour to perform a mini gastric bypass surgery. Then the patient is taken from the Operation Room to the Recovery Area where under close observation by nurses and doctors the patient wakes up from the anesthesia, all vital signals and oxygen levels are monitored. After about 1 -1.5 hours in the recovery area, the patient is taken back to their hospital room, where if accompanied by a family member he is reunited with their companion for the rest of their hospital stay.
If a patient travels alone, our on-site facilitating team that is present at the hospital 24/7 will be happy to inform the family members who stayed at home about the outcome of the procedure and the patient`s recovery status (of course if the patient requests such updates prior to surgery).
HOSPITAL AND HOTEL STAY
Two days and two nights are required at the hospital for the gastric mini bypass in Tijuana, Mexico.
(Please visit What to Expect in Tijuana and NEWCITY Hospital or CIBA Surgical Center for more details).
Two nights at the hotel are recommended, but three nights are included in the surgery package to allow for additional recovery if needed.
Plan your trip for a mini bypass surgery in Tijuana this way:
Day 1. Arrival, pre-op testing, hotel stay
Day 2. Surgery, hospital stay
Day 3. Hospital stay
Day 4. Discharge, hotel stay
Day 5. Departure or additional hotel stay (this night is optional)
Day 6. Departure
RECOVERY TIME
- For a sedentary type of work – a minimum of 7 to 10 days off.
- If your job requires more strenuous physical activity and lifting over 15 pounds, we recommend at least 2-3 weeks off.
- The weight lifting restrictions are: up to 15 pounds for 2-3 weeks post-op, and up to 35 pounds for another 2-3 weeks. After 6 weeks you may go back to normal weight lifting but gradually.
- For jobs that require strenuous physical activities and long working hours such as nurses, as an example, we recommend 4 weeks off.
- Keep in mind that you will feel very weak and lack energy, and get easily tired during the first 4 to 8 weeks post-op due to a low-calorie diet and dehydration. So, it may be difficult to concentrate on work (mental or physical) during this time until your body adjusts and your diet progresses to the point where you can tolerate a greater variety of foods and more calories. Usually energy levels return after 8 weeks post-op.
Short Term Disability or FMLA paperwork:
Our medical team will gladly complete the required forms for your employer. If you need a simple doctor`s note to take time off or a return to work release note, please request with your patient coordinator.
Send the forms (STD or FMLA) to your patient coordinator via email or fax them to 855-457-1400. Please be sure to complete the portion of the form that is non-medical related. Our medical team will complete only the portion of the form that is required to be completed by the attending physician. Usually, the top portion of any form asks for the patient to enter their personal and job-related information.
When you send us the form, please answer the following questions along with it:
- The first day off work;
- The day you plan on returning to work;
- Will you need any work restrictions for a certain period of time after you return to work, such as no heavy lifting, light duty, frequent breaks, etc., if yes, for how long; or will you need a release to full duty?
Our medical team takes 7 business days to process the forms, please send them taking into consideration the processing times.
BENEFITS OF MINI GASTRIC BYPASS
- More dramatic weight loss compared to only restrictive bariatric surgeries (such as gastric sleeve).
- Statistically longer lasting weight loss results (less percentage of patients regain the weight).
- Works by both restriction and malabsorption.
- Substantial improvement in many health problems related to morbid obesity such as (but not limited to):
✓ Type 2 diabetes mellitus (may resolve completely)
✓ Type 1 diabetes mellitus (insulin dosage will decrease significantly)
✓ Sleep apnea
✓ Hypertension
✓ High cholesterol
✓ High triglycerides
✓ Joint pain
✓ Lower risk of heart attack and other serious cardiovascular issues
WHAT TO EXPECT AFTER MINI BYPASS SURGERY IN MEXICO
- Recovery, pain and complications are very similar to traditional RNY Gastric Bypass surgery.
- Pain is usually caused by the gas residue in the abdominal cave and walking helps to get rid of it faster. By the 3rd day post-op when the patient is discharged from the hospital, pain is easily manageable by non-opioid painkillers.
- In order to prevent blood clots, blood clot symptoms, and to promote healing, our medical team will have you up and moving as soon as possible following surgery. Special compression stockings will be used on your legs to help with blood clot prevention. Extra blood thinners may be prescribed upon hospital discharge, this is determined by our internal medicine doctors for each patient individually. Learn more about factors that increase blood clot risks here.
- Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly and lead to dumping syndrome. This can cause diarrhea and make you feel faint, shaky, and nauseous. It also can make it hard for your body to get enough nutrition. The same post-op diet is recommended for all surgery types. It is important to follow it without skipping any stages and without rushing, this will allow for a smooth recovery.
- During the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. Bit by bit, you will be able to add solid foods back into your diet. And after approximately one to two months you will come back to normal solid food intake. However, you will be asked to follow a new diet that will include more protein, vegetables and fruit for the rest of your life. Your stomach is much smaller and there is no room for junk food (you need to maximize nutrients from every bite you eat).
- It is important to keep sipping water throughout the day to avoid dehydration. Learn more about post-op dehydration (IV hydration)
- You may notice that your bowel movements are not regular right after your surgery. This is common, and if the condition lasts for more than 4 or 5 days you may need to use a light laxative, however, do consult your doctor before taking any additional medication. Learn more about post-op constipation.
- You must chew food very thoroughly and learn to stop eating when you feel full. This can take some time to get used to. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit.
