Gastric bypass surgery is the type of surgical procedure usually performed on obese patients to lose weight. This surgery changes the anatomy of the patient’s stomach, creating a smaller stomach pouch and bypassing the small intestine. This way, the patient is forced to restrict the intake of food and, additionally, his/her small intestine absorbs fewer nutrients and, therefore, fewer calories from the food eaten.
Most people who had gastric bypass surgery lost 2/3 of the excess weight over the period of two years after the surgical procedure. There are two different types of gastric bypass surgery, based on the procedure used to create the small stomach pouch. There is RGB (Roux-en-Y gastric bypass) and extensive (or biliopancreatic diversion) gastric bypass.
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This type of gastric bypass surgery might be performed as laparoscopic or as open surgery. The difference is in the incisions made on the abdominal cavity. Open gastric surgery requires general anesthesia and large incisions, while laparoscopic surgery is done through small incisions and guided with the camera and video screen.
Laparoscopic surgery is the better option for most patients, since there are fewer risks of complications and the recovery time is much shorter than for open gastric bypass surgery. The surgeon will create a small stomach pouch and connect it with a Y-shaped small intestine. The lower part of the stomach is bypassed, and the food the person takes goes directly to the jejunum.
Extensive Gastric Bypass
Because of the complicated procedure, this type of gastric bypass surgery is not very common. The surgeon will remove the lower part of the stomach and connect the created pouch with the most distant part of the small intestine, bypassing both the duodenum and jejunum. Patients are guaranteed to lose weight after this surgery, but it can also cause many severe nutritional deficiencies and lead to anemia, metabolic bone disease, or osteoporosis.
Gastric Bypass Surgery
Patients may experience many complications after the gastric bypass surgery, including pouch stretching, breakdown of the staple line, or band erosion. “Dumping syndrome” characterized by nausea, weakness, sweating, and sometimes even after-meal diarrhea is also a possibility after gastric bypass surgery, as well as gallstones.
Some may also have problems with the leakage of the stomach contents in the abdominal cavity or with the nutritional deficiencies and complications it may cause, all due to the surgery. Both of these later-mentioned problems might be very serious.
- The surplus of calories is stored as fat, either in peripheral adipose tissue, or within the abdomen, muscle, and liver. A potential consequence is the development of metabolic syndrome, which includes diabetes mellitus, hypertension, hyperlipidemia, and fatty liver. Together, obesity and these related diseases significantly increase the risk of cardiovascular disease and reduce life expectancy.
- Substantial weight loss is the definitive treatment for metabolic syndrome. However, the means by which this is achieved can be difficult. Diet programs can be effective, but they are usually temporary and their effects indurable. Furthermore, it is extremely difficult to lose large amounts of weight (>100 lb) by these conservative measures.
- Bariatric surgery offers the most effective and durable outcome. The most commonly performed bariatric procedures are Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding.
- The Roux-en-Y gastric bypass involves the creation of a small gastric pouch and intestinal rerouting. The sleeve gastrectomy is performed by removing 75% of the stomach. The adjustable gastric band is a silicone ring placed around the stomach that acts by limiting the amount of food that can be consumed.
- A multitude of scientific studies have confirmed that bariatric surgery is the most effective tool available to lose weight and to maintain the loss, thereby improving health and life expectancy. In one study, bariatric surgery was shown to reduce the relative risk of death in morbidly obese individuals by 89%.
- Yet all bariatric surgeries are not created equal. The gold standard is the Roux-en-Y gastric bypass, which yields an average loss of 70% of excess weight. The sleeve gastrectomy yields an average loss of about 60% of excess weight. The gastric band is least effective and carries a high long-term failure rate. Current research indicates that the effectiveness of the type of bariatric surgery is linked not only to volume restriction, but, even more so, to the metabolic effect. The Roux-en-Y gastric bypass and sleeve gastrectomy have been shown to have significantly greater metabolic effects than the adjustable gastric band.
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