This is the simplified version of Roux en y gastric bypass. It is more powerful than RYGB. This became more popular in India because it is simple and more effective than either gastric sleeve or roux en y gastric bypass. A lesser curve based gastric pouch is created in the stomach. Jejunum up to 200 cm beyond the duodenojejunal junction, is anastomosed (attached) to this pouch in a loop fashion.
Since up to 200 cm of small intestine is bypassed, undigested food reaches distal ileum (last part of small intestine) rapidly leading to increase in GLP1 & Peptide YY (Satiety hormones). Proximal intestine (duodenum and proximal jejunum) is bypassed, leading to lowered anti incretin hormones. There will be more than 200 hormonal changes after surgery. These hormonal changes reduce appetite, increase energy expenditure and reset the ‘fat mass’ to a lower level, resulting in long lasting, effective weight loss. Same hormonal changes are responsible for long lasting type 2 diabetes remission. Anti incretins act against insulin. As levels of these hormones come down, insulin resistance comes down. Since GLP 1 hormone is increased, insulin production increases and insulin resistance comes down. Diversion of biliopancreatic juices also contributes to the metabolic effects of this surgery. Role of restriction or malabsorption of food is secondary, in inducing weight loss or diabetes remission.
MGB – OAGB is relatively simple and safe surgery. When bypassed segment of intestine is less than 200 cm, malabsorption risk is less.
Stomach is not removed in this surgery. So there is ‘at risk gastric remnant’. If you develop ulcer or cancer in remnant stomach, it is not possible to monitor by upper gastrointestinal endoscopy. It is not possible to access common bile duct (pipe below liver) by endoscopy. Since duodenum (1st part of intestine) is bypassed, risk of calcium and iron deficiencies is high. Since pylorus (valve below stomach controlling food output) is bypassed, risk of dumping syndrome (dumping of nutrients into intestine leading to fluctuations in blood glucose) is high. Since it is a loop anastomosis ( attachment between gastric pouch and jejunum), there is risk of bile reflux into gastric pouch. Long term consequences of this bile reflux are unknown. Risk of weight regain and diabetes recurrence are less than that after gastric sleeve or roux en y gastric bypass surgery. If anyone develops weight regain or diabetes recurrence after MGB – OAGB, they may need revision bariatric/ metabolic surgery to induce further hormonal changes necessary for weight loss and diabetes remission. Most of the limitations of MGB-OAGB are addressed by combining sleeve with loop bypass (Sleeve + Bypass).
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