Bypass means using a shortcut. As its name suggests, Gastric Bypass means creating a passage from the stomach to the intestine with the surgery. It is a method in various diseases that obstruct the stomach outlet. In the meaning of used in obesity surgery, Gastric Bypass is a surgical method in which most of the stomach is disabled and the food taken is digested by using almost only half of the intestines.
Gastric Bypass operation restricts both food intake and food absorption. A small part is separated at the entrance of the stomach and sewn into the small intestine. Consequently, food intake is restricted because the stomach gets smaller.
It is suitable for patients with obesity who are unable to lose weight or who have weight-related insulin resistance. Moreover, it was the most common surgical method five years ago.
However, as the tube stomach operations became more popular, its frequency of application decreased. It is now used as a second surgery (revision surgery) in patients who gain weight after tube stomach procedures. Keep in mind that all of these procedures can be done by the laparoscopic (closed) method.
With this surgery, the stomach is shrunk, and additionally, the small intestine is attached to the shrinking stomach. As a result of this process, the patient eats fewer thanks to the shrinking stomach. Moreover, the absorption of nutrients decreases because the small intestine is attached to the stomach. Thus, calorie intake is reduced significantly, and weight loss is achieved.
Gastric Bypass is an older and different method compared to other obesity treatment methods. Following this surgery, it is possible for diseases such as type 2 diabetes, hypertension, sleep apnea, and to improve in proportion to weight loss.
Gastric bypass surgery is a method of obesity surgery, which is a kind of weight-loss operation. It is accomplished by creating a separate passageway for foods from the stomach to the intestine.
Gastric bypass surgery helps you lose weight in 3 ways:
- By reducing the total volume of your stomach
- By reducing the amount of food that can be absorbed by your body and lowering the total calories you take.
- By affecting the mechanism of your gout hormones and reducing your appetite.
The advantages of gastric bypass surgery include a permanent solution for health problems due to obesity, excessive weight loss in a short time and permanent, long-term results. The data show that even 20 years after surgery, most patients retain more than 50 per cent of excess weight loss.
Before the Gastric Bypass Surgery
Before deciding on any obesity surgery, you need to contact your surgeon and make sure you know the answers to the following questions:
- Why do you prefer this application
- What result should you expect from the application
- What are the risks and advantages of surgery or application
- What are the possible side effects or complications
- Who will perform the surgery and what are the qualities of the surgeon
- Alternative medicine and practices to consider
- When will you see the results of the operation or application
- If you have questions or problems, who will you share with after the surgery
- How much will you have to pay for this surgery or application
After getting answers to these questions, the following tests are applied to each patient before the operation.
- Blood Biochemistry tests
- Hormone tests
- Hepatitis tests
- Ultrasound of the whole abdomen
- Stomach endoscopy (with anesthesiologist)
- ECG (Heart X-Ray)
- Lung radiography
- Lung breathing test
- Stress test and ECO (Electrocardiography)
After all these tests, the necessary examinations are performed by Anesthesia, Internal Medicine, Cardiology, Chest diseases and Endocrine specialists. As a result of these examinations, it is first checked whether there is an underlying disease that may cause the patient to gain weight.
If there is no such disease, the patient is examined in terms of anaesthesia. Then, it is checked whether there is an obstacle or not. Relevant experts advise on the treatments to be applied before surgery if necessary. In this way, the problems that may occur during and after the surgery are minimized.
Gastric Bypass Process
Although the first operation was performed in 1967, laparoscopic Gastric Bypass, Roux-en-Y, was performed for the first time in 1993 and was considered one of the most difficult operations to perform. Neverth, the use of this method has made this operation very popular thanks to the shortened length of hospital stay and less chance of surgery hernia.
In the process, the swallowing tube joins to the entrance of the stomach by closing and cutting a small piece of the stomach (5-10% of the entire stomach) on the swallowing tube side. Thus, a proximal gastric pouch (at the entrance of the stomach) smaller than 30 mL is created. This new stomach pouch has a smaller size than one tea glass.
In this surgery, any part of the stomach is not removed and left in place, unlike the tube stomach surgeries. By creating a pouch, the existing stomach becomes disabled, and the food is provided to come here. The stomach is taken from the part of the small intestine towards the distal (large intestine) and cut approximately 50-75 cm and connected to the new stomach pouch created.
The end of the small intestine approaches and connects to the intestine 70-80 cm ahead. All these cutting, separating, joining and mouth grinding processes are possible thanks to special tools that are completely high-tech products.
Finally, the leak test is performed during Gastric Bypass operation and on the 2nd day. The main aim of the leak test in the operation is to determine whether there is a problem in operation. If there is a leak, an additional stitch is placed on the relevant part and leakage is prevented. Again, before starting liquid foods after surgery, a leak test is performed, and necessary precautions are taken and intervened on time.
