Expert: John Pilcher, MD - 8/28/2007

Question
QUESTION: Can you tell me what the long term complications from a mini gastric bypass would be.  Thanks.

ANSWER: Kim,
I will give you the best answer I can, but this will have to be provisional information for several reasons:
1)  I don't do the mini gastric bypass
2)  The anatomy of the mini gastric bypass has changed over time, so it is hard to pin down
3)  There is very little research available on medium and long term outcomes after mini gastric bypass

One feature that has been constant in all the manifestations of the mini gastric bypass that I know of, is that bile and pancreatic juices travel up to bathe the stomach pouch and possibly the esophagus, before they mix with food and travel downstream.  Constant exposure of the esophagus to these digestive juices can cause reflux/heartburn symptoms, and possible damage to the esophagus.  There are not any reliable reports on how often this happens.

In recent years, the mini gastric bypass has structured the small intestinal anatomy in a way that creates malabsorption.  This feature is intended to improve weight loss by causing nutrients to pass through without absorption.  It usually causes foul smelling bowel gas and frequent loose bowel movements.  More importantly, this aspect of the operation can lead to very serious nutritional deficiency.

Obviously, any bariatric surgical procedure can have complications and side effects.  The impression of the bariatric surgical community as a whole is that these side effects are more common with the mini gastric bypass.  The Roux-en-Y gastric bypass, the Lap-Band, and the gastric sleeve are all understood to give outcomes that are more predictable and more likely to be compatible with long term health.

I hope this is helpful,
Dr JP

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. JP.

Thank you for your generous reply.  May I ask you one more question relating to this.  My brother had a mini gastric bypass operation last year, approximately 9 months ago and he cannot quit losing weight.  Normally that is a good thing, but in his case he is already very thin with the appearance of a cancer patient with a very drawn face and looks malnourished and his hair is falling out.  Is there anything he can do to fix the problem that he has now.  He is eating 7 times per day and states that he cannot gain weight and in fact has lost another 20 pounds in the last month.  I am afraid things have gotten out of control because he cannot stabilize his weight as he continues to head in the wrong direction and I think he is going to be very sick.  Any comments would be appreciated.

Answer
Kim,
It sounds like your brother is experiencing nutritional complications that can  occur following the mini gastric bypass.  This is a fairly urgent problem for your brother, because the mini gastric bypass has been known to result in permanent neurologic damage in cases like you describe.

Your brother very likely needs serious supplemental nutrition, and probably also needs surgical revision of the intestinal anatomy created at the time of the mini gastric bypass.

I advise the following specific actions for your brother, as soon as possible:
1) Return for follow up with the surgeon who did the operation.  That surgeon needs a shot at addressing the situation.  Your brother should fully document his attempts to meet with that surgeon, as well as the outcomes of such visits.

2)  Simultaneously, your brother should seek a second opinion from a reputable bariatric surgeon and bariatric surgical program.  The best way to find one near him is through the website
www.asmbs.org

Best of luck to you and your brother,
Dr JP