Laparoscopic Single Anastomosis Gastric Bypass

Laparoscopic Single Anastomosis Gastric Bypass

This operation is relatively new and old. It is considered new from the bariatric standpoint, since it does resemble the Roux En-Y Gastric Bypass (LRYGB), but differs in these aspects:

  • Size of the gastric pouch (the new stomach used for food) may be a little longer.
  • The length of the bowel bypassed is usually 2 meters (longer than the standard proximal bypass)
  • Only one connection (anastomosis) is made: between the bowel and the gastric pouch. No anastomosis between the small bowel is made as in the LRYGB.
This procedure stemmed from the old Billroth II gastrectomy procedure done for the ulcers in the past. It carried the risk of bile reflux at the time, that is why a second connection (anastomosis) is usually done these days as a standard. The proponents of this procedure advertise the anti-reflux way of suturing the bowel to the pouch preventing this from happening. However, bile reflux gastritis still occurs in about 10% of cases, severe enough to require a revision to be converted to LRYGB. 

As a must, our patients who undergo the mini Gastric Bypass, need to have annual upper endoscopy to check for bile reflux gastritis. If present and is significant, they will need revision to LRYGB to prevent future potential gastric cancer, which is a well established sequel to bile reflux gastritis.

The Advantage of this procedure however, lies in the less dumping symptoms experienced by patients and less hyperinsular state as suggested by Dr. Himpens from Belgium. It is almost similar to LRYGB in its Diabetes resolution, leak rates and the rest of the complications. It is however superior to LRYGB in maintaing the long term weight loss at 80% of the excess weight. It also carries the risk of malabsorption, especially iron deficiency causing anemia.

Some surgeons would like to advertise this procedure as a safer procedure to LRYGB. In our experience, it is as safe short term, but long term carry the risk of bile reflux gastritis and the potential of gastric cancer if left untreated. Vitamin & iron requirements are more in comparison to LRYGB as well.