- If you drink a lot of high-calorie liquids such as soda, fruit juice, milk, frappuccinos, etc., weight loss will slow down, stop and eventually you will start regaining the weight. The importance of food texture (solid foods vs liquids) in Mini or RNY bypass surgeries is explained in Restriction after gastric sleeve vs restriction after Mini or RNY bypass.
- If you continually overeat, the new stomach pouch and pouch opening (stoma) will stretch. If the stoma stretches, you will not benefit from your surgery and its restrictive effect will be lost.
- In a mini-gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, our nutritionists will work with you on your vitamin intake and analyse your post-op lab work results. Taking vitamins post-op is highly recommended for Mini and RNY bypass for the rest of your life.
- Post-op lab work is recommended for all surgery types at 3-, 6-, 12, and 24-months post-op. Learn more at Blood work post-op.
- It is important to avoid heavy lifting: no more than 15-20 lb for the first 2-3 weeks, then no more than 35 lb for another 2-3 weeks. After 6 weeks it is safe to resume regular weight lifting but gradually.
- Light exercising is recommended after surgery as soon as you gain enough energy: walking, walking up the hill, elliptical, very light weights. Strenuous exercising is not recommended until 2 months post-op. Once your diet progresses to the stage where you can tolerate a greater variety of foods and your caloric intake increases, it is beneficial to add regular exercising to boost further weight loss.
RISK OF MINI GASTRIC BYPASS SURGERY
Complications occur in all types of bariatric surgery. Most of the serious complications happen within the first 24 to 48 hours post-op, while the patient is still at the hospital, and our medical team takes care of the issue immediately. Extra expenses associated with a surgery complication that is not caused by a pre-existing condition are covered for our patients. Learn more about our Medical Complication Insurance that is included in each surgery package automatically. Our surgery complication rate is between 0.001 and 2% depending on the type of complication.
It is not always possible to collect the correct statistical data as not all our patients report on how their recovery progresses and many eventually stop regular communication as they approach their goal weight. These are the numbers based on our observations among our own patients since 2014:
Incisional hernia – 3 patients
Bile reflux – 1 patient
Postoperative Bleeding – 1.5 % of patients
Gastrointestinal leak – 3 patients (1 after a gastric sleeve, 2 after a revision from sleeve to RNY bypass)
Marginal ulcers – 1.5 – 2% of bypass patients
Blood clots – 1 or 2 patients had pulmonary embolism, at least 3 or 4 had DVT (deep vein thrombosis)
Stenosis or stricture – less than 1% for all surgery types
Wound sepsis – less than 0.5% of patients
Bowel obstruction – less than 1% of bypass patients
Esophageal issues – 1 patient
Severe malnutrition – 1 or 2 patients
Death rate – 0 %, 0 patients
Some of the above are minor and easily treated while others can be more serious. Such surgery consequences as phlebitis (temporary vein inflammation due to an IV infiltration) or acid reflux as a side-effect of gastric sleeve are not considered acute surgery complications.
LOWER YOUR MINI GASTRIC BYPASS SURGERY RISKS
Before having mini gastric bypass surgery (or any other weight loss surgery), you can limit post-op side effects and complications by following these steps:
-
- Be completely honest in your medical questionnaire and when speaking to the medical team before surgery, do not hide any health conditions.
- Lower your BMI and shrink the fatty liver by strictly following the pre-op protein diet.
- Quit smoking cigarettes and marijuana, drinking alcohol, coffee and sugary/carbonated beverages, any type of street drugs.
- Exercise regularly (even if it is only walking)
- Stop (or continue) certain medications before surgery according to our medical team`s instructions (antacids, NSAIDs, hormonal medications, etc.)
- Start taking vitamins pre-op
HOW DO I KNOW IF MINI BYPASS SURGERY IS RIGHT FOR ME?
As the name suggests, mini gastric bypass surgery (MGBP) is a simplified form of Roux-en-Y gastric bypass surgery (RNY). Even though MGBP sounds like an obvious choice between the two procedures, there are a few significant reasons why this might not always be the case.
- Unlike in RNY gastric bypass surgery, digestive enzymes and bile are not diverted away from the stomach after mini gastric bypass. This can lead to bile reflux gastritis which can cause nausea and pain that are difficult to treat (the best treatment in such a case is a revision from Mini to RNY bypass). Bile reflux gastritis may also increase the risk of cancer in the stomach pouch.
- For the same reason Mini bypass is not the best option for patients who suffer from GERD (acid reflux).
More long-term research is needed to solidify mini gastric bypass surgery’s position as a viable bariatric surgery option. Visit Compare Bariatric Surgeries to learn about other surgical options.
Our qualified bariatric surgeons, Dr. Francisco Zavalza and Dr. Cynthia Hernandez, can help you determine if the mini gastric bypass is your best option depending on your BMI, health problems, personal preferences, and weight loss goals.
For an alternative source of information about mini gastric bypass surgery, go to
http://www.bariatric-surgery-
DISCLAIMER
Please note! Weight loss surgery results and health improvements vary in every individual case and depend on a person`s initial weight, metabolic rate, health issues, diet adherence and physical activity, hormones, age, and other factors. Do not compare your results to those of other patients: every person`s body is a unique and complex system, and your weight loss process will not be exactly the same as that of other patients of the same sex, age, and BMI.
HEALTH HISTORY QUESTIONNAIRE
To determine what type of weight loss surgery will be most beneficial for you, please complete our health history questionnaire.
Once we receive the completed form, we will contact you via email within 24 hours and arrange a free consultation with one of our bariatric surgeons via a cell phone or a video call.
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