06/05/2025
Morbid obesity surgery in Egypt:
Advantages of the Omega Loop Surgery and Its Superiority Over Sleeve Gastrectomy
Introduction:
Patients suffering from morbid obesity often face confusion when choosing the most suitable bariatric surgery. In this article, we aim to guide them toward making the right decision.
Bariatric surgeries are varied and can be classified into two main categories:
1. Restrictive Procedures (Stomach Size Reduction):
Such as sleeve gastrectomy, gastric banding, gastric balloon, and stapling. These surgeries primarily depend on forcing the patient to consume very small food portions to feel full. While they offer certain benefits, their limitations and weaknesses often outweigh their advantages, as shown below:
Advantages of Sleeve Gastrectomy (as a well-known example):
• A relatively simple procedure with same-day discharge.
• Involves removing 75% of the stomach, leaving a small portion to receive food and induce satiety.
• Success rates of about 60%, depending on the patient’s commitment to avoiding high-calorie foods and drinks like sweets and soda, as these can lead to weight regain due to their high caloric content and minimal volume.
Disadvantages of Sleeve Gastrectomy:
1. Irreversible: Once performed, the removed stomach cannot be restored, unlike the Omega Loop surgery which involves no organ removal and can be reversed if medically necessary.
2. Vomiting and Regurgitation: Common after sleeve gastrectomy, unlike Omega Loop where eating is smoother and more comfortable.
3. Severe Dietary Restrictions: Patients must avoid sweets, soda, and juices to maintain weight loss, which negatively impacts their psychological well-being. In many cases, sleeve patients require psychological support to accept lifelong food restrictions. In contrast, Omega Loop allows moderate intake of sweets without regaining weight.
4. High-Pressure Surgery: Since food is retained in a small tubular stomach, pressure builds up, weakening the diaphragm muscle over time and causing acid reflux and heartburn. Over 50% of sleeve patients who had no prior reflux issues develop it postoperatively. Omega Loop is a low-pressure operation where food passes smoothly into a low-pressure intestinal loop, eliminating this problem.
5. Stomach Dilation Over Time: After five years, the stomach often stretches, leading to increased food intake and weight regain, limiting the long-term success of sleeve gastrectomy to about 60%. In comparison, Omega Loop maintains a 93% success rate, making it the gold standard for lifelong obesity treatment.
6. Inferior Swallowing Quality: Sleeve patients often experience belching, vomiting, difficulty swallowing, and acid reflux, while Omega Loop patients enjoy smooth food passage without discomfort.
7. Limited Effect on Type 2 Diabetes: Sleeve’s impact is confined to weight loss by reducing food intake. If the patient regains weight due to dietary noncompliance, diabetes often returns. Omega Loop, however, treats Type 2 diabetes via multiple mechanisms: reducing calorie intake, minimizing food absorption, preventing pancreatic strain, and stimulating beneficial gut hormones that enhance pancreatic function — leading to long-term diabetes resolution and prevention in genetically predisposed patients.
8. Minimal Effect on Cholesterol: Sleeve gastrectomy offers limited improvement in cholesterol levels, unlike Omega Loop, which significantly lowers cholesterol by reducing its absorption.
9. Higher Risk of Bleeding and Leakage: Sleeve requires five laparoscopic ports and stapling devices containing surgical blades, posing known risks of bleeding and leakage, documented in medical literature. Omega Loop can be performed either:
• Via Cosmetic Surgery: Using specialized non-cutting tools to avoid these risks, a unique technique offered exclusively by Dr. Mahmoud El Ekiaby in Egypt and the Middle East.
• Via Laparoscopy: Using standard staplers and blades similar to sleeve gastrectomy, carrying comparable bleeding and leakage risks. This is the common approach in Egypt and the Middle East.
10. Vitamin B Deficiency: Sleeve removes the stomach region responsible for producing intrinsic factor, essential for Vitamin B complex absorption required for blood production, necessitating lifelong Vitamin B injections. Omega Loop preserves this region, maintaining normal function.
