Archive for November 2013

Mini Gastric Bypass (MGB) – A simpler, safer and more effective weight-loss surgery.

The Occam’s Razor suggests that entities should not be multiplied endlessly. Although it is true in many situations, in some fields where evolution and progress is ongoing, this is not true. One such field is in Bariatric surgery where yet another procedure is making great promise. It goes by the name of Mini Gastric Bypass (MGB).


Dr R Rutledge, an American surgeon devised the procedure in 1997 and the author had the honour and privilege to learn the procedure directly from him.


Literature suggests that when compared to the other bariatric procedures, MGB is a simpler, shorter and a very effective technique in weight loss surgery. In fact it takes less than an hour to do this surgery. Most patients are home the next day.


The other significant short-term advantage is the time to get back to a solid diet after surgery. In other bariatric procedures, it is common for the patients to get back to solid food after a period of 3 to 6 weeks. However a patient after MGB can get back to a solid diet as early as 2 days! No more listening to the patients post surgery “Doctor, when can I eat? I am tired of drinking”.


The MGB works differently from other procedures in the sense that it causes more malabsorption than standard procedures like sleeve gastrectomy and conventional gastric bypass. So a patient who eats more will still lose weight or maintain the weight loss achieved even years after bariatric surgery- a phenomenon not seen consistently in other procedures. This has been documented in some studies where MGB was found to be more effective in sustained weight loss even at long term where the durability of other procedures have been questioned.


There is one more novel advantage of MGB. In all the bariatric procedures thus far, the surgery would be the same irrespective of the weight loss and metabolic effect desired. In MGB, however the procedure can be tailored to produce a measured response. In this manner, the surgery can work as a pill with the dosage in our control. Practically this is achieved by altering the length of the bowel bypassed in MGB. Shorter bypass achieves a lesser weight loss and metabolic control. The longer bypass obviously achieves more.


The other great thing about MGB (it doesn’t seem to end!) is that it is both easily reversible and revisable. Let me explain. If for some reason (and that would have to be something great, considering the benefits) a patient wanted to undo the procedure, it would take less than an hour in the operation theater to do so.  Lets take another situation. If after some time after bariatric surgery, the patient does not have the desired result of weight loss- it may have been too much or too less of weight loss- then the surgery can be revised by performing another simple procedure.


Though there is a lot of evidence in the benefits of bariatric surgery on obese diabetics, there is actually little data and good evidence on the benefits of bariatric surgery on non-obese diabetics. Some studies are showing promising results of MGB even in non-obese diabetics.


With excellent long-term weight loss and these wonderful benefits, it is not surprising to know why this surgery is fast becoming more popular with the obese and diabetic patients.


You can see how we do the procedure at the YouTube

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A New Approach in Diabetes – Don’t Die a Diabetic?


What is the conventional treatment of Diabetes?

Diabetes is conventionally treated by a low sugar diet, physical activity and medicines that lower sugar levels in the blood. In advanced stages, insulin is also needed.


What are the complications of Diabetes?

There can be long-term complications in the Eye, Kidneys, Nerves, Heart, Brain and Limbs – practically every part of the body- in diabetes. This is because of chronic cell starvation – sugar staying in the blood and not entering the cells. This may result in eye surgery for cataract, stenting for heart disease, strokes, dialysis for kidney disease, infections, loss of limb, etc. And all this can still happen despite medical treatment of diabetes.


What is Surgery to “cure” Diabetes?

Recent research has shown that the small intestines play a major part in diabetes. When food comes in contact with certain part of the gut such as the duodenum, it releases certain hormones that are responsible for inactivity of insulin. Based on such knowledge, operations have been devised to reroute the food in the gut by altering its path. This results in the “cure” of diabetes. It is also called bariatric or metabolic surgery.


Who are the candidates for surgery to “cure” diabetes?

Diabetic patients who have are obese, have diabetes for less than 5 years and are not on insulin, have the best chance of resolution of diabetes from the surgery.


How is the surgery done? What is the cost of the surgery and is it cost-effective?

It is a laparoscopic surgery requiring a 2-day hospital stay. The cost of the surgery varies from 2-5 lakhs INR depending on the procedure, technology and the class of accommodation. If one calculates the expenditure of medications, tests and the risks of complications, one may find this price cost-effective.


How effective is the surgery to resolve diabetes?

So effective is the diabetes surgery that it has been hailed as the most important discovery of the decade. Many patients are exchanging their life of medications with a single shot surgery. The disease that was till recently considered incurable is now being considered “potentially curable”.

Watch the video on Diabetic Surgery on YouTube.

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