Gastric Bypass Surgery

Gastric Bypass Surgery Weight loss surgeries, also known as bariatric surgery, are performed to change the patient’s stomach and digestive system in order to control the amount of food that will enter the body and nutrients that will be absorbed. There are several types of this weight loss surgery and gastric bypass is one of them. During this surgery, the surgeon will adjust your stomach and small intestine to change the way they digest food and absorb it. The size of the patient’s stomach shrinks so that they cannot eat as much as before the gastric bypass surgery. The surgeon will re-route or bypass the patient’s digestive system while performing the surgery.

Gastric bypass surgery results in more weight loss compared to adjustable gastric banding or gastric sleeve surgery, so it is considered as a great option for weight loss. Plus, the weight loss after this operation is constant and regaining the lost weight is pretty unlikely.

Gastric bypass surgery will help you lose weight by restricting the amount of food that will enter your stomach, limiting the amount of nutrients and calories that will be absorbed by your body and changing your hormones which will result in a longer time of feeling full.

How Is The Gastric Bypass Surgery Done?

During the gastric bypass operation, the patient is under general anesthesia. The surgeon opens up a few small cuts and inserts surgical instruments through these cuts and also a camera that has a light so that they are able to see clearly. While doing this, the surgeon fills the abdominal cavity with inert carbon dioxide in order that the surgical tools move freely inside the patient’s abdomen.

After that, the surgeon divides the top part of the stomach from the rest of the stomach and creates a small pouch, which is about 30 ml in volume. This decreases the amount of food that will be held in the stomach to a large extent.

The small intestine is cut from the middle and connected directly to the new small pouch of the stomach. This way the food taken into the body bypasses the first part of the intestine and passes through the patient’s stomach and goes directly to the middle of the small intestine

Gastric bypass operation also causes some hormonal and physiological changes in the body since the food no longer passes through the duodenum, which is the first part of the small bowel. It decreases the levels of a hormone called ghrelin, which is the “hunger hormone” that tells your brain when you are hungry and also increases the levels of a hormone called leptin, which is the “satiety hormone”. These changes lead to a decrease in the feeling of hunger and suppress your appetite.

There are different types of gastric bypass surgery:

Roux-En-Y Gastric Bypass Surgery

Roux-en-Y gastric bypass is the most popular and common type of gastric bypass surgery. It is considered as the gold standard of bariatric surgeries. Surgeons are able to perform it trough a small cut and the recovery time is shorter than other complex operations. So, how is Roux-en-Y gastric bypass surgery performed?

First, a small stomach pouch, right about the size of an egg, is made by stapling a part of the stomach and dividing the top from the rest of the stomach or by a vertical banding, which will limit the amount of food you are able to eat. After that, the small intestine is divided and a Y-shaped section of the small intestine is connected to the new and smaller pouch. This creates a bypass for the food you consume and makes it skip a part of your digestive system; therefore, the amount of calories and nutrients that are absorbed by the body is reduced.

Extensive Gastric Bypass (Biliopancreatic Diversion)

This type of gastric bypass is not commonly preferred since it is so much more complicated and has a high rate of complication. During this method, the surgeon removes the lower part of the stomach and connects the small pouch directly to the last part of the small intestine. This means it is performed by bypassing completely the first two parts. This does help with weight loss; however, it may leave you deprived of important nutrients.

Who Is A Good Candidate For Gastric Bypass Surgery?

Gastric bypass surgery is resorted when there is a case of severe obesity. However, the operation may have some risks and side effects, since it is a major operation. Therefore, before deciding to go through with this operation, patients should discuss possible benefits and risks with the doctors.

Although fast and effective weight loss might sound appealing, not everyone is suitable for the procedure. Like other major operations, gastric bypass too has important health risks and side effects. While this type of a weight loss surgery may help with health problems that are related to overweight, such as type 2 diabetes, high blood pressure, heart diseases and sleep apnea, it may also cause major complications. To decide whether gastric bypass surgery is the right procedure for you or not, you will need to go through some comprehensive evaluations.

In general, you might be considered as a candidate for gastric bypass surgery if you have some conditions. For example, if you have tried to lose weight trough diet and exercise and failed, if you have a Body Mass Index of 35 or higher and you have a health problem related to overweight. However, even if you qualify these general guides, you will be asked to go through an extensive screening process in order to make a final decision.

A team that consists of a doctor, dietitian, psychologist and a surgeon evaluate and determine whether gastric bypass is the right choice for you or not. Usually, if the benefits that will result from the gastric bypass surgery outweigh the potential risks, they will decide that it is an appropriate operation for you.

The team also considers your psychological needs and whether you are ready to go through such surgery; because the procedure may challenge patients and increase some risks if they have mental health conditions that are not being handled well. For example, it is recorded that the risk of suicide increases in some people who have had a weight loss surgery, especially in patients who have attempted to commit suicide in the past. This does not mean that bariatric surgery should not be performed on people who have had suicidal thoughts or attempts; it only means that the health care team that deals with such people should be aware of the patient’s history and monitor them closely while supporting them throughout the whole process.

