Gastric bypass surgery

Gastric bypass surgery is a type of weight loss surgery in which some changes are made in the digestive system of the patient. These changes result in;

  1. lesser consumption of food by the patient as compared to earlier
  2. lesser absorption of the nutrients in the patient’s body

Gastric bypass surgery and related weight loss surgeries are performed only when the weight of the patient cannot be controlled by exercise or diet, or when the patient has some serious medical health problems due to obesity like type 2 diabetes, high blood pressure etc. There are various types of weight loss surgeries which are collectively known as bariatric surgery. Gastric bypass surgery is the gold standard among all bariatric surgeries and is performed very often. It has excellent safety profile and fewer complications. The patient is asked to follow a healthy lifestyle and proper   diet to ensure the long-term success of the bariatric surgeries.


Why it's done Risks How you prepare What you can expect Results

Gastric bypass surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

Gastric bypass and other weight-loss surgeries are typically done only after you've tried to lose weight by improving your diet and exercise habits.

Who it's for

In general, gastric bypass and other weight-loss surgeries could be an option for you if:

  • Your body mass index (BMI) is 40 or higher (extreme obesity).
  • Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

But gastric bypass isn't for everyone who is severely overweight. You may need to meet certain medical guidelines to qualify for weight-loss surgery. You likely will have an extensive screening process to see if you qualify. You must also be willing to make permanent changes to lead a healthier lifestyle. You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and your medical conditions.

And keep in mind that bariatric surgery is expensive. Check with your health insurance plan or your regional Medicare or Medicaid office to find out if your policy covers such surgery.

As with any major surgery, gastric bypass and other weight-loss surgeries pose potential health risks, both in the short term and long term.

Risks associated with the surgical procedure can include:

  • Excessive bleeding
  • Infection
  • Adverse reactions to anesthesia
  • Blood clots
  • Lung or breathing problems
  • Leaks in your gastrointestinal system
  • Death (rare)

Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:

  • Bowel obstruction
  • Dumping syndrome, causing diarrhea, nausea or vomiting
  • Gallstones
  • Hernias
  • Low blood sugar (hypoglycemia)
  • Malnutrition
  • Stomach perforation
  • Ulcers
  • Vomiting
  • Death (rare)

If you qualify for gastric bypass or other weight-loss surgeries, your health care team gives you instructions on how to prepare for your specific type of surgery. You may need to have various lab tests and exams before surgery. You may have restrictions on eating and drinking and which medications you can take. You may be required to start a physical activity program and to stop any tobacco use.

You may also need to prepare by planning ahead for your recovery after surgery. For instance, arrange for help at home if you think you'll need it.

 

During the procedure:

  • The anesthesiologist gives general anesthesia to the patient, which is administered through an IV line (intravenously) or by inhaling. A breathing tube is then inserted. In this process, the patient’s complete body becomes numb and goes into a temporary state of unconsciousness, at least for a few hours.
  • The patient’s vitals such as pulse rate, body temperature, oxygen levels or breathing rate, and heart rate, are monitored continuously.
  • The specifics of the gastric bypass surgery depend upon the individual’s situation. These days’ majority of the gastric bypass surgery is done “Laparoscopically” or “key holes” with help of camera and instruments. A laparoscope is a, slender, long tube with a camera attached to it. With the help of this, the surgeon is able to see the internal structures of the abdomen on a big screen outside the patient’s body. The laparoscopic or robotic gastric bypass surgery is performed by small incisions through which the thin, small surgical instruments are inserted.
  • The gastric bypass surgery takes average 2-4 hours to complete.
  • The patient is shifted to the recovery room after the surgery.
  • The patient is kept under continuous monitoring and observation in the recovery room and the vital signs such as pulse rate, body temperature, oxygen levels or breathing rate, and heart rate, are monitored continuously.

 

Types of various bariatric surgery:

  • Roux-en-Y Gastric Bypass – This is a common technique for gastric bypass surgery (it is a type of gastric bypass surgery). However, this surgery is not reversible. In this procedure, the surgeon cuts the top portion of the patient's abdomen and seals it off. The small pouch is almost similar to the size of a lemon and hence, is able to hold only 30-50 ml of the food in it. Typically, the stomach can hold 1-1.5 litre of food in it. The small intestine is, then cut by the surgeon and a portion of it is sewed onto the small pouch of the stomach. The food then goes from the small pouch of the stomach directly into the small intestine sewed into it. The food actually bypasses the major portion of the stomach and also the first portion of the small intestine and instead enters directly into the mid-portion of the small intestine.
  • Sleeve gastrectomy – This is also known as vertical sleeve gastrectomy and is a new type of weight-loss surgical procedure. After the sleeve gastrectomy procedure, the shape of the patient’s stomach changes into a tube-like structure, which will absorb less calorie diet. In this procedure compared to gastric bypass, no bypass or re-routing of the intestine is done and food still passes through normal intestinal path. Over the years Sleeve gastrectomy has proves as a safe and effective weight loss procedure (when compared to the Gold standard gastric bypass).

 

  • Biliopancreatic diversion with duodenal switch – This is another type of gastric bypass surgery. It is a complex surgical procedure in which almost 60% of the stomach portion is removed. This surgical procedure bypasses the major portion of the small intestine by just connecting the small end portion of the small intestine to the duodenum, connecting the patient’s stomach. This refers to the Biliopancreatic diversion with a duodenal switch. This surgery limits both, the intake of the quantity of the food and the amount of nutrient absorption. This procedure is although effective but leads to the deficiency of vitamin and causes severe malnutrition. Laparoscopic adjustable gastric banding (LAGB) – In this type of weight loss surgery, the surgeon places an inflatable band around the top portion of the stomach. When this band is inflated, the stomach gets compressed and acts like a belt-tightening the stomach. This further separates the stomach into 2 portions, which creates a very small upper stomach pouch which communicates through a channel prepared by the band with the rest of the portion of the stomach. The top pouch limits the food a patient can eat. This band is adjustable according to the entry of food to be limited. This procedure does not cause as much weight loss as the other methods do and also, the patient has to get the inflated band adjusted periodically.

All these surgeries are helpful in weight loss but the specific type of surgery for a particular patient depends upon the BMI, various health problems to the patient, previous surgeries (if any) and the amount of risk to the patient with a particular procedure.

 

After the procedure:

  • After the gastric bypass /bariatric surgery l procedure, the patient is not allowed to eat for 1 to 2 days, to let the digestive tract and the stomach to heal properly.
  • The doctor advises a specific diet to the patient to follow for at least 12 weeks.
  • This diet starts by having liquids first, then slowly switching to soft food items and then later, regular food.
  • The patient might also have some restrictions as to how much to eat and what can be eaten.
  • For the initial several months, the patient will have to come for many follow-ups to monitor the health and lifestyle of the patient.
  • The doctor may ask getting some lab tests done.
  • There are some changes observed and experienced by the patient in the initial few months as the body reacts to the sudden weight loss, as mentioned below.
  • Feeling cold
  • Body aches
  • Dry skin
  • Mood swings
  • Feeling fatigued as if the patient has flu
  • Hair loss and hair thinning

 

  • The success of the gastric bypass surgery depends upon the after-surgery lifestyle and health habits of the patient.
  • The gastric bypass surgery can help the patient lose weight and also various problems related to overweight which are as follows:
  • High blood pressure (Hypertension)
  • Type 2 diabetes
  • Gastroesophageal reflux disease
  • Serious sleep apnea
  • Severe heart diseases
  • Stroke

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