The Mini-Gastric Bypass original technique

Abstract

Introduction: Mini-Gastric Bypass (MGB) is becoming more and more popular as shown by the numerous articles published over the past 15 years, supporting the operation as a short and simple procedure with excellent outcomes and low complication rates. There is still confusion amongst surgeons on the technique of the operation. The purpose of this paper is to review and describe the technique of MGB by its originators.

Methods: With 20 years of experience of performing the original MGB, the authors present the details of the MGB.

Results: The MGB consists of a long conduit from below the crow's foot extending up to the left of the angle of His. It is similar to, but importantly, not the same as the pouch of the Sleeve Gastrectomy. MGB has a wide gastro-jejunal anastomosis to an anti-colic loop of jejunum 150-200 cm distal to the ligament of Trietz. The power of MGB comes from the fact that it is both a "Non-Obstructive" restrictive procedure and it also has a significant fatty food intolerance component with minimal malabsorption.

Conclusion: In this article we describe the original Rutledge technique of Mini-Gastric Bypass. Notably this is neither a "Single Anastomosis bypass", nor an "Omega Loop Bypass" and also not the "One Anastomosis Bypass of Carbajo". It is a particular technique first created by Rutledge in 1997 and associated with low risk and excellent outcomes. The goal of this manuscript is to help avoid complications and problems seen when the operation deviates from some of the basic principles of general surgery used in the original operation.

Keywords: Bariatric surgery; Billroth II; Collis gastroplasty; Diabetes; Edward Mason; Gastric bypass; Mini-gastric bypass; Morbid obesity; Small bowel anastomosis; Surgical technique.