Your health care team will ask about your weight trends, diet attempts, eating habits, exercise regimen, stress level, time constraints, motivation and other factors. They will want to know about your medical history since some health conditions may increase the risks of surgery, such as blood clots, liver disease, heart problems and kidney stones. They will evaluate medications you use and whether you drink alcohol or smoke. They will give you a physical examination and laboratory tests. These tests will help the team while determining eligibility for weight loss surgery. Also, some mental health conditions such as binge-eating disorder, substance abuse, anxiety disorders, major depression, schizophrenia, severe bipolar disorder and issues related to childhood sexual abuse can make it harder for patients to maintain the benefits that result from gastric bypass surgery. These conditions might not restrain you from having gastric bypass surgery; however, your doctors might decide to postpone the surgery date in order to treat those conditions and any sources of anxiety.

There is no age limit to having gastric bypass surgery. However, the operation was considered too risky for teenagers and older patients until the recent past, since when newer  studies have shown that it may be performed safe and soundly in adults who are 60 or older and some teenagers who have a Body Mass Index of 36 or higher and also suffering from health problems realted to obesity.

What Are The Advantages And Disadvantages Of Gastric Bypass Surgery?

Advantages of gastric bypass surgery include losing 60 to 80 percent of the excess weight in a very short term, being free of health problems that are related to obesity and lasting, long term results. According to the studies, most of the patients who have this surgery maintain more than 50 percent of their excess weight loss.

However some disadvantages of the gastric bypass surgery exist, too. For example, patients are not permitted to take aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) after the operation. All patients are bound to take vitamins for life after the procedure. If not, it can lead to vitamin and mineral deficiencies in the long term, especially to deficiency of vitamin B12, iron, calcium and folate. Plus, complication rate is slightly higher than with sleeve gastrectomy in the long term. But of course, these complications can be avoided and handled with proper care.

What Are The Risks Of Gastric Bypass Surgery?

Patients may experience pouch stretching over time. When they eat more than they should their stomach will get bigger and stretch back to the size before gastric bypass surgery. Also, staples used during the operation may fall apart leading to the breakdown of staple lines. Patients’ bodies will not be able to get as much nutrients as before; this is why they may experience vitamin and mineral deficiencies. The patients may get gallstones due to losing weight too fast. Your doctor will give you the necessary medication if that happens.

The patients may experience a condition called stomal stenosis. This condition is caused by the narrowing of the connection of the stomach and small intestine. The symptoms include nausea, vomiting, reflux, and then inability to eat. It will need to be dilated in order to be treated.

There is also a condition called dumping syndrome that may be caused by gastric bypass surgery. When this condition occurs, the food consumed by the patient moves too quickly from the stomach to the small intestine. The symptoms of this condition are nausea, weakness, sweating, fainting, and, occasionally, diarrhea after eating, as well as becoming extremely weak after eating sweets.

What Happens Before Gastric Bypass Surgery?

You will be given some instructions by your health care team while preparing for the gastric bypass operation. You may need to make restrictions on eating and drinking, quit smoking and start a supervised exercise program. During this period, you will receive lifestyle counseling to help you adjust the changes in your diet and exercise. Some patients may be asked to lose weight before having gastric bypass surgery.

Even if your gastric bypass surgery day is scheduled, it can still be cancelled or delayed in some situations such as if you are not medically or psychologically ready for the operation, if you have not succeed in making changes in your diet or exercise habits, if you gained weight during the process.

What Happens After Gastric Bypass Surgery?

After the first four weeks following the gastric bypass surgery, you will only be able to consume liquids and some amount of soft food. As the days pass by, you will gradually be able to make transition to the solid food. You will realize that you feel full very quickly with a very small amount of food about two tablespoons. Your doctor may recommend you some nutritional supplements so that you do not experience deficiency.

It is likely that you will lose one-half to two-thirds of your excess body weight within the first two years after gastric bypass surgery. You may continue losing weight for another year and a half before stabilizing.

Patients should keep in mind that the gastric bypass surgery is not a miracle procedure. Having the operation alone will not guarantee you weight loss. It definitely does not mean that you will lose all of your excess weight or keep your weight loss in the long term. If you do not make the necessary changes in your diet and exercise habits, it is likely that you will not succeed in losing weight or regain the weight you have lost.

When you eat a large meal your stomach will stretch and later contract. If you keep eating large meals your stomach will continue to stretch and you will feel like you need more food in order to feel full. This may lead to a cycle of eating to the fullness and you may start eating more and more food in order to feel full. In order to avoid stretching your stomach after the gastric bypass surgery, you should not eat until you feel full. Instead, eat no more food than the predetermined size meal. If the amount of food you will be eating is more than the size of your fist, it is likely that you are eating too much. You should not drink and eat at the same time in order to avoid the stretching. Give yourself a break of at least 30 minutes between food and liquids. Also, you should avoid carbonated beverages since the bubbles may cause pressure on your stomach.