Gastric Bypass (“roux-en-y” procedure)

bypass

Gastric bypass weight loss surgery is work by utilizing both a decrease in stomach size and a partial bypass of the small intestine to limit calorie intake. It is restrictive and malabsorptive in the same time.

Patients who have had this procedure feel full much faster, and stay that way for much longer, than is typical. This is because a pouch is created to isolate only a small section of the stomach for the processing of food. In addition, a section of the small intestine is bypassed to reduce the amount of food, and therefore the calories that can be used by the body.

The Gastric Bypass Surgery Procedure

If you undergo this procedure, you must make radical changes in your food intake and lifestyle in order for the procedure to have the maximum effect. Meals following surgery must be limited to 30 gm each; drinking fluids with meals can fill the pouch, too, so you should be mindful that doing so may prevent the intake of solid food.

The bypass surgery is typically performed in a hospital or a surgery center, using General Anesthesia. Most of the time, the procedure is performed Laparoscopically, which means the surgeon operate through 4-5 tiny incisions.

The surgery begins with multiple 1-1.5 cm long incisions in the area of the stomach. The surgeon begins by creating a pouch from the area of the stomach closest to the esophagus. The pouch is completely detached from the rest of the stomach, which is stapled closed and remains in the body (although it will no longer digest food). The sphincter muscle, which holds food in the stomach, remains attached to the unused portion of the stomach; the upper stomach sphincter becomes the entrance to the pouch.

Once the pouch is formed, the small intestine remains attached to the portion of the stomach that does not process food. An incision dividing the small intestine into a lower and upper section is made, with the upper section being stapled closed. The lower section of the stomach is then attached to the newly made pouch. The upper part of the small intestine remains in the body, attached to the unused stomach, but it, too, no longer processes food.

The Typical Outcome of Gastric Bypass Surgery

This procedure is more successful than restrictive procedures, such as gastric banding, because it does not rely solely on behavior modification. While the pouch helps create a feeling of fullness and does not allow for large meals to be consumed, the calories that are consumed are not fully used by the body due to the bypass of part of the small intestine.

Patients typically lose at least 60% of their excess weight after surgery; over a third of them lose 80%. Most patients reach their lowest weight about two years after surgery.

What to Expect After Surgery

Most people can return to their normal activities in 3 to 5 weeks.

After surgery, you’ll need to make big, permanent changes in how you eat:

  • You can eat only a few ounces of food at a time. Your new stomach will only hold a tiny amount of food.
  • You must eat very slowly and chew your food to mush. Otherwise, you may vomit often and have pain.
  • You won’t be able to drink for 30 minutes before you eat, during your meal, and for 30 minutes after you eat. There won’t be room in your stomach for both drinks and solid food.
  • You probably will need to take vitamins and supplements.
  • You may have to avoid foods that contain simple sugars-like candy, juices, ice cream, condiments, and soft drinks. Simple sugars may cause a problem called dumping syndrome.

Potential Drawbacks of Gastric Bypass Surgery

Immediate Risks

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

Fewer than 10 out of 1000 people die after weight-loss surgery

Long-term Risks

Many patients experience dumping syndrome, a condition where food moves very quickly from the stomach into the small intestine, causing feelings of nausea, cold sweats, chills and often severe diarrhea and chest pain. Most patients find that limiting meal size and sugar consumption prevents dumping syndrome.

Malnutrition is also a risk, as this procedure decreases the body’s ability to absorb nutrients, and most patients need vitamin and mineral supplementation for the rest of their lives, 30% may develop vitamin B12 deficiency and 50% may develop iron deficiency anemia.

Stomal ulcers & Stomal stenosis (in the connection areas between the stomach and the intestine) may develop in 5-15%.

The surgery is practically not reversible , but the restrictive nature of the surgery can be eliminated by consistent overeating, which can stretch the pouch until the amount of food able to be digested and used by the body is far less restricted than intended by the surgeon.

Long-term problems, such as osteoporosis and Gallstone formation

While it is a complex surgery with significant risks, patients have historically had better results with total weight loss, long-term weight maintenance and improved overall health than those who have opted for any other type of weight loss surgery.