rny vs mini

[lessismore1001 30]

help!!!! I just went to see my surgeon to decide on my surgery.

Oh man he really confused me. I had previously decided on rny. Then we start talking and he goes into detail about the 2 surgeries. I was always of the belief that rny is the king of the surgeries. He said, yes the original and the one most known...but....

Then he told me the results so far with the mini (still considered relatively new in comparison) are better then the rny. Obviously, they cannot tell long term as it is not old enough. It's less complicated then the RNY but can 'possibly' result in diarrhea and or bile reflux. He said only some people not all get the complications.

So now - what do I do. How did you all decide. I am terrible at decisions. Oh yes and told him to take the remaining Fluid out of my band. Due to the color, i have to have a gastroscopy as he's worried the band has eroded into my stomach. If so, it means 2 surgeries. One to take out the band and fix the stomach. Let it heal and then the next the bypass.

Any helpful advice regarding a decision would be so very much appreciated..thanks.

[Matt Z 4,139]

The Mini Gastric Bypass is essentially a sleeve and reconnect. They configure your stomach much the same way they do with the sleeve, then attach it to the intestines, so you only have the 1 staple line (on each side of the now bisected stomach) and 1 suture point. There is also some reports about the MGB having similar issues with acid reflux like the sleeve does.

The RYN bypass they make the small egg/walnut "stomach" has the 1 staple line (on each side of the now bisected stomach) and 2 suture points.

Both have *about* the same levels of malabsorption.



So, the MGB is almost like a sleeve with some added malabsorption, but with the downside of potential acid reflux issues like the sleeve. I don't see how the MGB would be drastically better than the RYN given that they both essentially do the same thing, restrict intake with an altered stomach/pouch and rerouted small intestines to provide the malabsorption.

My opinion of the 2... I'd go with the RNY over MGB, if only to make sure I didn't have to deal with reflux issues.

[RickM 1,747]

The mini bypass has been around for at least 15-20 years, as it was being touted by a few back when my wife and I first started seriously getting into this about 15 years ago. Since then, both the duodenal switch and the sleeve gastrectomy have made the jump to general acceptance by both the ASMBS and the US insurance industry and Medicare systems, while the mini bypass remains as an "experimental/investigational" procedure and has never gained traction in the US. This indicates that so far, the overall results have not shown to be as good, Recent years have shown some increase in its popularity in the Medical Tourism trade where cost is a major consideration.

Another consideration is how familiar is it where you live? Consider the situation where some years down the road you have some serious medical problem, related to your WLS or not. If you have had a common, mainstream procedure such as the RNY or VSG that is well known to your local medical community, the ramifications of your WLS can more readily be considered in treating your new problem; if you have had an unusual WLS that is not well known, that can complicate the diagnosis and treatment of your new problem.

For me, if I were to consider a procedure that is not mainstream, it would have to have demonstrably better results overall than what is common. This certainly applies to the DS, which while still a niche procedure owing to its greater complexity, typically yields better results in return; the marketplace and regulatory authorities don't seem to be finding a similar rationale for the MGB.

[Frustr8 7,886]

I'll serve on Rick M's committee. I think he is stating the truth. For me the the mini-,,would not be an option, my GERD is severe enough omeprazole doesn't touch it, I'm on Dexilant, so it was RnY from the get-go. The people at my local hospital were beaten with a stupid stick so even with my traditional choice I'll have to return to Columbus for anything the least bit complicated. Recently they did start doing lap band and some sleeves, they keep advertising they will start doing RnY but that will be 2029 or 2021, and frankly I don't want to wait THAT Long..
An side FYI I saw,just the other day,one of my firmer and younger co-workers aziz I just don't know. She told many of us she was having a band p k aced locally last January so almost 5 months ago. Something ain't right, either she didn't have it done(which I doybt) or she's eating around it. At 5 months. she should be smaller, and if anything she is bigger and her color doesn't look as healthy. She was 41 with a co-morbid, now she's a 43-44 and on a 5ft3in it doesn't look too good. I'm a little torn, when I saw her before around Christmas and she told me her news I did mention I was going to Columbus but left it at that. Should I have pressed it more? I figured any further preaching she might have resented, but she's only in her 39s has 2 children, a single mom, if the State paid for surgery they got "took" because she's bigger and less healthy looking than me & I'm still pre-surg, and easily old enough to be her mother or a youngish grandmother, many,of my high school classmates have grandbabies Erica's age. And the grandma in me says " Don't stay obese as long as I have!" . She looks closer to a ❤ attack than I do! And I worry about her kids, the older father is in prison, been a guest of the state for most of her,sons life, her daughter's father is married with a family with his wife, although he dies send support his wife only allows minimal interaction. Maybe,afraid her hubby and my young friend might make another baby? It's a not-healthy situation all around.👦😪👸

