465 © Springer Nature Switzerland AG 2020 J. Ettinger et al. (eds.), Gastric Bypass, https://doi.org/10.1007/978-3-030-28803-7_49 Mini Gastric Bypass: Why It Is Better than Gastric Bypass in India Mohit Bhandari, Manoj Kumar Reddy, Winni Mathur, and Susmit Kosta Mini gastric bypass is also known as single anas- tomosis gastric bypass. The procedure incorpo- rates a long gastric tube of size 15–18 cm with a loop gastroenterostomy of size 4.5 cm. Essentially the procedure involves nonrestricted malabsorp- tion. The limb lengths of biliopancreatic limb vary in different studies and centres. Most studies published have mentioned different limb lengths ranging from 150 cm to 300 cm [1]. Advantages of Mini Gastric Bypass Mini gastric bypass is regarded as a safe, simple, reversible procedure. There is only one anasto- mosis and no mesenteric defect. It has shorter operative time. The procedure is safe and simple as the anastomosis is low lying and there is less tension on the anastomosis. In a gastric bypass, it is known that the anastomoses are close to the gastroesophageal junction and are in more ten- sion than mini gastric bypass [2]. Cons of Mini Gastric Bypass There are concerns about a higher incidence of marginal ulcers, bile refux, malignancies in long-term and excessive weight loss with protein- energy malnutrition of mini gastric bypass [3]. Reasons for Preference of Mini Gastric Bypass in India The major reasons for preference of mini gastric bypass in India are as follows: 1. Dietary habits: Most Indians are vegetarians, and the diet consumed by most is full with carbohydrates and fats. This puts Indian sub- set of patients to do bulk eating and consum- ing huge quantity of fat. The protein in the diet is in very less proportion as compared to car- bohydrates/fats. Mini gastric bypass having a wide anastomosis with propensity to cause fat malabsorption makes it a more durable and useful procedure for Indian patients. 2. Severe type 2 diabetes: India is now the world capital of diabetes. We have the highest num- ber of individuals with type 2 diabetes across the world. The patients get diabetes at a lower BMI as compared to their Caucasian counter- parts. The severity of diabetes is also high. The mini gastric bypass procedure is suitable as it has a long biliopancreatic limb which is more suitable for diabetics. The metabolic M. Bhandari (*) · M. K. Reddy W. Mathur · S. Kosta Department of Surgery, Mohak Bariatrics and Robotics Surgical Center, Indore, India 49