Mini-Gastric Bypass Technical Errors, Tips & Pointers The Mistake of the Twisted PouchAnterior Gastro-Jejunostomy (No it is Not A Good Idea!) Doing the MGB WrongThe Twisted Gastric Pouch The Neo-Gastric Pouch Should not be twisted That should be obvious The lesser curve should lie at 9 o'clock, medially The Neo-Greater curvature should lie at 3 o'clock, laterally Twisted (Wrong) pouch makes the anterior GJ “look” like a good choice Twisted Gastric Pouch Syndrome: Post op Nausea and vomiting CTScan, Endoscopy all negative “INVISIBLE ILLNESS” Rx: Revision Prevention: Simple, Do Not Twist the Pouch & Never Anterior Anastomosis