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“Mini” Gastric Bypass: Systematic Review of a Controversial Procedure


Mini gastric bypass is being explored by many bariatric surgeons as a standalone bariatric procedure. Several surgeons from different parts of the world have now published their extensive experience with this procedure. It appears to be an effective bariatric procedure with acceptable weight loss, co-morbidity resolution, and complication rates in the short and medium term. Its proponents claim that it is safer and easier than the gold standard Roux-en-Y gastric bypass. However, concerns with regard to symptomatic gastric or oesophageal biliary reflux requiring revisional surgery and long-term risk of gastric and oesophageal cancers persist. This paper reviews the published experience to date with this procedure and examines the surrounding controversy.

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Fig. 1



Mini gastric bypass


Preferred Reporting Items for Systematic Reviews and Meta-Analyses


Excess weight loss


Randomised controlled trial


Impact of weight on quality of life


Roux-en-Y gastric bypass


Laparoscopic adjustable gastric banding


Vertical banded gastroplasty


  1. 1.

    Rutledge R. The mini-gastric bypass: experience with the first 1274 cases. Obes Surg. 2001;11(3):276–80.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15(5):648–54.

    PubMed  Article  Google Scholar 

  3. 3.

    Fisher BL, Buchwald H, Clark W, et al. Mini-gastric bypass controversy. Obes Surg. 2001;11(6):773–7.

    PubMed  CAS  Google Scholar 

  4. 4.

    Olchowski S, Timms MR, O’Brien P, et al. More on mini gastric bypass. Obes Surg. 2001;11(4):532.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Johnson WH, Fernanadez AZ, Farrell TM, et al. Surgical revision of loop ("mini") gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):37–41.

    PubMed  Article  Google Scholar 

  6. 6.

    Collins BJ, Miyashita T, Schweitzer M. Gastric bypass. Why Roux-en-Y? A review of experimental data. Arch Surg. 2007;142(10):1000–3.

    PubMed  Article  Google Scholar 

  7. 7.

    McQuaid KR, Laine L, Fennerty MB, et al. Systematic review: the role of bile acids in the pathogenesis of gastro-oesophageal reflux disease and related neoplasia. Aliment Pharmacol Ther. 2011;34(2):146–65. doi:10.1111/j.1365-2036.2011.04709.x. Epub 2011 May 25.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Gillen P, Keeling P, Byrne PJ, et al. Implication of duodenogastric reflux in the pathogenesis of Barrett’s oesophagus. Br J Surg. 1988;75(6):540–3.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Kauer WK, Peters JH, DeMeester TR, et al. Mixed reflux of gastric and duodenal juices is more harmful to the esophagus than gastric juice alone. The need for surgical therapy re-emphasized. Ann Surg. 1995;222(4):525–31.

    PubMed  CAS  Google Scholar 

  10. 10.

    Noun R, Zeidan S. Laparoscopic mini-gastric bypass: an effective option for the treatment of morbid obesity. J Chir (Paris). 2007;144(4):301–4 [Article in French].

    Article  CAS  Google Scholar 

  11. 11.

    Chevallier JM, Chakhtoura G, Zinzindohoué F, et al. (Paris). [Laparoscopic mini-gastric bypass]. 2009; 146(1): 60–4

  12. 12.

    Copăescu C, Munteanu R, Prala N, et al. Laparoscopic mini gastric bypass for the treatment of morbid obesity. Initial experience. Chir (Bucur). 2004;99(6):529–39 [Article in Romanian].

    Google Scholar 

  13. 13.

    Hu XG, Zheng CZ, Ji XR, et al. Short-term outcome of laparoscopic gastric bypass and minigastric bypass on obesity patients with type 2 diabetes mellitus. Zhonghua Wei Chang Wai Ke Za Zhi. 2009;12(6):554–7 [Article in Chinese].

    PubMed  Google Scholar 

  14. 14.

    Guo X, Yin K, Zhuo GZ et al. Efficacy comparison between 2 methods of laparoscopic gastric bypass surgery in the treatment of type 2 diabetes mellitus. Zhonghua Wei Chang Wai Ke Za Zhi. 2012; 15(11): 1125–8 [Article in Chinese].

  15. 15.

    García-Caballero M, Valle M, Martínez-Moreno JM, et al. Resolution of diabetes mellitus and metabolic syndrome in normal weight 24–29 BMI patients with One Anastomosis Gastric Bypass. Nutr Hosp. 2012;27(2):623–31.