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Now moving to the second category of surgeries, which combine restriction and malabsorption:
2. Combined Procedures (Reduce Intake and Absorption):
These include:
• Classic Gastric Bypass (Roux-en-Y)
• SASI (Single Anastomosis Sleeve Ileal Bypass)
• Omega Loop ( minigastric bypass)
Given their superiority over sleeve gastrectomy, we’ll review each:
Classic Gastric Bypass (Roux-en-Y):
The oldest bariatric operation with excellent long-term outcomes for treating obesity, diabetes, and cholesterol. It also suits patients with acid reflux. Its main drawback is the risk of nutrient malabsorption, potentially causing malnutrition or excessive weight loss, since absorption occurs only in the distal small intestine.
SASI (SADI-S):
A combination of sleeve gastrectomy and a dual-path intestinal connection. Originally designed to facilitate access to the biliary system, its necessity has diminished with the invention of retrograde endoscopy.
Disadvantages include:
• Removal of 75% of the stomach (retaining sleeve gastrectomy’s drawbacks)
• Inaccurate food division ratios, leading to inconsistent results among patients
• Lack of long-term, statistically validated success rates, unlike Omega Loop which has maintained excellent results since international recognition in 2006
• Risk of chronic stomach inflammation due to bile reflux, often requiring surgical reversal to a simple sleeve procedure.
Omega Loop Gastric Bypass ( minigastric bypass surgery) :
Invented in 1998 and internationally approved in 2006, it is the most effective bariatric surgery to date, with numerous benefits and minimal side effects.
Procedure Overview:
• Step 1: Creation of a small gastric pouch.
This can be done:
• Via cosmetic surgery with non-cutting instruments to prevent bleeding and leakage (exclusive to Dr. Mahmoud El Ekiaby in Egypt and the Middle East)
• Via laparoscopy with standard staplers and blades, similar to sleeve gastrectomy, carrying known risks.
The remaining stomach continues to function, secreting digestive enzymes into the duodenum to mix with food downstream.
• Step 2: Creation of an Omega-shaped connection between the small pouch and the intestine to reduce calorie absorption, especially sugars and fats.
Surgery Duration: 1.5 hours
Hospital Stay: 1–2 days
Recovery: 7–10 days, resuming light office work thereafter.
Weight Loss Results:
• 60–70% of excess weight lost within the first 6 months
• Remaining weight over the following 6 months
Vitamins:
One daily multivitamin tablet for 12–18 months
Pregnancy:
Safe after 12–18 months like other bariatric procedures.
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Omega Loop Advantages:
1. Reversible: No stomach tissue is removed.
2. No Vomiting or Regurgitation: Smooth swallowing and excellent eating comfort.
3. No Acid Reflux or Heartburn: Low-pressure operation prevents gastroesophageal reflux.
4. Flexible Diet: All foods permitted moderately after reaching ideal weight.
5. Treats Obesity, Type 2 Diabetes, and High Cholesterol comprehensively.
6. High Success Rate: 93% success, easily maintained with moderate eating and light exercise.
7. Safer Surgical Technique:
• Dr. Mahmoud El Ekiaby’s unique cosmetic surgery approach avoids cutting tools as he uses linear staplers which didn’t contain knives so he staple stomach without cutting it to rise safety and decrease surgical risks , significantly reducing bleeding and leakage risks — a distinguished technique available only at his clinics in Egypt and the Middle East.
Omega Loop Drawbacks:
• Temporary hair loss during the first 2 months, preventable with medication
• Possible dumping syndrome if excessive sugars are consumed, preventable by moderating intake
• Bleeding and leakage risks are minimal with Dr. El Ekiaby’s cosmetic surgery technique, though laparoscopic Omega Loop (with staplers and blades) carries risks similar to sleeve gastrectomy.
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Surgeries Performed by Dr. Mahmoud El Ekiaby
Available in Cairo and Alexandria in state-of-the-art hospitals equipped with advanced technologies, including pain management systems.
Consultations available in Cairo, Alexandria, and via online consultations for international and Arab
What’s up Link for DR/ MAHMOUD ELEKIABY
https://iwtsp.com/201066557773
