[MINI GASTRIC BYPASS THREAD – PLEASE CONSIDER YOUR SURGERY AND EXPERIENCES MAY NOT APPLY TO MINI GASTRIC BYPASS PATIENTS]

Hi all BP’ers and lurkers out there; especially hi to everyone who had the mini gastric bypass (AKA the one-anastomosis gastric bypass/single-anastomosis gastric bypass/omega loop gastric bypass)

It’s my surgiversary!

I can’t believe it’s already been a year. But what a year it has been. Man. I wanted to share a lot of thoughts about my journey – there’s not a ton of MGB patients out there yet, and especially not in the US.

I’ll admit I’ve been working on this for a while, because I want to share the good word about the MGB and contribute some of the things I simply cannot find out there. Well, now I know, at least how it’s been the first year for myself. So that’s my small contribution.

Below, I’ll post the following posts individually so it’s easy to browse for anyone new:

• The surgery: what is it, how does it work, what does science say about weight loss and complications with MGB?
• My journey to weight loss surgery
• My weight journey for a year after the mini gastric bypass
• My diet and calories – stages + what does a typical day look like after a year?
• Exercise – what and when and how much?
• Alcohol and MGB
• What I wish they had told me prior to surgery
• Setting a goal
• Why I think you should consider the MGB
• What it’s like being a mini gastric bypass patient on BariatricPal – what I found useful, and why I needed a pause from participating on the forum
• What now?

I hope you’ll find some of this enjoyable.

Edited December 7, 20214 yr by Guest

The surgery: what is it, how does it work, what does science say about weight loss and complications with MGB?

What is it?
There’s nothing ‘mini’ about the MGB. The name was given by Dr. Rutledge who invented it in 1997 to describe its simpler configuration compared to Roux-en-Y gastric bypass.

Basically, the stomach is divided and a long, narrow pouch is created (a little like the sleeve), but the rest of the stomach is left in place (like with RNY). A loop of the small intestine is then connected to the pouch, and that’s it.

There’s one connection point – one anastomosis – and unlike the sleeve, the food travels directly down into the intestine, as the pyloric valve is bypassed. The bypass is anywhere from 150cm – 350cm (3 to 9 feet), though recently most surgeons do 150cm to avoid malnutrition later on.

Here’s a diagram:

How does it work?
As with all bariatric surgery, there are things we know and things we don’t know. We obviously feel full faster due to the smaller stomach, but because it’s ‘open’ in the bottom to the intestine, and this anastomosis is not especially narrow, we can usually eat pretty large amounts fairly soon after surgery.

My personal experience is that I’ve only felt I ‘had no more room’ a few times, and always with minced meat, weirdly enough.

The big trick is that you feel satisfied very quickly, because the food lands undigested pretty far down the intestine. It’s like the feeling after a huge Christmas dinner. Technically, I could eat more, but I feel stuffed (and satisfied). So I don’t.

We have at least 3-4x the malabsorption of RNY, so there’s some calories being flushed right out. Personally, I can see when I eat a higher-fat meal that some of it goes through undigested (sorry for theTMI).

How much do you lose?
Unlike what people think, there are tons of studies out there documenting that weight loss is generally greater after MGB than after sleeve and RNY. Not a single study out there shows less weight loss with MGB when comparing MGB and RNY.

Excess Weight Loss (EWL) ranges from mid-60s % EWL to the 80s after one year (a few studies show even higher WL, but those are generally from cohorts of fairly low-BMI study populations).

All-in-all, weight loss is excellent and looks like it’s long-term durable in the studies. Especially when compared to the sleeve.

Complications?
For some reason, there’s a ‘feeling’ among American bariatric surgeons that MGB carries a higher risk of stomach cancer. This is not true, and it has been studied. A few patients experience bile reflux, but this is a lesser concern with the Spanish ‘anti-reflux stitch’ most MGB surgeons now use. Mine did as well, and while I suffered heavily from GERD prior to surgery, this is no longer a problem.

