Thoughts on a mini-byapss?

[ryan_86 335]

I was hoping to get folks' opinion on the mini-bypass vs the bypass.

Because I'm considering a revision, my thinking is I'd rather have the less dramatic revision. There are fewer adverse effects and nutritional requirements with the mini, and if in the future for some reason I need to convert to a full bypass, that option is on the table.

On the other hand, I regret not going with the bypass 6 years ago. I didn't know how bad my GERD would get, but I also didn't think I'd regain as much weight as I did (40 pounds out of 140 lost).

Who else has thought about these alternatives? What did you go with and why?

[RickM 1,753]

The mini bypass has been kicking around for a long time - it was around the periphery of bariatrics some twenty years ago when my wife and I first started looking into WLS, and it's still there today, not having achieved mainstream status (and many, if not most, US insurance companies still don't cover it.) in the meantime, the BPD/DS, VSG and now the SIPS/SADI have gone mainstream, gaining acceptance by the ASMBS and insurance industry. It would pay to understand why that is. When I last looked into these things, 2-3 years ago, ASMBS was fairly positive about the SIPS/SADI, but they didn't yet have the data to recommend it; they apparently do now. I would suggest looking through their site to see if they have any current opinion on the MGB and why it doesn't get on their recommended list. Amongst the MX surgeons, the MGB seems to mostly be sold as a cheaper alternative to the RNY rather than a technically better one.

Classically, bile reflux is one of the problems with these simplified, single anastomosis procedures. There are claims that some techniques have been developed to mitigate that problem, but I don't know how much of that is real progress and how much is marketing.

The MGB does seem to be more mainstream in other countries, so there may be something to the claims of improvement, and it simply lost its best opportunity to be sold to the US industry and authorities. Given that, I would be apprehensive about getting it done while living here in the states, if for no other reason than long term support - how many US doctors, bariatric or otherwise, understand it, and how to treat you in the years ahead should there be a problem. It's something like owning a French car here in the States - parts and service are a problem. My wife has a DS, which has something of that issue, despite being mainstream and approved, as it is still something of a niche procedure, with few surgeons understanding it. It, however, has the redeeming value of having demonstrably better performance - both initial loss and most particularly regain resistance; the MGB doesn't, as it's not markedly different than the RNY or VSG in performance.

Have you had your GERD evaluated as to its cause? A hiatal hernia or shape issue can usually be corrected while still maintaining the sleeve, though some surgeons may not be well practiced at that and would simply revise to a bypass to correct it (the old "VSG + GERD=you need an RNY" thing rather than fixing the basic problem - it might need an revision, or it might not.)

In correcting regain, these revisions seem to be only moderately successful - count on maybe twenty pounds or so - about what one would expect from the intense dieting required around surgery time, and one can expect similar results from a hiatal hernia repair. Basically, you have already learned how to eat around a small stomach, so shrinking it further with a revision doesn't yield nearly as good a result as your virgin procedure. Some do show remarkable improvement, but they seem mostly to be those who take the regain seriously and swear to "not let that happen again" and really buckle down and get with the program. One can almost consider the revision to be a placebo. If I were looking to seriously tackle a regain problem, I would lean more toward the BPD/DS as that more directly addresses the metabolic problem, though not the GERD as it retains the sleeve - that would remain an issue as to whether the sleeve itself is the cause of it and that can be corrected.