[RickM 1,747]

Frustr8, it is best to travel some if you have to in order to get what you need; even if you wait until your local guys start doing what you need, do you really want to be their guinea pig? A frequent recommendation is that your chosen surgeon should have several hundred of whatever procedure you choose under their belt to ensure that they are well up the learning curve.

I, likewise, traveled to get my VSG as it was still pretty new when I had it done seven years ago, so I went up to SF from LA to get it done by one of the established DS practices that had been doing them for twenty years or so. Paraphrasing one of the surgeons in our network when looking at images of a wonky VSG, "twenty years of doing bypasses and they think they know how to do a sleeve...." It may be a simpler and more straightforward procedure, but it still has its subtleties and nuances that one only really understands after doing a lot of them.

Likewise, though the bypass has been done for some forty years as a WLS, and relatives of it for some 140 years for other maladies, it still takes practice to get it right.

[kimberlymi 113]

Frustr8 , you make me laugh THANK YOU. 🤪. “ beaten with a stupid stick “ I love it.

[Frustr8 7,886]

Oh , a case in point. My cousin went to local "BandAid" with gall bladder symptoms. Lying there on gurney, Doctor walked in and asked Do you want a pap test? She said I have gall bladder sympyoms, my right shoulder hurts and I'm nauseous, my,lady parts are in just fine shape! Duhhh!

[MarinaGirl 609]

You need to find out if your insurance will agree to pay for 2 bariatric surgeries (i.e.one to remove the band and the second to do gastric bypass). If not, you need to work with a surgeon that will do both procedures in 1 surgery.

I had MGB surgery in April 2017, which resolved my acid reflux and allowed me to get below goal weight, BUT now I’m dealing with bile reflux so will be revising to an RNY in the very near future. YMMV

[lessismore1001 30]

Ahh interesting MarinaGirl.. right now I have to do an endoscopy because the surgeon thinks there is a possibility that my band has eroded into my stomach. if that's the case then def 2 surgeries, if not I can do 1.

Can I ask you why you went for the mini in the first place? Were you happy with it ... besides developing the bile reflux? Are you upset you didn't go RNY first? Big weightloss?

[MarinaGirl 609]

15 hours ago, lessismore1001 said:

Can I ask you why you went for the mini in the first place? Were you happy with it ... besides developing the bile reflux? Are you upset you didn't go RNY first? Big weightloss?

My insurance would not pay for WLS due to low BMI (35), so I decided to go to Mexico for surgery (self-pay). My surgeon in TJ did not recommend VSG because of my longtime history with GERD/acid reflux. Instead, he suggested One Anastomosis Gastric Bypass (aka MGB), which is a type of gastric bypass that is popular outside of USA (i.e. in Mexico, Latin America, Asia, India, Europe). I didn’t expect to get the MGB side effect (low incidence) of bile reflux so did not insist on an RNY instead of an MGB.

The good news is that my insurance will pay for revision from MGB to RNY, which is a huge relief. In retrospect, I wish I had the RNY instead of the MGB. If I had to do it all over again, I would go to Mexicali Bariatric Center, which has some of the best WLS surgeons in Mexico, for a Roux-en-Y Gastric Bypass.