Long-term, malnutrition is an issue, so take your vitamins. Think of vitamins as being generally a good idea for sleevers, mandatory in the beginning for RNY’ers and then see how your labs develop as the years pass, to very important for MGB, also long-term, and life-or-death for our duodenal switch friends. This reflects the malabsorption – none in sleeve, a little in RNY, a moderate-to-significant amount in MGB, and a lot in DS.

Edited December 7, 20214 yr by Guest

My journey to weight loss surgery

We all have our journeys, and I love to talk about mine. I’m not ashamed in the slightest over having a hard-to-work-with metabolism in a world that isn’t made for us. It messed me up, but here I am taking back my life.

I’ll keep it fairly brief here, though:

• I was a chubby kid, had some years in a normal weight range, dieted all the time, yo-yo weight, started working a stressful job and eventually fell into a full-on eating disorder (BED).
  
• After receiving treatment for this, I was ready for bariatric surgery, and studied my options intensively.
  
• I initially ruled out the sleeve due to the regain rates + GERD. I then wanted RNY because of its ‘tested and verified’ legacy but landed on the MGB for the superior possibility for weight loss, higher chance of keeping the weight off, and for how easy it is to revise or reverse if the need arises later.

I have not regretted my choice for a second ever since.

Edited December 7, 20214 yr by Guest

My weight journey pre-op + for a year after the mini gastric bypass

• I reached my highest weight – 364 lbs – fairly close to surgery. I then lost from 364 to 344 at day of surgery.
• In the first month, I lost 34 lbs, and at the 60 day mark, I had lost 61 lbs. So 2 months after surgery, I was down to 283 lbs.
• At the 6 month mark, I was down to 234 lbs (total loss 130 lbs), and at the 12 month mark I’m at 201 lbs (total loss 163 lbs).
• My EWL is 88.8%, and I’m of a pretty muscular build, so for all intents and purposes, I’m done losing.

More importantly, I think I look fantastic! I went from a 54” waist to wearing 32” jeans, and from a 6XL to a medium or large in men’s tops. I can see the individual parts of the shoulder muscles, there’s tricep definition, my legs look like pro soccer player legs … in a way, my fat decade was a massive bulk for the fellow weight lifters out there

As for excess skin, it looks like I gave birth to quintuplets a few weeks ago, and there’s loose skin everywhere. I’m only wanting surgery on the stomach area, though. I think the rest will gradually be okay, and I don’t really need to be perfect. I’m great as I am.

I’ve debated whether to include photos, but what the hell. I have nothing to be ashamed of, and if this motivates just one person to go do this for themselves, I’ll be happy.

DAY BEFORE SURGERY (this is 20 lbs lower than my heaviest)

... aaand:

FROM THE PAST WEEK (163 lbs lighter than my heaviest, BMI around 27.5)

Edited December 7, 20214 yr by Guest

My diet and calories – stages + what does a typical day look like after a year?

My post-op plan was pretty standard:

• 1 week of fluids
• 1 week of puréed
• 1 week of soft solids and then gradually into solids.

It was easy, but I had reached out for help prior to surgery and had family take care of me.

I could’ve done it on my own, but I do recommend letting all pride go and simply take as much time off work as you can, ask for all and any help you can from the people around you. You have no idea how willing people are to help. That first month is so crucial to get off to a great start – it’s a long journey – and we deserve it.

I had alcohol less than a month after surgery (for NYE) and it was fine. It was OK’ed with my surgeon’s team. I understand this is different for different cultures, but alcohol is a major part of life where I live, and I am done doing unsustainable things. So I had to practice flexible control right off the bat. It works well for me.

For me, tracking calories and protein has been crucial I was on:

• 1400 cals/day for 6 months, then
• 1800 cals a day for 3 months

and then the bariatric team asked me to stop losing and find my balance. Since then, I’ve lost 7-8 lbs as I’m finding my equilibrium.

I stopped tracking on weekends, and I still track on weekdays. It’s good to keep that sense of what 2000-2200 calories look like, but it’s also a more long-term sustainable solution for me to not sit at a restaurant and think about whether I go 50 over or under on a Friday.

