The MGB2i is described as having a lower risk profile than other bariatric procedures due to its use of hand sewing instead of staples, which aims to eliminate staple line leaks and bleeding. It also adds a gastrojejunostomy to the anterior
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Introducing the MGB2.pptx
1. The
Mini-Gastric
Bypass (2i)
Recognize Most Common Complications of Bariatric Surgery
Minimal Modification of the MGB
1. Decrease Risk Bleeding & Leaks
2. Decrease in Operative Time & Resource Utilization
3. Decrease Risk of Reflux
4. Philosophy of the MGB/MGB2i
• Remove Resivoir Fuction of the Stomach/Covert to Extention of
the Esophagus (Collis Gastroplasty)
• Avoid the EG junction, leave the fundus
• Extend the Length of the Gastric Pouch 30-50%
• Decrease the ischemia of the lateral GJ anastomosis,
(marginal ulcer/perforation)
• Increased GJ outlet (Dumping)
• Decrease/eliminate staple line bleed/leak
• Easy revision/reversal
• Easily tailored: from normal weight diabetic to super super obese
5. The Mini-Gastric Bypass
**NOT** Mason Gastric Bypass
• Of course anyone is entitled to perform any surgery they
see fit
• But some surgeons have performed an operation that they
claim is a “Mini-Gastric Bypass”
• Do not understand the
Anatomy & Physiology of the
• Basic GI Surgery the MGB Not
Failed Mason Loop Gastric Bypass
7. Fear of Malnutrition &
Excess Weight Loss
• Death from Malnutrition with Zero Food Intake:
=> Requires 2 - 4 Months! With some food: 3 - 6 months!
• Simple Takeaway #1: IF Loose to Much => Revision!
• We need Patient & Surgeon Education
• Signs & Sx of malnutrition: Weak, edema ...
• Rx: Revision, short simple 30 min surgery
13. Complications of Gastric Plication
• Loss of restriction & weight regain
• Plication breakdown (Ischemia Poor Blood Supply)
• GE Reflux/Persistent heartburn
(Narrowing/Stricture Fundus)
• Gastric wall herniation (Ischemia / perforation)
• Gastric intussusception
• Gastric ulcers (Chronic Ischemia)
14. MGB2i vs Gastric Plication
MGB2i RX Complications of Gastric Plication
• Classical Gastric Plication
• Loss of restriction & weight regain
• Plication breakdown (Ischemia Poor
Blood Supply)
• GE Reflux/Persistent heartburn
(Narrowing/Stricture Fundus)
• Gastric wall herniation (Ischemia /
perforation)
• Gastric intussusception
• Gastric ulcers (Ischemia)
• MGB2i Modifications
Loss of restriction & weight regain:
+2 Meter Gastric Bypass
• Plication breakdown (Ischemia Poor Blood Supply)
No Devascularization of Greater Curve
• GE Reflux/Persistent heartburn
(Narrowing/Stricture Fundus)
Loose Fundus & Gastro-J => Low Pressure
• Gastric wall herniation (Ischemia / perforation)
No devascualrization of the plicated stomach
• Gastric intussusception
Downward traction on the stoamch pouch + GJ
• Gastric ulcers (Ischemia)
No devascualrization
15.
16. MGB -OT vs. MGB2i
Medial vs. Lateral Approach of Staplegun
MGB-OT
(Original
Technique)
Medial
Approach of
Staple-gun
MGB-OT
(Original Technique)
Medial Approach
of Staple-gun
MGB2i
Lateral
Approach of
Staple-gun
MGB2i
Lateral
Approach of
Staple-gun
17. MGB -OT vs. MGB2i
Medial vs. Lateral Approach of Staplegun
MGB2i
Lateral
Approach of
Staple-gun
Narrow
Afferent
Limb GJ
Outlet
18. POD 1 Leak Test
• Esophagus
• EG Junction
• Proximal Gastric Pouch
19. MGB2i, POD 1 Leak Test
• Esophagus
• EG Junction
• Proximal Gastric Pouch
• Midpoint of the Gastric Pouch
• Junction of the Body/Antrum
• Gastro-jejunostomy
• Efferent Limb
20. POD 1 Leak Test
• Esophagus
• EG Junction
• Proximal Gastric Pouch
• Midpoint of the Gastric Pouch
• Junction of the Body/Antrum
• Edema Gastro-jejunostomy
• Efferent Limb
• Antrum + Plicated Pylorus
21. POD 1 Leak Test
• Esophagus
• EG Junction
• Proximal Gastric Pouch
• Midpoint of the Gastric Pouch
• Junction of the Body/Antrum
• Edema Gastro-jejunostomy
• Efferent Limb
• Antrum + Plicated Pylorus
22.
