Gastric bypass surgery,
a type of bariatric surgery (weight loss surgery), is a surgical procedure that alters the process of digestion. Bariatric
surgery is the only option today that effectively treats morbid obesity in people for whom more conservative measures such
as diet, exercise, and medication have failed.
There are several types of gastric
bypass procedures, but all of them involve bypassing part of the small bowel by greater or lesser degrees. For this reason,
procedures of this type are referred to as malabsorptive procedures, because they involve bypassing a portion of the small
intestine that absorbs nutrients.
Some of these procedures
also involve stapling the stomach to create a small pouch that serves as the “new” stomach or surgically removing
part of the stomach.
Although a gastric bypass
procedure is malabsorptive, it may also be restrictive because the size of the stomach is reduced so that the amount of food
that can be eaten is “restricted” due to the smaller stomach. While malabsorptive procedures are more effective
in causing excess weight to be lost than procedures that are solely restrictive, they also carry more risk for nutritional
deficiencies.
You can expect to
lose between 65% to 80% of your excess body weight, the reduction in weight is very dramatic initially stabilising to 2-3lbs per week.
The attraction to this type of surgery is that it is permanent, weight loss is experienced from the day of surgery and
unlike gastric banding there are no adjustments required. This is a higher risk procedure and surgery takes approximately
2 hours, with up to 3 nights stay in hospital.
You will have to also take daily nutritional supplements for the rest of your life, vitamin B12 injections are recommended
every 3 months to prevent Pernicious Anaemia in later life.
Over-eating and poor eating habits can still jeopardise your success and you are also likely to experience 'dumping syndrome'
if you consume foods high in sugar or fat. The side effects include diarrhoea, stomach cramps, sweating and dizziness.
Patient experience dramatic weight loss and according to latest research are typically maintain around 65-70% of their
excess weight loss five years after surgery.
Roux-en-Y Gastric Bypass (RGB) Roux-en-Y
gastric bypass, the most commonly performed bariatric procedure, is both malabsorptive and restrictive. This surgery can result
in two-thirds of extra weight loss within two years. The procedure involves stapling the stomach to create a small pouch that
holds less food and then shaping a portion of the small intestine into a “Y”. The “Y” portion of intestine
is then connected to the stomach pouch so that when food is being digested it travels directly into the lower part of the
small intestine, bypassing the first part of the small intestine (called the duodenum) and the first part of the second section
of the small intestine (called the jejunum). The effect of bypassing these sections of the intestine is to restrict the amount
of calories and nutrients that are absorbed into the body.
The Roux-en-Y gastric bypass may be performed with a laparoscope
rather than through an open incision in some patients. This procedure uses several small incisions and three or more laparoscopes
- small thin tubes with video cameras attached - to visualize the inside of the abdomen during the operation. The surgeon
performs the surgery while looking at a TV monitor. Persons with a Body Mass Index (BMI) of 60 or more or those who have already
had some type of abdominal surgery are usually not considered for this technique. A laparoscopic method allows the physician
to make a series of much smaller incisions. Laparoscopic gastric bypass usually reduces the length of hospital stay, the amount
of scarring, and results in quicker recovery than an open procedure.
Biliopancreatic Diversion
(BPD) A biliopancreatic diversion is both restrictive and malabsorptive,
and is a more complicated procedure than the Roux-en-Y procedure. In this procedure a large part of the lower stomach is removed.
The small part of stomach that is left is connected directly to the last part of the small intestine. As food is digested,
it completely bypasses the duodenum and the jejunum. Because this procedure may result in nutritional deficiencies, it is
not as commonly performed.
A variation of the biliopancreatic diversion is a procedure called the duodenal switch.
More of the stomach is retained, including the valve that controls the release of food into the small intestine. A small part
of the duodenum is also retained.
Suitable Candidates
Candidates who are guided towards this type of procedure are typically
those with the greatest of weight loss challenges in that they are morbidly obese, but do not trust themselves with the task
of eating significantly smaller quantities for the rest of their life. However, this surgery would only be suitable for a
patient who was completely committed to taking nutritional supplements and to eating additional protein in their diet on a
daily basis as this is required to combat the malabsorbtion caused by the bypass of the small intestine.
National Gastric Balloon Centre
The National Institute of Clinical Excellence (NICE) has laid down specific
guidelines for surgeons selecting patients for obesity weight loss surgery:
You must be 18 years or over
Have a Body Mass Index (BMI) of 35 kg/m² in the presence
of significant co-morbid conditions (e.g. diabetes, hypertension, heart disease, raised cholesterol levels etc) OR a BMI of
40 kg/m² or above
You should have tried all available non-surgical approaches
and failed in your pursuit to reduce and maintain your weight loss
You need to be in a healthy state to undergo
general anaesthesia
Be prepared to undergo intensive follow-up and monitoring
after weight loss surgery
Understand that obesity surgery is not a cure,
rather it is an effective "tool" to help you keep the disease under control
Advantages of B.P.D (with or without the switch)
Up to 96% of patients see cure or improvement of their diabetes.
Up to 90% of patients see cure or improvement of their high blood pressure.
Up to 80% of patients see a cure or improvement of their sleep apnoea.
Patients see a lessening in their pain related to osteoarthritis.
Patients see a lessening in their gastric reflux symptoms.
Some patients see an improvement in fertility.
Statistics prove that patients who have this type of surgery experience dramatic
weight loss and can maintain an average of 75% to 80% of excess weight loss of the amount they are over their ideal weight
ten years after surgery.
Patients who have this type of surgery experience greater and more sustainable
weight loss than with diet, exercise and medication.
Patients are less likely to gain the weight they've lost than with any other
weight loss procedures.
Disadvantages (with or without switch)
As part of the stomach is removed and the small intestines divided and rerouted,
post operative leakages can occur.
Complications - such as pulmonary embolism (a blood clot to the lungs), bleeding,
pancreatitis (an inflammation of the pancreas), infection, narrowing of the intestine or stricture due to a build up of scar
tissue, hernia and even in rare cases death - can occur.
Post operative patients can be at an increased risk of liver failure.
Ulceration can occur at the hook up site of the stomach and intestine.
Odorous wind and flatulence can be a significant problem to some.
Patients may have four to eight bowel movements per day, depending on diet.
There is an increased risk of intestinal obstruction.
The intestinal bypass may result in severe nutritional deficiencies which
in severe cases can lead to night blindness, brittle bone disease and protein malnutrition.
You will need to take nutritional supplements for the rest of your life.
Because part of the stomach is removed, this surgery is absolutely not reversible.
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Gastric Balloon Centre & National Obesity Surgery Centre®
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