This video presents a detailed step-by-step demonstration of Laparoscopic Mini Gastric Bypass performed by Dr. R. K. Mishra, a pioneer of minimally invasive surgery. The video is designed for surgeons, trainees, and medical professionals to understand the standardized technique, key anatomical landmarks, and safety principles of Mini Gastric Bypass surgery.

Laparoscopic Mini Gastric Bypass (MGB) is one of the most commonly performed bariatric surgery and slowly getting popular all over world as obesity surgery. This video demonstrate step by step technique of performing mini gastric bypass surgery by Dr R K Mishra at World Laparoscopy Hospital for a female suffering from Morbid Obesity. Mini Gastric Bypass has Restrictive, Malabsorptive and Hormonal component. Restrictive: A small stomach pouch is created restricting the amount of food you can eat. Malabsorptive: A portion of the small intestine is bypassed. Since the small intestine is responsible for absorbing the calories from the food you eat, bypassing a portion of the small intestine results in fewer calories being absorbed, thus creating additional weight loss. Hormonal: The hormone ghrelin has been nicknamed the “Hunger Hormone” by researchers because of its significant effect on appetite. Gastric Bypass results in a fall in ghrelin levels resulting in a reduced appetite.

In the evolving field of bariatric surgery, Laparoscopic Mini Gastric Bypass (LMGB) has emerged as an effective and efficient minimally invasive procedure for morbid obesity and its associated metabolic disorders. Dr. R. K. Mishra—a globally recognized pioneer in laparoscopic and robotic surgery—has showcased this procedure through a meticulous step-by-step demonstration, highlighting precision, technique, and patient safety throughout the operation. 

About the Procedure

LMGB, also known as One-Anastomosis Gastric Bypass (OAGB), combines restrictive and malabsorptive elements to trigger substantial and sustainable weight loss. It involves creating a small gastric pouch and rerouting part of the small intestine to limit food intake and reduce nutrient absorption. Compared to open surgery, the laparoscopic approach offers reduced postoperative pain, shorter recovery, and smaller scars. 
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About Dr. R. K. Mishra

Professor Dr. Rajneesh Kumar Mishra is an internationally acclaimed laparoscopic and robotic surgeon with decades of experience in minimal access surgery. He has trained thousands of surgeons worldwide and leads advanced surgical education at the World Laparoscopy Hospital. His contributions to surgical technique, education, and research have influenced bariatric and general surgery practice globally. 

Step-by-Step Demonstration of LMGB

Below is an overview of the key stages as demonstrated by Dr. Mishra, summarizing the technique and the critical surgical workflow.

1. Patient Selection & Pre-operative Preparation

Proper candidate selection is essential for optimal outcomes. Ideal candidates typically include patients with:

Body Mass Index (BMI) ≥ 40 kg/m², or ≥ 35 kg/m² with comorbidities such as diabetes or hypertension.

Inadequate response to conservative measures like diet, exercise, and lifestyle modification.

Pre-operative preparation includes thorough evaluation—clinical history, labs (including metabolic panel and endocrinologic work-up), endoscopy to rule out gastric pathology, and anesthesia assessment. Nutritional optimization and pre-operative dieting may be recommended to reduce liver size and facilitate laparoscopic access. 

2. Patient Positioning & Port Placement

The patient is positioned supine with a gentle reverse Trendelenburg tilt to improve exposure of the upper abdomen. Pneumoperitoneum is established using carbon dioxide, and trocars are strategically placed to allow ergonomic access for instruments and the camera. Optimal port placement ensures efficient instrument manipulation throughout the operation. 

3. Creation of Gastric Pouch

Using laparoscopic stapling devices and careful visual guidance, the surgeon creates a narrow and vertically oriented gastric pouch along the lesser curvature. The pouch limits food intake and serves as the new functional stomach with reduced volume. Precision is crucial to ensure consistent pouch size and prevent leaks. 

4. Measuring and Selecting Bowel Loop

A loop of jejunum—typically 150–200 cm from the ligament of Treitz—is identified and measured. This portion will be brought up to the gastric pouch to create the anastomosis (connection). Dr. Mishra’s technique emphasizes gentle handling of the bowel and meticulous measurement to balance malabsorption and nutritional outcomes. 

5. Gastrojejunostomy Creation

A single, tension-free gastrojejunostomy is constructed using staplers and laparoscopic suturing. This is the key step where the small intestine is anastomosed to the gastric pouch, creating a direct route for food passage. Secure suturing and leak testing are performed to ensure safety. 

6. Inspection and Hemostasis

After completing the anastomosis, the operative field is inspected for bleeding or tension. Hemostasis is confirmed, with careful observation of staple lines and suture integrity. This critical check helps prevent postoperative complications such as leaks or bleeding. 

7. Closure and Recovery Planning

The trocars are removed, and port sites are closed. The patient is then transferred to recovery with a structured postoperative plan involving pain control, diet progression (from liquids to soft foods), and follow-up for nutritional monitoring. Dr. Mishra emphasizes multidisciplinary care—including dietitians and bariatric nursing support—to ensure long-term success. 

Clinical Benefits & Considerations

LMGB offers several advantages:

Minimally invasive approach: Smaller incisions lead to less pain and quicker recovery.

Effective weight loss: Combines restriction and malabsorption.

Metabolic improvements: Many patients experience resolution or improvement of type 2 diabetes and other comorbid conditions.

However, long-term follow-up, micronutrient monitoring, and lifestyle changes are critical to maintain outcomes and prevent deficiencies. 

Educational and Surgical Impact

Dr. Mishra’s demonstration serves not only as a practical guide but also as an educational model for surgeons and trainees. By presenting each critical component with clarity and focus, his work advances the understanding of laparoscopic bariatric procedures and encourages high standards of surgical care. 

Conclusion

The laparoscopic mini gastric bypass represents a milestone in bariatric surgery, offering durable weight loss with a minimally invasive technique. The step-by-step demonstration by Dr. R. K. Mishra highlights not just the technical precision necessary for success but also the holistic approach required for patient care—spanning preoperative planning, surgical execution, and postoperative support. His contribution continues to educate and inspire surgeons around the world, promoting excellence in minimally invasive bariatric surgery.