23. Background Knowledge
• MGB Superb short & long term procedure
• Early Complications:
All Bariatric Surgery: Leak & Bleeding
• Staples: Superb tools, but Imperfect (Leak/Bleeding)
• Most modern Bariatric surgery face
Risk of bleeding & leak reported in rates of 0.1 to 5%
24. Gastric Plication: Pro/Con (Good/Not Perfect)
Twelve year experience of laparoscopic gastric plication
Mohammad Talebpour
• 800 cases, EWL 70% after 24 months
• 55% after 5 years following surgery.
• Mean Op time 72 min (49–152) minutes
• Mean hosp stay 72 hours
• Cost: $2,000.00 < band & sleeve
$2,500.00 < RNY
• Complications: Weight regain 31% @12 yrs
• 1% re-operation leak, obstruction, intra-abdominal
bleeding and vomiting
25. Gastric Plication: Issues Pro/Con
• Pro: *Short op time & hosp stay, *Moderate weight loss
• *Low Cost $2,000 - $2,500 less
• Con: Complications: Weight regain; leak, obstruction,
intra-abdominal bleeding & vomiting (ischemic plication)
• Con 2: Moderate Effectiveness +
Usual Complications++ (Leak/Bleeding etc.)
• Why: ischemia of the plicated stomach
26. Gastric Plication: Issues Pro/Con
Ischemia/Necrosis of the plicated stomach
• Con: Complications: Weight regain; leak, obstruction,
intra-abdominal bleeding and vomiting
• Con 2: The most common side effects reported by
patients include:
Vomiting, severe nausea & abdominal pain
which can last for a week or more
• Why: Ischemia/Necrosis of the plicated stomach
27. Mini-Gastric Bypass
• Almost “Perfect” Operation
• Short Simple Effective Reversible Revisable
• Can be Tailored to Patient’s Needs
• BUT: Like most bariatric procedures
• Has small but significant rates of leak & bleeding
28. The Simple Theory of the MGB 2
Stapless MGB
• No/Minimal Staple Line Leak or Bleeding
• How: Anterior Plication of the
Stomach Pouch: No Cutting No Staples
• Avoid the limitations/complications of Plication
• How:
• 1. Do not devascularize the gastric tissue and
• 2. Add the MGB bypass to increase the power of the
operation & decompress the stomach pouch to avoid
subsequent dilation/weight regain
29. Short-term Outcome of Single-Anastomosis Plication Ileal Bypass
(SAPI) Springer, December 2020Obesity Surgery
• Many Good Men & Women have had similar ideas:
i.e. The SAPI procedure involved
• plication of the greater curvature of the stomach in two
rows
• then performing a stapled side-to-side anastomosis
between an ileal loop and the gastric antrum.
30. Nothing New Under the Sun
SAGI PGP
• Many authors have led similar/same
procedure(s)
• Our own concern was the lateral
devascularization of the greater
curvature and the reported
ischmia, pain, necrosis and
perforations reported in
Plication Series
Single Anastomosis Gastro Ileal Bypass with Pyloric and Gastric Plication (SAGI PGP): A New Innovative Bariatric Operation
Ferman Faris Mohammed1* and Rafil Abdel Alwahab Aldaaod2
31. Failed AnteriorGastric Plication
S. A. Brethauer et al. / Surgery for Obesity and Related Diseases xx (2010)
• Laparoscopic gastric plication for treatment of severe obesity
• Stacy A. Brethauer, M.D.,*, Jason L. Harris, Ph.D.b
• , Matthew Kroh, M.D., Philip R. Schauer, M.D., Bariatric and Metabolic
Institute, Cleveland Clinic, Cleveland, Ohio
• Ethicon, Endo-Surgery, Cincinnati, Ohio
• Received May 6, 2010; accepted September 22, 2010