    PubMed  Google Scholar 

  16. 16.

    Kim Z, Hur KY. Laparoscopic mini-gastric bypass for type 2 diabetes: the preliminary report. World J Surg. 2011;35(3):631–6.

    PubMed  Article  Google Scholar 

  17. 17.

    Lee WJ, Ser KH, Lee YC, et al. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22(12):1827–34.

    PubMed  Article  Google Scholar 

  18. 18.

    Lee WJ, Lee YC, Ser KH, et al. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2011;7(4):486–91.

    PubMed  Article  Google Scholar 

  19. 19.

    Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI > 35 and <35 kg/m2. J Gastrointest Surg. 2008;12(5):945–52.

    PubMed  Article  Google Scholar 

  20. 20.

    Lee WJ, Wang W, Lee YC, et al. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18(3):294–9.

    PubMed  Article  Google Scholar 

  21. 21.

    Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242(1):20–8.

    PubMed  Article  Google Scholar 

  22. 22.

    Peraglie C. Laparoscopic mini-gastric bypass (LMGB) in the super-super obese: outcomes in 16 patients. Obes Surg. 2008;18(9):1126–9.

    PubMed  Article  Google Scholar 

  23. 23.

    Chakhtoura G, Zinzindohoué F, Ghanem Y, et al. Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital. Obes Surg. 2008;18(9):1130–3.

    PubMed  Article  Google Scholar 

  24. 24.

    Piazza L, Ferrara F, Leanza S, et al. A laparoscopic mini-gastric bypass: short-term single-institute experience. Updates Surg. 2011;63(4):239–42.

    PubMed  Article  Google Scholar 

  25. 25.

    Carbajo M, García-Caballero M, Toledano M, et al. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg. 2005;15(3):398–404.

    PubMed  Article  Google Scholar 

  26. 26.

    Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15(9):1304–8.

    PubMed  Article  Google Scholar 

  27. 27.

    Noun R, Riachi E, Zeidan S, et al. Mini-gastric bypass by mini-laparotomy: a cost-effective alternative in the laparoscopic era. Obes Surg. 2007;17(11):1482–6.

    PubMed  Article  Google Scholar 

  28. 28.

    Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22(5):697–703.

    PubMed  Article  Google Scholar 

  29. 29.

    Rutledge R. Hospitalization before and after mini-gastric bypass surgery. Int J Surg. 2007;5(1):35–40.

    PubMed  Article  Google Scholar 

  30. 30.

    Begg C, Cho M, Eastwood S. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996;276(8):637–9.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Sacks BC, Mattar SG, Qureshi FG, et al. Incidence of marginal ulcers and the use of absorbable anastomotic sutures in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2(1):11–6.

    PubMed  Article  Google Scholar 

  32. 32.

    Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis. 2006;2(4):460–3.

    PubMed  Article  Google Scholar 

  33. 33.

    Dallal RM, Bailey LA. Ulcer disease after gastric bypass surgery. Surg Obes Relat Dis. 2006;2(4):455–9.

    PubMed  Article  Google Scholar 

  34. 34.

    McCarthy HB, Rucker RD, Chan EK, et al. Gastritis after gastric bypass surgery. Surgery. 1985;98:68–71.

    PubMed  CAS  Google Scholar 

  35. 35.

    Scozzari G, Trapani R, Toppino M, et al. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis. 2013;9(1):133–42.

    PubMed  Article  Google Scholar 

  36. 36.

    Babor R, Booth M. Adenocarcinoma of the gastric pouch 26 years after loop gastric bypass. Obes Surg. 2006;16(7):935–8.

    PubMed  Article  Google Scholar 

  37. 37.

    Taha AS, Angerson WJ, Morran CG. Reflux and Barrett’s oesophagitis after gastric surgery—long-term follow-up and implications for the roles of gastric acid and bile in oesophagitis. Aliment Pharmacol Ther. 2003;17(4):547–52.

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Nason KS, Farrow DC, Haigh G, et al. Gastric fluid bile concentrations and risk of Barrett’s esophagus. Interact Cardiovasc Thorac Surg. 2007;6(3):304–7.

    PubMed  Article  Google Scholar 

  39. 39.

    Champion G, Richter JE, Vaezi MF, et al. Duodenogastroesophageal reflux: relationship to pH and importance in Barrett’s esophagus. Gastroenterology. 1994;107(3):747–54.