It is controversial to put additional stitches on special materials called staples in obesity surgeries. Some surgeons think that stitching reduces the likelihood of bleeding and leakage.
Some surgeons, on the other hand, say that stitching may reduce the risk of bleeding, although it does not reduce the risk of leakage. As for the clinical approach, we are between these two.
Although we do not put additional stitches on each patient, if the stapler line is not safe enough for us, we definitely put on extra stitches. The most crucial point here is that the surgeon performing the surgery should have the skill and competence to intervene and correct any problems.
Two Steps of Gastric Bypass
The first step is to shrink the stomach. The surgeon divides the stomach into two, with the upper part smaller and the lower part larger. The upper part of the stomach (pouch) is where the food taken will go. This small portion of the stomach is the size of a walnut and contains only 28 grams of the food. Therefore, the patient feels saturated and loses weight when he eats less.
The second step is Bypass, that is, bridging. The surgeon removes part of the small intestine from the digestive tract, shortening the path of absorption of nutrients. The first part of the small intestine is bypassed, and the second part is connected to the small sac formed in the stomach.
The foods now pass into this new pouch and then into the second part of the small intestine. As a result, a large portion of the stomach and part of the intestine are removed from the digestive tract after surgery. Thanks to the small stomach, the patient consumes less food, and since some of the small intestines is bypassed, the body absorbs fewer calories.
What are the Different Applications of Gastric Bypass Surgery?
Gastric Bypass, Roux-en-Y (proximal)
This variant is the most commonly used gastric bypass technique and is the most common bariatric procedure in the world. It is the operation that causes the least nutritional problem.
A proximal gastric pouch (at the entrance of the stomach) smaller than 30 mL is created at the entrance of the stomach. This new stomach pouch has a smaller volume. By creating a stomach pouch, the usual stomach is disabled, and the food comes here.
It is taken from the part of the small intestine towards the distal (large intestine) and cut approximately 50-75 cm and connected to the new stomach pouch created. The end of the small intestine, behind which bile and pancreatic fluid come from, is approached 70-80 cm in the future and is joined to the intestine again.
Gastric Bypass, Roux-en-Y (distal)
The normal small intestine is between 600-1000 cm. The bile end of the intestine is combined with the food intestine approximately 1 meter ahead. The combination of saffron with food towards the end of the small intestine mainly causes reduced absorption of fats.
Absorbed fats and starch pass into the large intestine. This can provide faster weight loss but more serious nutritional problems (such as severe vitamin deficiency). Also, the bacterial activity here can lead to the production of irritant substances and the formation of malodorous gas.
Loop Gastric Bypass (Mini Gastric Bypass)
Here, the intestine is directly combined with the stomach, without dividing it into two. Although it is simpler to form, this method causes bile and pancreatic enzymes to escape from the small intestine to the stomach and from the oesophagus leading severe inflammation. Although its application is simpler, it is not a preferred method.
After the Gastric Bypass
As the surgery is laparoscopic, you can stand up and walk for an hour or two after surgery. Even during your stay in the hospital, you will be able to do your own self-care. Patients working at a desk or working in jobs that do not require heavy effort can return to work within a week. Patients who require substantial effort should take a break from work for at least one month. After the operation, patients are given a rest report for a sufficient period of time.
There is no need to take stitches as self-absorbing stitches do not require this process. If a non-absorbable stitch is used for a different reason, when you come to the tenth-day check, the stitch is checked and removed if appropriate.
The risk of regaining weight after Gastric Bypass is very low. In order to obtain the maximum benefit from this physiology, the patient should only eat at meals, take 2-3 meals a day, and avoid snacks between meals. This surgery requires changing the eating habits that have been acquired over a long period of time. In almost all cases where weight gain regained late in the operation, there was no increase in meal capacity.
The reason for gaining weight again is between meals, especially high-calorie snacks. There is no known operation to eliminate the side effects of this type of eating habit.
Considerations on the Surgery
The operating room and the hospital where the surgery is performed must have specific equipment and standards. Adequate intensive care beds, full-time physicians are required in all branches. All equipment from the operating table to the patient bed should be suitable for obese patients. Therefore, it is not appropriate to perform the procedure in every hospital.
- Obesity surgery should not only end with the operation process, but there should be a support team that you can reach 24 hours a day, 7 days a week.
- Meeting all these requirements increases the cost of the operation slightly more than other surgical procedures. Even if you put the quality of life aside, the main cost is obesity when viewed as a long term. The money you spent on the treatment of health problems such as joint abrasions, diabetes, asthma, sleep apnea, and blood pressure by obesity is many times higher.
- It is crucial to follow the 1-year diet program special for the patient after the operation. Since the patient will take fewer calories than the preoperative period, the nutritional values of the foods should be high. Consuming unhealthy foods such as fatty, sugary foods and high-calorie drinks prevents slimming. Therefore, the patient’s nutrition program includes low carbohydrates and high protein.