Note that in spite of my issues with bile reflux, I’ve lost 100 lbs from my highest weight and am currently below goal weight. And I do not have any issues with bowel movements.

Edited June 20, 2018 by MarinaGirl

[MarinaGirl 609]

On 6/19/2018 at 7:27 AM, Matt Z said:

The Mini Gastric Bypass is essentially a sleeve and reconnect. They configure your stomach much the same way they do with the sleeve, then attach it to the intestines, so you only have the 1 staple line (on each side of the now bisected stomach) and 1 suture point. There is also some reports about the MGB having similar issues with acid reflux like the sleeve does.

The RYN bypass they make the small egg/walnut "stomach" has the 1 staple line (on each side of the now bisected stomach) and 2 suture points.

Both have *about* the same levels of malabsorption.



So, the MGB is almost like a sleeve with some added malabsorption, but with the downside of potential acid reflux issues like the sleeve. I don't see how the MGB would be drastically better than the RYN given that they both essentially do the same thing, restrict intake with an altered stomach/pouch and rerouted small intestines to provide the malabsorption.

My opinion of the 2... I'd go with the RNY over MGB, if only to make sure I didn't have to deal with reflux issues.

Your statement that MGB is “essentially a sleeve and reconnect” is wrong. In VSG, the stomach is permanently altered; approx. 80% is cut away and removed from the body. This does not happen with MGB. It is like the RNY in that a pouch is created and the old section of the stomach is still there. Therefore, MGB is considered reversible, unlike the VSG. MGB also does not result in new diagnoses of acid reflux, unlike the VSG.

MGB surgery is quicker and technically easier, so it carries a lower complication rate compared to traditional RNY gastric bypass.

Again, MGB doesn’t have an increase risk of ACID reflux, but it does have an increase risk of BILE reflux. These are not the same. My acid reflux was resolved after MGB, which has been verified with multiple EGD endoscopies and Bravo pH testing. But 6 months ago I developed bile reflux; new issue and symptoms that I’m working with medical specialists to correct.

[lessismore1001 30]

Very helpful Marina...thank you. When do you think you will have the revision?

[Matt Z 4,139]

13 hours ago, MarinaGirl said:

Your statement that MGB is “essentially a sleeve and reconnect” is wrong. In VSG, the stomach is permanently altered; approx. 80% is cut away and removed from the body. This does not happen with MGB. It is like the RNY in that a pouch is created and the old section of the stomach is still there. Therefore, MGB is considered reversible, unlike the VSG. MGB also does not result in new diagnoses of acid reflux, unlike the VSG.

MGB surgery is quicker and technically easier, so it carries a lower complication rate compared to traditional RNY gastric bypass.

Again, MGB doesn’t have an increase risk of ACID reflux, but it does have an increase risk of BILE reflux. These are not the same. My acid reflux was resolved after MGB, which has been verified with multiple EGD endoscopies and Bravo pH testing. But 6 months ago I developed bile reflux; new issue and symptoms that I’m working with medical specialists to correct.

Actually, if you look at the procedure you'd understand what I was saying. The "pouch" is identical to a sleeve. The stomach is sleeved and reconnected to the digestive tract, I never said it was identical to the sleeve procedure itself, I said it was "essentially" a sleeve and reconnect, which, it is, they sleeve the stomach and rather than remove the other portion of the stomach, they reconnect the sleeve to existing anatomy. Pretty straight forward exactly what is done.

My comment about the reflux, I didn't make that up, "Bile *AND* Digestive juice could reflux" and what do we call "Digestive juices"? Acid! So, I'm glad that this surgery resolved your Acid reflux issues, but, medical professionals state that it has the potential to increase both BIle and Acid reflux.

[MarinaGirl 609]

8 hours ago, lessismore1001 said:

Very helpful Marina...thank you. When do you think you will have the revision?

Hopefully in July. The final hurdle is getting approval on the hospital stay from my insurance as this will be done out-of-state (by a revision WLS expert).