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Theisen J, Peters JH, Fein M, et al. The mutagenic potential of duodenoesophageal reflux. Ann Surg. 2005;241(1):63–8.

    PubMed  Google Scholar 

  41. 41.

    Lagergren J, Lindam A. The risk of oesophageal adenocarcinoma after gastrectomy for peptic ulcer disease. Eur J Cancer. 2012;48(5):749–52.

    PubMed  Article  Google Scholar 

  42. 42.

    Lagergren J, Lindam A, Mason RM. Gastric stump cancer after distal gastrectomy for benign gastric ulcer in a population-based study. Int J Cancer. 2012;131(6):E1048–52.

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Freedman J, Lagergren J, Bergström R, et al. Cholecystectomy, peptic ulcer disease and the risk of adenocarcinoma of the oesophagus and gastric cardia. Br J Surg. 2000;87(8):1087–93.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Lacaine F, Houry S, Huguier M. Stomach cancer after partial gastrectomy for benign ulcer disease. A critical analysis of epidemiological reports. Hepatogastroenterology. 1992;39(1):4–8.

    PubMed  CAS  Google Scholar 

  45. 45.

    Avidan B, Sonnenberg A, Schnell TG, et al. Gastric surgery is not a risk for Barrett’s esophagus or esophageal adenocarcinoma. Gastroenterology. 2001;121(6):1281–5.

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Lundegårdh G, Adami HO, Helmick C, et al. Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med. 1988;319(4):195–200.

    PubMed  Article  Google Scholar 

  47. 47.

    Fisher SG, Davis F, Nelson R, et al. A cohort study of stomach cancer risk in men after gastric surgery for benign disease. J Natl Cancer Inst. 1993;85(16):1303–10.

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Birgisson S, Rice TW, Easley KA, et al. The lack of association between adenocarcinoma of the esophagus and gastric surgery: a retrospective study. Am J Gastroenterol. 1997;92(2):216–21.

    PubMed  CAS  Google Scholar 

  49. 49.

    Nishijima K, Miwa K, Miyashita T, et al. Impact of the biliary diversion procedure on carcinogenesis in Barrett’s oesophagus surgically induced by duodenoesophageal reflux in rats. Ann Surg. 2004;240(1):57–67.

    PubMed  Article  Google Scholar 

  50. 50.

    Freedman J, Ye W, Näslund E, et al. Association between cholecystectomy and adenocarcinoma of the esophagus. Gastroenterology. 2001;121(3):548–53.

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Lorusso D, Pezzolla F, Linsalata M, et al. Duodenogastric reflux and gastric mucosal cell proliferation after cholecystectomy or Billroth II gastric resection. Gastroenterol Clin Biol. 1994;18(11):927–31.

    PubMed  CAS  Google Scholar 

  52. 52.

    Hansson LE, Nyrén O, Hsing AW, et al. The risk of stomach cancer in patients with gastric or duodenal ulcer disease. N Engl J Med. 1996;335(4):242–9.

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984;1(8390):1311–5.

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Moose D, Lourie D, Powell W, et al. Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting. Am Surg. 2003;69(11):930–2.

    PubMed  CAS  Google Scholar 

  55. 55.

    Wang W, Huang MT, Wei PL, et al. Laparoscopic mini-gastric bypass for failed vertical banded gastroplasty. Obes Surg. 2004;14(6):777–82.

    PubMed  Article  Google Scholar 

  56. 56.

    Noun R, Zeidan S, Riachi E, et al. Mini-gastric bypass for revision of failed primary restrictive procedures: a valuable option. Obes Surg. 2007;17(5):684–8.

    PubMed  Article  Google Scholar 

  57. 57.

    Rutledge R. Revision of failed gastric banding to mini-gastric bypass. Obes Surg. 2006;16(4):521–3.

    PubMed  Article  Google Scholar 

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Correspondence to Kamal K. Mahawar.

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Mahawar, K.K., Jennings, N., Brown, J. et al. “Mini” Gastric Bypass: Systematic Review of a Controversial Procedure. OBES SURG 23, 1890–1898 (2013).

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  • Bariatric surgery
  • Obesity surgery
  • Gastric bypass
  • Single anastomosis gastric bypass
  • Omega loop gastric bypass
  • Mini gastric bypass