What is the gastric bypass?
The gastric bypass is currently the "gold standard" of bariatric surgery. It is a mixed technique that results in the creation of a small reservoir of about 20 to 30cc and an intestinal bypass known as Roux-en-Y. This technique has undergone multiple modifications over the years.
The Gastric bypass is usually a permanent procedure but can be reversed if needed. By having the Gastric bypass surgery, you will lose more weight quickly, this is achieved by reducing your intake of food and giving you a feeling of complete satiety.
How does it work?
What happens during a gastric bypass operation?
The gastric bypass works in several ways. Firstly, as the size of the stomach is reduced, you will start to feel full earlier so therefore eat less, secondly the procedure causes a degree of malabsorption of food, the extent of which varies depending on the configuration of the small bowel loops, this prevents your body from absorbing too many calories, and thirdly there is a pro-incretin effect (antidiabetes) due to the early arrival of food in regions of the small intestine, where hormones are secreted, stimulating insulin production and decreasing appetite.
Weight loss starts as soon as you have had the operation. After 36 months the pouch stretches so it is important to maintain sensible portion sizes and not wait for the bypass to stop you eating. If you eat the recommended foods (not soft or liquids), you will not feel hungry. You will need to take multivitamins for life, including quarterly B12 injections, calcium, iron and sometimes vitamin D.
The gastric bypass achieves weight losses of between 60-70% of bodyweight at 5 years, with a complication rate of less than 10% and an overall mortality of 1%.
What is the procedure?
With a gastric bypass, the surgeon creates a small pouch in the stomach and performs an intestinal bypass known as Roux-en-Y. There are multiple variants depending on the type of anastomosis and the length of the loops of intestine involved.
The laparoscopic (‘keyhole’) approach is currently considered a choice. It has been shown that it presents lower morbidity and mortality compared to classic open surgery. With this procedure, the structure of your stomach is changed and greatly reduced, restricting the number of calories your body absorbs as the bypass affects the absorption of foods, mainly carbohydrates. During meals, food is quickly collected in the pouch.
As the pouch needs only a small amount of food to fill, receptors in the stomach responsible for sending signals of feeling full to the brain are activated earlier, so you feel full earlier, and therefore eat less.
What happens during a gastric bypass procedure?
Before gastric bypass surgery you’ll be given a general anaesthetic. The procedure is performed laparoscopically, using keyhole surgery, and usually takes between two and three and half hours.
Your weight loss surgeon will make several small cuts in your abdomen and insert a long, thin telescope with a light and camera lens at one end, called a laparoscope and other surgical instruments to cut a large part of your stomach. The surgeon creates a small pouch from your stomach. Then connect the small pouch directly to the middle portion of the small intestine (jejunum). Since the size of the opening between the stomach and the small intestine is smaller, the rate at which the food is emptied is delayed and, therefore, you feel full for longer. In addition, you will be less hungry as a result of the contents of the stomach pouch being emptied directly into the bowel of the small intestine differently from the normal configuration. The purpose of a gastric bypass is to help obese patients lose weight and turn to a healthier lifestyle.
Since food skips the first portion of the small intestine (duodenum), the body absorbs less nutrients and calories. Compared with normal digestion, foods are digested at a later stage, delaying the time when they are mixed with the juices of the stomach, bile and pancreatic juices. This means that most of the food leaves the body with faeces. Your surgeon may decide to change the length of the bowel segments to induce a greater or lesser degree of malabsorption
Benefits of Gastric Bypass Surgery
Rapid, dramatic weight loss results
Minimally invasive.
You will notice when you should stop eating and will feel full earlier
It does not need any regulation nor should it carry any foreign bodies used as in the Lap Band surgery
The resulting smaller stomach is able to digest all foods normally with the exception of foods with high carbohydrate content
Very effective weight losses of between 60-70% of body weight at 5 years after the procedure can be achieved
Complication rate of less than 10% and an overall mortality of 1%.
It has been observed that it is capable of resolving Type 2 diabetes mellitus in the medium term in 85% of cases
It will reduce the amount of food you can eat during a single meal (restriction)
It makes you absorb less of the food you eat (malabsorption)
It will make you intolerant of foods that you should avoid anyway (eg, fats and concentrated sugars)
Fast recovery and small scars
Surgery is performed laparoscopically
