Gastric Bypass

Gastric bypass, also known as Roux-en-Y gastric bypass, is a bariatric or weight loss surgery for obese patients who have not been successful losing weight through dieting, exercise and medication.

The surgery uses a combination of restrictive and malabsorptive techniques to achieve a successful outcome. Staples are used to create a smaller stomach to limit the amount of food intake, and a large portion of the small intestine is bypassed to limit the nutrients and calories absorbed.

The goal of the surgery is to make you feel full quicker so you don’t overeat, and absorb fewer calories by the modifications made in the small intestine.

Gastric bypass surgery has been shown to help reduce obesity and related illnesses, including heart disease, high blood pressure, and especially type 2 diabetes. It is highly effecgtive at reducing or even eliminating the need for diabetes medications, blood pressure medications, or CPAP in individuals with sleep apnea.

It can be performed laparoscopically through tiny incisions (minimally invasive technique) or through a large open incision (open technique).

Disease Overview

Obesity is a chronic condition in which there is an excessive accumulation of fat in the body.

Obesity is defined as a Body Mass Index (BMI) of 30 to 34.9 and extreme obesity is a BMI of 40 or more. When a person’s BMI is 50 or higher, it is referred to as super obesity.

Obesity is a global problem affecting people of almost all age groups and is associated with a greatly increased risk of chronic diseases.

Indications:

Gastric Bypass surgery may be recommended when diet, exercise or medications have not helped in reducing your weight.

It is indicated for people with a BMI of 40 or more, and in those whose BMI is 35 to 39 that are suffering from obesity associated health conditions such as:

  • Type 2 diabetes
  • Heart disease
  • High blood pressure
  • High cholesterol
  • Sleep apnea
  • Nonalcoholic fatty liver disease
  • Cancer

Surgery:

Gastric bypass surgery is performed under general anesthesia. Your surgeon makes several small incisions on your abdomen. A laparoscope, a thin instrument with a light and camera on the end, is inserted through one of the incisions, allowing your surgeon to clearly view the internal organs on a monitor. Small surgical instruments are inserted through the other incisions to perform the surgery.

The first step is to reduce the size of the stomach so that it holds less food. The upper portion of the stomach near the esophagus is converted into a pouch by stapling.

The second step of the surgery involves the creation of a bypass for food to flow from the new stomach pouch. The small intestine is divided into upper and lower segments.

The lower section of intestine is attached to the opening in the stomach pouch creating what is referred to as the “roux limb”. The upper section of the small intestine which carries digestive juices from the remaining portion of the stomach is attached at the distal end of the roux limb. The roux limb enables food to bypass the lower stomach, duodenum, and a portion of the small intestine. At the end of the procedure, the incisions are closed with sutures

Post-operative care:

After gastric bypass surgery, you must stay in the hospital for 1-2 days in most cases.

Your doctor will prescribe pain relieving medications to keep you comfortable. You will be given instructions to follow regarding wound care, diet and activity such as:

  • Keep the incision area clean and dry.
  • Avoid strenuous exercises and lifting heavy weights
  • You will remain on a liquid diet for the first two weeks, and then a soft diet for two weeks.
  • Sip water throughout the day to prevent dehydration.
  • Follow the diet regimen given to you by the dietician.
  • Follow an exercise program per your surgeon’s instructions to maintain the weight loss.

Advantages and Disadvantages

Gastric bypass surgery can help you lose about 10 to 20 pounds a month in the first year following surgery. You will gradually lose more weight by eating a healthy diet and participating in regular exercise. The surgery also helps you manage obesity-related health conditions.

Disadvantages:

  • It is not possible to fully reverse the procedure
  • Lifelong follow up with a physician is required for blood tests to ensure proper health and nutrition.

Risks and Complications:

As with any surgery there are potential risks and complications involved. Complications associated with Gastric Bypass include:

  • Problems associated with anesthesia
  • Bleeding
  • Infection
  • Bowel obstruction
  • Leaks in your gastrointestinal tract
  • Deep vein thrombosis (blood clot in the leg)
  • Dumping syndrome leading to diarrhea and nausea
  • Hernia
  • Gallstones
  • Malnutrition
  • Ulcers