Metabolic surgical procedures

Single Anastomosis Gastric Bypass: A new metabolic surgical procedure

Obesity is the root cause of many life-threatening diseases. It is a result of a sedentary lifestyle and dietary changes. Long term obesity dysregulates the hormonal function in the body which result in uncontrolled glucose level, lipid level in blood and high blood pressure.

Complications due to obesity include metabolic diseases, high blood pressure, insulin resistance, type-2 diabetes mellitus, many cardiovascular disorders, osteoarthritis, and increased risk of malignancy.

Metabolic surgical procedures

How can we treat obesity?

Metabolic surgery is the most effective treatment of severe obesity. Metabolic surgical procedures cause weight loss, control complications of obesity, increase patient’s quality of life and eventually life expectancy.

Categories of metabolic surgeries

Metabolic surgeries are usually are divided into three categories:

  • Restrictive: Reduce stomach size and limit food intake
  • Malabsorptive: Bypass parts of the small intestine and limiting the absorption of food eaten
  • Combination: Limit absorption of food and reduce the size of the stomach

Types of metabolic surgeries

All the weight loss procedures are restrictive, malabsorptive. Some metabolic surgeries are a combination of restrictive and malabsorptive.

Different types of metabolic surgical procedures are:

Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy is a restrictive procedure. In this procedure, the outer margin of the stomach is removed to restrict the food intake. This leaves a sleeve of the stomach, the size, and shape of a banana, and the muscles that control the emptying of food from the stomach to the small intestine.

After laparoscopic sleeve gastrectomy, the patients feel full even after consuming less food and taking in fewer calories. In this surgery portion of the stomach is removed that produces the hormone responsible for feeling hungry.

Laparoscopic sleeve gastrectomy is simpler than gastric bypass as it does not involve bypassing or reconnecting the intestines.  It also does not require any banding device to be implanted in the stomach.

Laparoscopic Adjustable Banding

Laparoscopic adjustable gastric banding is done as a laparoscopic surgery in which small incisions are made in the upper abdomen. Then the surgeon places an adjustable band on the top part of the stomach, creating a small pouch. With this small pouch, the patient feels full after eating less amount of food and reduce weight.


Intestinal Bypass

In intestinal bypass, 14 inches of the duodenum, the part of the small intestine closest to the stomach, is connected to the 4 inches of ileum, the part of the small intestine closest to the large intestine. This creates a loop and bypasses 85-90% of the small intestine.

These metabolic surgical procedures greatly reduce the absorption of nutrients and lead to apparent weight reduction.

Biliopancreatic diversion

Biliopancreatic diversion has two parts: gastrectomy and intestinal bypass. In the first part, gastrectomy, a large portion of the stomach is removed which reduces the apatite of the patient. The second part, intestinal bypass, anastomosis the proximal duodenum, and the distal ileum.

This type of intestinal bypass is different from the other types as in this bypass the blind loop carrying digestive enzymes and bile drain into the distal portion of the small intestine.

As a result of this surgical procedure, the absorption of nutrients such as fat is reduced tremendously.

Gastric Bypass

Gastric bypass surgery reduces the size of the stomach, so the patient can satisfy the apatite by eating less. In this operation, the surgeon, re-rout the digestive tract which limits the absorption of nutrients.

There are several types of gastric bypass:

Laparoscopic Roux-en-Y Gastric Bypass

In Laparoscopic Roux-en-Y gastric bypass, surgeons make a small pouch of the stomach by stapling a large part of the stomach together. This reduces the apatite of the patient.

After this restriction procedure, the surgeons attach the pouch of the stomach with a Y-shaped section of the small intestine. In this way, food skips a large portion of the digestive tract and reduces the absorption of fewer calories and nutrients.

Single Anastomosis Gastric Bypass

Single Anastomosis Gastric Bypass is one of the newest metabolic surgical procedures. It is a combination of Sleeve Gastrectomy and Gastric Bypass.

Single Anastomosis Gastric Bypass is also called Mini Gastric Bypass Surgery. This operation combines restriction with some malabsorption and as result, it provides apparent weight loss with good quality of life.

Who qualifies for Single Anastomosis Gastric Bypass?

Individuals with a BMI greater than 40 and who have tried all other types of diets without long-term success are eligible for this surgical procedure.


The Operation

Single Anastomosis Gastric Bypass takes approximately 1-2 hours to complete. It is performed laparoscopically under general anesthesia.  In this operation through small incisions, surgical instruments including a small camera are inserted. The upper part of the stomach is stapled and a thin tube is formed. This makes a smaller stomach which is then joined with the jejunum, skipping the first part of the small intestine.

How does Single Anastomosis Gastric Bypass help in losing weight?

This procedure assists the patients in two ways:

  • Limiting the amount of food eaten, causing the feeling of fullness from a small portion of food.
  • Limiting the absorption of nutrients and calories as a result of bypassing a large part of the small intestine.

Advantages of Single Anastomosis Gastric Bypass

It is effective for patients with larger BMI as it has more reliable outcomes as compared to other procedures, such as Adjustable Gastric Banding.

Hormonal changes after the surgery enable the patients to reduce the need for diabetic medication and in some cases stop the medication altogether.

It does not require ongoing adjustments that are required with Gastric Banding. But regular follow-ups are required to monitor the weight loss.

Hence, Metabolic Surgical Procedures improve the quality of life of patients. These help cure obesity-related complications. Among other metabolic surgical procedures, Single Anastomosis Gastric Bypass is more effective and efficient.

According to an article, efficiency and risks of one-anastomosis gastric bypass, Single Anastomosis Gastric Bypass has relatively short operation time, low complication rate, excellent weight loss results, and improvement in obesity-related diseases.