<P> This variant is the most commonly employed gastric bypass technique, and is by far the most commonly performed bariatric procedure in the United States . The small intestine is divided approximately 45 cm (18 in) below the lower stomach outlet and is re-arranged into a Y - configuration, enabling outflow of food from the small upper stomach pouch via a "Roux limb". In the proximal version, the Y - intersection is formed near the upper (proximal) end of the small intestine . The Roux limb is constructed using 80--150 cm (31--59 in) of the small intestine, preserving the rest (and the majority) of it from absorbing nutrients . The patient will experience very rapid onset of the stomach feeling full, followed by a growing satiety (or "indifference" to food) shortly after the start of a meal . </P> <P> The small intestine is normally 6--10 m (20--33 ft) in length . As the Y - connection is moved further down the gastrointestinal tract, the amount available to fully absorb nutrients is progressively reduced, traded for greater effectiveness of the operation . The Y - connection is formed much closer to the lower (distal) end of the small intestine, usually 100--150 cm (39--59 in) from the lower end, causing reduced absorption (malabsorption) of food: primarily of fats and starches, but also of various minerals and the fat - soluble vitamins . The unabsorbed fats and starches pass into the large intestine, where bacterial actions may act on them to produce irritants and malodorous gases . These larger effects on nutrition are traded for a relatively modest increase in total weight loss . </P> <P> The mini gastric bypass procedure was first developed by Robert Rutledge from the US in 1997, as a modification of the standard Billroth II procedure . A mini gastric bypass creates a long narrow tube of the stomach along its right border (the lesser curvature). A loop of the small gut is brought up and hooked to this tube at about 180 cm from the start of the intestine </P> <P> Numerous studies show that the loop reconstruction (Billroth II gastrojejunostomy) works more safely when placed low on the stomach, but can be a disaster when placed adjacent to the esophagus . Today thousands of "loops" are used for surgical procedures to treat gastric problems such as ulcers, stomach cancer, and injury to the stomach . The mini gastric bypass uses the low set loop reconstruction and thus has rare chances of bile reflux . </P>

When was the first gastric bypass surgery performed