- The patient should eat liquid and nutritious foods in the postoperative period. Then the nutrition program is changed in stages.
- The patient should chew food a lot and facilitate digestion. In addition, it should behave precisely according to the recommendations of the doctor and dietitian in water consumption.
- Low blood levels may be associated with eating less. To prevent this, the patient should take vitamin and mineral supplements.
- In the first month after gastric bypass surgery, the person should only consume liquids and small amounts of soft foods. However, gradually, solid foods are added to the diet again. After Gastric Bypass surgery, the person will realize that they feel full for a long time with very little food.
- After Gastric Bypass surgery, the person can get help from the nutritionist about how to make changes in eating habits and vitamin and mineral supplements to take. It is predicted that the person will lose two-thirds of his body weight in the first two years after gastric bypass surgery.
Gastric Bypass is a type of obesity surgery that aims to reduce food intake by connecting the stomach and small intestine. Unlike tube stomach surgery, it restricts not only food intake but also food absorption.
Too fast and too many calories after Gastric Bypass surgery may cause a syndrome that causes abdominal cramps, nausea and diarrhoea. Some people have low blood sugar and weakness after surgery. However, it is possible to avoid these complications with proper care. All patients should take vitamin and mineral supplements after surgery. If not, this situation may cause B12, iron and calcium deficiencies.
Rarely, after Gastric Bypass surgery, problems such as leakage due to staple line in the stomach or obstruction of the intestine may be possible. In order to avoid these conditions, an experienced doctor should perform the operation. Keep in mind that there is no return of the procedure.
Who Can Have Gastric Bypass Surgery
Tube stomach and gastric bypass surgeries can be performed for anyone between the ages of 18-65, who have a body mass index of 35 and above, and who do not have any discomfort to prevent surgery.
Operation for patients under the age of 18 may rarely occur, but in such a case, parent’s consent is obtained prior to surgery.
If the patient has any psychological problem or alcohol dependence that may interfere with the operation, surgery approval is obtained from the relevant branch doctors, and the operation is performed.
Different tests are used to make sure that gastric bypass surgery is a suitable procedure for the person. The person’s medical history, body mass index, and personal weight loss goals are important factors in determining whether they are a viable candidate for Gastric Bypass. In addition, diseases such as heart diseases, reflux, high cholesterol, sleep apnea, high blood pressure, diabetes or infertility can prevent Gastric Bypass surgery.
What are the Risks of Gastric Bypass Surgery?
The complications that can occur in gastric bypass surgery and the risks associated with them are as follows:
- Nausea, cold sweating, rapid heartbeat, dizziness, and possible diarrhoea can occur. These problems may occur by the consumption of certain foods, such as foods high in fat or refined sugar.
- There might be an enlargement of the sac caused by constant overheating. This causes insufficient weight loss or, in some cases, some weight gain.
- Inadequate absorption of iron and calcium may occur. This may require a lifelong vitamin supplement.
- Anaemia and reduced calcium absorption caused by malabsorption of vitamin B12 and iron in menstruating women can cause osteoporosis and metabolic bone disease.
The more comprehensive the bypass process, the greater the risk of complications and malnutrition.
Our Approach to Gastric Bypass Treatment
Most obesity patients consider obesity surgeries as an option when they cannot get results from preoperative treatments in weight loss. In this context, Gastric bypass surgery is also offered as a treatment method.
We listen to the general goals of patients concerned with Gastric B
Bypass therapy regarding their health and ensure that they learn more about the current procedures.
Although patients sometimes believe that surgery is necessary, surgical methods are not always required in the treatment of obesity.
If the general health of the patient does not allow surgery, we inform and guide him about the preoperative treatments.
If an operation is necessary, we determine whether there is a more suitable treatment method among alternative options such as tube stomach surgery, stomach balloon.
We offer the necessary psychological support regarding the treatment process clinically. In addition, patients can access a support group, if they wish, to contact other patients who have had surgery or are about to undergo surgery.
Do diseases such as diabetes, asthma and high blood pressure prevent gastric bypass surgery?
On the contrary, these were diseases caused by obesity and further aggravated it. These diseases are not a hindrance to surgery, but a reason.
Does pain happen after Gastric Bypass surgery?
Since gastric bypass surgery is performed laparoscopically (closed), through the millimetre holes, the pain after the intervention is less than open surgery.
Is there a trace after gastric bypass surgery?
Aesthetic results are also extremely good because the incisions are very small. After a few months, these lines will become almost invisible.
What is the Cost of Gastric Bypass Surgery?
Our clinic is SGK contracted and provides services at affordable costs as much as possible. You can learn detailed information from our contact numbers.