This gets into the mental game, and I’ll cover that below.

A typical day now looks like this:

Breakfast
Protein Oatmeal (around 200 cals)

Lunch
Meat + mixed salad + a little dressing at work. Small plate.

Early afternoon
A protein snack, like Quest Protein Chips.

Late afternoon
Usually some fruit, a slice of protein bread with low-fat cheese.

Dinner
I’ve grown fond of Thai curries with chicken + cauliflower rice. I truly have no desire for, say, burgers and pizza – it’s too heavy for my system. I repeat: it’s not that I can’t have it, I just don’t really want to. New times indeed.

Evening snack(s)
I tend to leave 400-600 calories for after dinner (which is easier on 2200 calories, mind you).

I unfortunately work a bunch, and this has been the problem in the past – working and snacking all night long.

I spend those calories on a smoothie with protein and fruit, and usually a bariatric-friendly treat like sugar-free chocolate, popsicles, or something like that.

This keeps the habit of stuffing myself with empty calories somewhat at bay, while also not setting me up for failure by pretending I can go from 7pm to bedtime at 1am without eating.

I can’t, so I don’t.

Edited December 7, 20214 yr by Guest

Exercise – what and when and how much?

I was told to exercise at least 4 times a week for 30 minutes, and then incorporate walking on top of that. In reality, I haven’t done that much, but I’ve done some. I think that works for me – I was always so either/or, and I’m trying to live in the middle now.

I walked maybe 3 times a week in the first 3 months. Then, at around 260 lbs, I gave running a go. I hate running. There, I said it. So I did interval running. Basically week 1 and later on, 2, of Couch-2-5K. Gave it my best for a minute, walked two. Rinse and repeat. For a grand total for 20-25 minutes. Did this twice a week for a couple of months. And didn’t increase the running time much, just increased speed in the intervals.

Did I mention I hate running? That’s why. If I know it’s going to be unsustainable, I’m finding something that is. And that was the gym. I like going. I don’t go all that much, maybe 1.5 times a week on average. I took up boxing once a week, but sometimes other things get in the way. Then I go the next week. Again, not all or nothing, just getting by.

I bike to work now, except when it rains. It’s not a long journey by any means, but it counts. And so on and so forth. Not once have I beat myself over the head, and that kept me moving.

That said, I’ve been ecstatic about seeing what my body can do. I just walked home from work, 20 minutes brisk walk. Didn’t break a sweat. Didn’t consider what other people might think of the fat guy walking there because, well, I’m not fat. I’m free.

Edited December 7, 20214 yr by Guest

Alcohol and MGB

So this will be controversial for the Americans. Sorry in advance. I’ve had alcohol weekly since week 5. I made room for it in my calorie count. Sometimes, I went over. And then got right back on the counting the next day.

Alcohol is a part of life where I live. And I’ve found myself wanting to go out more. I get drunk super fast, and I have to pace myself. It hasn’t really been an issue; I can see why people get addicted, but I’ve never been the kind of guy who would drink alone and that’s a hard rule for me.

YMMV is what I’m saying. If you’re reading this thinking you’ll never drink again, well, a lot of us are while being successful still.

Don’t you wish you had refrained from drinking and then your EWL might have been 95 instead of 89?

Absolutely not. I wouldn’t have gotten to a year by staying in. I did this my way, and it worked for me.

Edited December 7, 20214 yr by Guest

What I wish they had told me prior to surgery

I honestly had no idea how much pain I would be in right after waking up. And due to COVID-19, I wasn’t allowed anyone in the hospital to help me tell the nurses to seriously give me more morphine. I had about half an hour when I seriously wanted to kill myself due to being inflated from surgery and nowhere near covered by pain meds. Yep.

It won’t feel like it, but you should get up as soon as you can. I mean that seriously. It lowered my pain from 10 to high 8 immediately. I’ve done rough contact sports, I’ve had my knee cap dislocated, torn my ACL, had a ruptured appendix, broken more bones than I care to count. And nothing compared to this.

