What is the Gastric Bypass?
Gastric bypass (Roux-en-Y Gastric Bypass) is regarded internationally as the “gold standard” of weight loss surgery designed to reduce your food intake if you have tried and failed to lose weight through diet and exercise. Follow up to 15 years after surgery has shown patients maintain weight loss after gastric bypass surgery.
Gastric bypass can greatly improve the quality of life not only because of an improvement in appearance and an increase in mobility, but also because it can reduce the number and severity of health problems that overweight people are prone to suffer, such as diabetes and heart problems.
Gastric bypass is performed laparoscopically, meaning that the surgeon makes small incisions as opposed to one large incision.
A small stomach pouch is created, restricting the amount of food that can be eaten initially, but long term, the operation also works by switching off the desire to eat. The stomach and about one meter of the small intestine are bypassed. This restricts food intake and stimulates hormones in the gut that suppress hunger and improve diabetes if present.
This type of bypass operation has proven to be an effective, consistent way of losing weight and keeping it off, but to achieve these results it requires lifelong changes to lifestyle and eating.
How does Gastric Bypass work?
Gastric bypass is both a restrictive and malabsorptive procedure. This dual mechanism – restrictive (restricts the amount of food) and malabsorptive (reduces the amount of calories absorbed) – gives gastric bypass twice the weight-loss power as other procedures. In gastric bypass, the surgeon divides the stomach in two parts; the large portion of the stomach is closed off with staples to create a smaller pouch. The smaller stomach (15-30 ml), your new pouch, restricts the amount of food you can eat at one time. The remainder of the stomach is not removed, but is completely stapled shut and divided from the new stomach pouch. The small intestine is cut below the duodenum and reattached to the new stomach pouch. The other end of the small intestine coming from the duodenum is connected to the side of the small intestine coming from the new stomach pouch at a distance of 100-150 cm from the first connection. So, food is reduced in amount and absorption because it passes through long segment of the small intestine without any gastric or intestinal secretions that is responsible for digestion and absorption. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat. Because of the malabsorptive component, your body will not be able to process certain foods. Eating certain foods, like sweets, may result in dumping syndrome. This may be identified by nausea, vomiting, diarrhea and abdominal pain or cramping.
Who is a good candidate for Gastric Bypass?
The indications for gastric bypass are those aged 18-65 years old (with some exceptions) with body mass index greater than 40. In addition people with body mass index between 35 and 40 may also be candidates for gastric bypass if they have obesity related illnesses such as diabetes, high blood pressure or high cholesterol. Gastric bypass is the gold standard for those patients with metabolic syndrome (diabetes, high blood pressure or high cholesterol) as it has a dual mechanism for weight loss (restrictive and malabsorptive).
Gastric Bypass Surgery risks and complications?
It is important for you to understand that the risks of surgery are low and that the majority of patients have no complications. However, as with any surgery, there may be immediate and long-term complications and risks. These risks are greater for individuals who suffer from obesity. Your weight, age and medical history play a significant role in determining your specific risks.
Possible general risks can include:
- Complications due to anesthesia and medications
- Deep vein thrombosis
- Pulmonary embolism
- Heart attack
Risks and disadvantages of gastric bypass include:
- Leaking of the staple lines as there is always a chance that the staples won’t hold, resulting in a leak. The leaking stomach acids or intestinal secretions frequently lead to infection of surrounding tissues and other serious problems that may require another operation or a drainage tube.
- Gastric or intestinal ulcers, particularly in smokers
- Small risk of intestinal blockage
- Nutritional deficiencies (iron, calcium, vitamin B12 deficiency and others). However, all of these deficiencies mentioned can be managed through proper diet and vitamin supplements.
- A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
- The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.
Advantages Of Gastric Bypass?
Compared with other types of weight loss surgery, gastric bypass has these advantages:
- No need for adjustment.
- No foreign bodies are left in the body during the procedure. With gastric banding, the band may slip, erode or become infected.
- Small stomach pouch and hormonal effect produce strong sensation of fullness with very small meals
- Excellent sustained long-term weight loss in most patients
- “Dumping syndrome” makes it harder to cheat by eating sweets
- Few patients vomit after the gastric bypass, while many patients continue to have vomiting episodes long after they have their Lap BAND placed.
- Gold standard for those patients with metabolic syndrome (diabetes, high blood pressure or high cholesterol) as it has a dual mechanism for weight loss (restrictive and malabsorptive).
What to expect after Gastric Bypass?
The operation is quite safe and just 1-2 days hospital stay. Most people can return to normal activities in 1 to 2 weeks. The expected weight loss from this surgery is on average 70-80% of excess weight. This procedure requires less effort than adjustable gastric banding to be successful. In addition, vomiting is less than with adjustable gastric banding. Patient must be committed to good eating habits and exercise. Gastric bypass is highly improving the blood sugar, lipids and blood pressure.