Anatomy - Mini gastric bypass / omega loop gastric bypass - general and visceral surgery

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  • Introduction

    The incidence and prevalence of morbid obesity with its associated comorbidities are increasing worldwide, especially in Western countries. According to information from the WHO, 600 million people are obese (BMI >30 kg/m22).

    As substantiatedunderpinned by high-quality data, obesitybariatric and metabolic surgical proceduressurgery are is the most effective and sustainedlasting treatment methods modality for morbid obesity and areis superior to conservative multimodal therapiestreatment protocols. 

    In addition to long-lasting weight loss, concomitant diseases associated with obesity can also be successfully treated. These mainly include sleep apnea and other breathing disorders, type II diabetes mellitus, obesity-related cardiomyopathy and hypertension, dyslipidemia, pseudotumor cerebri, orthopedic knee injuries, spinal problems, stress incontinence, polycystic ovariyan syndrome, and infertility. It is scientifically proven There is scientific evidence that massive weight loss leads toresults in prevention, relative improvement, or even remission of somatic diseaseorders associated with obesity.

    The dissemination and acceptance of bariatric surgery has greatly increased worldwide over the past 20 years (approximately about 150,000 procedures in 2003; 470,000 in 2013).

    The most important pathophysiological mechanisms are include restriction, malabsorption, and a combination of the two.

    Hormonal effects play a key role in all procedures that diverting food from the gastroduodenal tractnsit and/or resecting stomach  gastric volume. Since 80 % of ghrelin receptors (hunger hormone) are located in the stomach, fewer hunger sensations are signaled centrally as a result of diversion/resection.diversion/resection will reduce the hunger signaling to the brain.

    The results of the surgical measures go far beyond weight loss as a result of a variety of complex changes to the enterohumoral axis with metabolic effects.As a result of a variety of complex changes in the enterohumoral axis with metabolic effects, the sequelae of surgical procedures extend well beyond weight loss.

    The expanded indication spectrum is designated by the new term “metabolic surgery.”The new term "metabolic surgery" was coined to denote the extended spectrum of indications. It is expected that bariatric surgery will take on increasing significance in the management of metabolic syndrome.Bariatric surgery is expected to gain increasing importance in metabolic syndrome management.

    Many patients with type II diabetes mellitus have experience complete remission of the disease only a fewwithindays after the operationof surgery, long before significant weight loss has occurredsets in. Using “metabolic surgery” in diabetics who are of normal weight or slightly overweight has been discussed in the meantime.There is now discussion of managing normal weight and slightly overweight diabetic patients by "metabolic surgery".

    Due toFollowing the introduction of laparoscopic surgical techniques, the procedures, which were initially believed to beconsidered high-risk surgeriesy, canmay now be carried out todayperformed with anmanageableacceptable risk of complications.

    Bariatric metabolic surgeries are not included in the standard benefits catalog of German insurance companies.In Germany, the standard reimbursement scheme of the statutory health insurance funds does not cover bariatric-metabolic procedures. Deshalb muss für jeden Patienten ein individuelles Antragsverfahren für die Durchführung einer solchen Operation eingeleitet werden.This is why each patient must submit a personalized application for reimbursement before such surgery. 

  • Mini gastric bypass

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    Mini gastric bypass, MGB for short, is a malabsorptive procedure.The principle behind the mini gastric bypass, MGB for short, is artificially induced malabsorption. It was first performed for the first time in 1997 by Rutledge in 1997 and is considered a safe and effective procedure in obesity bariatric and metabolic surgery. The principle of MGB is to fashion a longitudinal gastric pouch on the lesser curvature aspect, combined with a biliary small intestine loop of a variable length.In MGB, a long gastric pouch fashioned from the lesser curvature is anastomosed with a biliary loop of the small intestine, the length of which may vary. 

    MGB has a low rate of complications; in particular, there are no complications involving the foot-point anastomosis.The complication rate in MGB is lower, and in particular, it eliminates all complications arising from the enteroanastomosis between the afferent and efferent limbs. The much lower incidence of internal hernias is constitutes another great advantagebenefit. This method technique providesoffers short-term advantagesbenefitswith regard toin terms of weight loss and the degree of antidiabetic activityefficacy compared with established standard procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy. The significance of biliary reflux with the correspondingits concomitant risks (gastric orand esophageal cancer) is still unclear to date.

    The number of postoperative complications afterin MGB is betweenranges from 0 and –28.6%. The mortality rate is 0–0.5%.