Other people have barely any pain. And you know what? I do it all again in a heartbeat. The results are that great.

Otherwise, I felt pretty well-informed. I called the bariatric team when 1400 cals clearly weren’t enough, and once they heard my loss at that point, they were like ‘yeah you should’ve been on 1800 a month ago, then’. So reach out, they’re there for you.

I had some stalls but expected them, talked to my close people about it, and reminded myself not to stress about it. I had a month or so of low blood sugar, but it fixed itself. I get constipated from iron supplements, so I’m actually managing without now that I can eat more (my iron increased from surgery to month 9, which is pretty neat).

Edited December 7, 20214 yr by Guest

Setting a goal

Look, I don’t really get the goal stuff. I had one myself – get under 100 kg/220 lbs. However, if we are to follow the science of this thing, we wake up after surgery with a new set point. Our bodies have a specific weight in mind it wants to be. We don’t know if it’s BMI 23 or BMI 33. We just know it’s lower than where we are.

My recommendation would be to
a) Stop comparing yourself
b) Start loving yourself
c) Give yourself the best chances of getting to whatever weight your body wants to be at, and if that’s BMI 33, live with it.

But … but … yeah, well, listen: we all know what happens when we starve ourselves. Our bodies will win in the end and we’ll give up on the whole thing. Wouldn’t you rather be a happy BMI 33 person than someome who got to BMI 29 and then put it all back on because it wasn’t a defensible weight and you gave up?

If you need to get off the internet and away from all the insane success stories you feel you’re not measuring up to … well, bye bye internet, hello enjoying your new body.

Whatever size it may be.

Edited December 7, 20214 yr by Guest

Why I think you should consider the MGB

I think this surgery is worth considering, even as a self-pay option (I paid myself). We don’t get the serious dumping usually, we lose as much or more than the RNY’ers, our surgery is simpler and can be reversed or revised, and we learn to eat a Mediterranean diet …

… by our anatomy. That’s right. My fat malabsorption steers me away from high-fat foods, and that includes pizza and burgers. I simply do not want them. I can have a slice, but it makes me feel … oomph. Not bad just not very nice. I find myself scanning restaurant menus for vegetarian options, just because I feel like it. One year out, I’m still experiencing shifts in what my body craves, and it’s fruit, veggies, protein.

That’s coming from someone who ended up living on a diet of mostly fast food, juicy steaks and quick carbs. I don’t even want ice cream anymore. Not because I dump-dump, but because it just doesn’t give me that satisfaction. I make smoothies instead when I feel like a treat. I know, boooring. 

Many MGB patients tell the same story. We can eat well, but we slowly learn to go for the things we should be eating. Automatically. Neat!

At least give it a look. And consider any surgical team has a business to run. If you’re asking for a product they aren’t selling, they’ll be inclined to sell you what they do sell. Usually, that’s RNY or a sleeve.

Did you know sleeves can be done as quickly as 14 minutes? That’s my surgical team’s record. And that RNY takes 2-3-4 hours? If you get paid the same, more or less, you’d be happy to sell your patient the 14 minute job, right?

(Yes, yes, I know, that’s not how all surgeons are. I’m just saying: consider your options. It’s your life and your money).

Edited December 7, 20214 yr by Guest

What it’s like being a mini gastric bypass patient on BariatricPal – what I found useful, and why I needed a pause from participating on the forum

I think the forum is a fantastic resource, I love the store, and I can’t imagine not having read all of you wonderful people’s stories along the way.

However, you feel lonely here as an MGB’er, because it’s very America-centric and there’s just not a lot of MGB’ers in America. That’s how it is. Consider this my tiny contribution to change that.

What drove me off the site is the already-discussed-ad-nauseam rigidity you meet, and I seriously urge anyone to consider if they’re posting their “I can only eat half a lentil a week, am I losing too fast?” story for themselves rather than for others.

Now that I’m below goal, I can say: I had a LOT more calories than what you’d believe was necessary to be a success. And I’m still losing on 2000-2200/day.

