Gastric Bypass Surgery is a method used to help obese patients to lose weight. It involves sectioning the stomach into two areas, and rearranging the small intestine to ‘bypass’ the main stomach area. Consequently, the food takes a shorter route through the digestive system, thus fewer calories are absorbed. Food passes into the smaller, upper part of the stomach only, which leaves the patient feeling full after eating just a small amount of food.
There are two methods for conducting gastric bypass surgery – open surgery and keyhole surgery – also known as laparoscopy. Both are carried out under general anesthetic. The choice of procedure is made by the surgeon and is influenced by a number of factors:
Patients who suffer from underlying health issues that put them at greater risk of adverse reaction to open surgery are recommended to have the laparoscopy. Anyone whose weight is in excess of 350 lbs or who has already had abdominal surgery will not be suitable candidates for the laparoscopy.
Open surgery involves making a large cut or incision to open up the stomach. The surgeon then enters the different areas of the stomach and small intestine directly to carry out the work.
The laparoscopy or keyhole method involves making a small number of tiny incisions into which a camera is passed, allowing video images to be relayed to guide the surgeon during the procedure. The resulting scars are smaller than with open surgery and patients experience less pain and a quicker recovery.
With either method of entry, the procedure itself involves sectioning the stomach into two. One section becomes a very small pouch, that can contain just 1 ounce of food, and the larger, lower section is effectively cut off, and referred to as the remnant pouch. The surgeon uses staples to create the two sections, then a small hole is made into the upper pouch to allow for the connection of the small intestine. This connection ensures that food travels from the small stomach pouch down a shorter small intestine, spending less time in the digestive system. This means that fewer calories have the chance to be absorbed.
Sutures are used to close the wound for either procedure, and the patient is allowed to resume consciousness. The whole process takes approximately 4 hours.
Who are the best candidates for gastric bypass surgery?
Patients who are over 100 lbs overweight and those with a body mass index above 40 are considered for this procedure, usually after alternative weight loss programs such as diet and exercise have been tried, and have failed.
Anyone with a BMI above 35 who is suffering obesity related problems such as sleep apnea, high blood pressure or diabetes are also eligible for gastric bypass surgery.
Patients should be considered mentally stable to allow them to manage the change in their lifestyle after the operation. There are new diets to follow and an exercise program to ensure the weight loss takes place. Overeating after the procedure can be dangerous so patients need to be able to accept a strict diet regime.
Are there any side effects?
Side effects are those commonly associated with general anaesthetic, such as nausea, tiredness, and feeling light headed, immediately after resuming consciousness. Patients are advised to remain in the hospital for 2 to 5 days to ensure the best recovery.
The stomach will be a little sore after the procedure. There will be some bruising and swelling at the site of the wounds. Usually, dissolvable stitches are used so there is no need to return to hospital for them to be removed.
Only soft, pureed food can be consumed for the first two weeks. Patients who overeat will suffer from vomiting, and if they eat sugary foods, an unpleasant process called dumping takes place. This is when the food passes too quickly through the small intestine and may result in a drop in blood sugar or blood pressure, which can lead to dizziness and fainting.
Are there alternatives to gastric bypass surgery?
While gastric bypass surgery has been the most common weight loss procedure for the last 30 years, there is another, less invasive procedure that is coming to the fore – lap band surgery. This involves sectioning off the two parts of the stomach in a similar way, but inserting a ring with a stoma that allows food to slowly enter the larger area of the stomach. It gives the patient a full feeling in a similar way to the gastric bypass. It does not, however, make any changes to the small intestine, and therefore it is less invasive, recovery time is quicker, and there are fewer associated risks.
Gastric bypass surgery is more effective at cutting out sugary, sweet foods, as the stomach cannot tolerate these substances, and it brings about a more rapid loss of weight during the first 6 months. Because of the shortened travel time through the digestive system, patients of gastric bypass surgery must ensure they carefully follow the recommended diet to ensure they do not suffer from a deficiency of nutrients. Every case is different and surgeons make the ultimate decision as to which procedure will deliver the greatest benefits with the least risks to health.
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