Had I gone by the consensus here, I would’ve given up a long, long time ago. And I see some of the posters who had surgery around the same time as me, who were very active, and very judgmental of me and people like me, well … they’re not posting anymore.

That makes me sad. Because I know why they did that; they needed the resolve and the boost from telling others they were doing it wrong. I hope they made it and that they’re happy wherever they are in their lives.

I am back to say we should be so much more forgiving, kind, and open to each other’s experiences. We have a whole world judging us and frankly, we shouldn’t put up with it.

That starts with forgiving ourselves and each other, and then stick together, us former, current, and future fatties

Edited December 7, 20214 yr by Guest

What now?

Now that’s the big question. Weight-wise, I’m going to find stabilization and probably put on the 5-10 bounce-back pounds. That’s fine.

I’m still seeing a bariatric therapist, and I know to reach out – to friends, family, therapist, work – at signs of trouble. I know I take on too much work, and that’s a problematic pattern I’m still working on. I know I need to find and keep finding ways to truly love myself, because that’s the key to saying no, doing things for me, prioritizing myself.

I am excited for where I am, and apprehensive about the next year. This journey has been magical through-and-through, but the compliments will stop, and this will be normal life again. What then?

I’ll keep finding out, and I’ll live by the mottos I taught myself to believe when getting my mind in the right place: I have a right to be here. And I can forgive myself for anything.

Even regain. Even falling into binge eating. Even losing my job. Even ending up single and lonely. I can forgive myself for anything, and that means I’m not scared of anything. Heck, for me it hopefully means I can face anything and deal with it before it becomes a problem.

That’s the most important thing for Year 2.

Love to all of you, thanks to each and every one of you for sharing your life with people like me, and keep being awesome!

Edited December 7, 20214 yr by Guest

Thanks for this post, MiniGastricBypassDude! Us Omega-Loopers are a clear minority on the forum, so it's great to read a detailed post from someone further along the journey than I am.

I concur with your praise of the MGB - despite a run-in with ulcers and my repeated stalls due to how little I've been able to eat (both have improved immensely now), I'm still super glad I got this procedure. Everything has resolved and it's now getting easier and easier. I can get more calories in now, so the stalling has stopped and I'm losing at a good clip.

My surgeon offers Sleeve, RNY, MGB and SADI-S, but is very pro-MGB over RNY because of all you mentioned. He says it has better long-term results, though yes, our supplements are vital. I had originally wanted the Sleeve (the malabsorbtion and potential dumping had me a little wary of a bypass), but because of existing GORD, he talked me out of it and into a MGB. Glad he did, as yes, this is the right surgery for me.

I'm also ETERNALLY grateful that I've never had an emotional attachment to food, or BED. I know I'm very fortunate that my head has been in a great space for this, and I feel for folks who are having a rougher time of it.

9 hours ago, Smanky said:

I concur with your praise of the MGB - despite a run-in with ulcers and my repeated stalls due to how little I've been able to eat (both have improved immensely now), I'm still super glad I got this procedure. Everything has resolved and it's now getting easier and easier. I can get more calories in now, so the stalling has stopped and I'm losing at a good clip.

Hey! Thanks for the response I'm sorry to hear about your problems, but glad it's going better. Don't worry, my surgery very much still works after a year, so you've got plenty of time!

Can I ask what made you choose MGB over SADI-S? I think I might have done the latter given the option, but I sure am glad I got the MGB in hindsight. It's just such an easy surgery to live with.

Absolutely amazing series of posts - thank you so much for taking the time to share. I've had a sleeve but so much of your experience is directly relatable and you have answered a LOT of questions I've been thinking about. I do hope you can stick around now to help us newbies. ?

8 hours ago, MiniGastricBypassDude said:

Can I ask what made you choose MGB over SADI-S? I think I might have done the latter given the option, but I sure am glad I got the MGB in hindsight. It's just such an easy surgery to live with.

SADI-S wasn't even discussed and would have cost me more to have done. MGB offers enough malabsorbtion for me, so even if the option had been there I still would have chosen the MGB.