Gastric Bypass Surgery

Overview

Gastric bypass surgery, also known as “Roux-en-Y” in French, is a medical procedure used to promote weight loss and alter metabolism. This surgery involves modifying the structure of your digestive tract to reduce calorie intake and absorption. It affects both the stomach and the small intestine.

The name “Roux-en-Y” derives from the way this surgery reshapes your digestive tract. During the procedure, your stomach and small intestine are divided, and these sections are then joined to create a “Y” shape.

Initially, the functional part of your stomach is reduced to a small pouch, which is separated from the rest using surgical staples. This limits the amount of food that can be accommodated in your stomach. Subsequently, a lower part of your small intestine is connected to this newly formed stomach pouch.

As a result, food now bypasses most of your stomach and the initial section of your small intestine as it travels through your digestive system. Due to this bypass, your digestive system cannot fully absorb all the nutrients and calories from your diet.

During the first year or two following surgery, weight loss is frequently substantial. Approximately 70% of the excess weight is average. Over the course of 20 years, most individuals who have undergone weight loss efforts tend to maintain a consistent long-term reduction in weight, typically achieving a 50% reduction in their excess weight. Although some individuals may experience fluctuations and regain some weight over time, this average reduction remains relatively stable.

During the first year or two following surgery, weight loss is frequently substantial. Approximately 70% of the excess weight is average. While some people regain some of their weight over time, the average long-term weight reduction is 50% of the excess weight. The figure remains constant for 20 years.

Reasons for undergoing the procedure

For patients with clinically severe obesity, gastric bypass surgery is advised, just as other bariatric surgery procedures. Numerous obesity-related medical conditions, including as type 2 diabetes, hypertension, obstructive sleep apnea, and GERD (chronic acid reflux disease), have been demonstrated to improve with its treatment.

If you are medically obesity, weight loss alone can have a significant impact on your health. However, gastric bypass surgery accomplishes more. It modifies your metabolic system in a long-lasting way to help you control your blood pressure, blood sugar, and hunger.

Following gastric bypass surgery, the following conditions improve:

• Diabetes
• Fatty liver disease
• Gastroesophageal reflux
• Sleep apnea
• Osteoarthrosis
• Heart disease
• Stroke
• Cancer
• Infertility
• Hyperglycemia
• Hyperlipidemia
• Hypertension

Risks

Short-term risks associated with gastric bypass surgery are similar to those of many other procedures, and they include:

• Infection
• Bleeding
• Anesthesia side effects

Following gastric bypass surgery, potential complications may include:

• Small bowel obstruction. Your small intestine may narrow or get obstructed due to scar tissue.
• Hernias. When an organ pushes through a gap in your muscular wall, a hernia develops.
• Anastomotic leaks. Your small intestine is divided and reconnected in multiple locations during gastric bypass surgery. Your abdominal cavity may get seriously infected if the connecting site leaks.

Certain digestive issues can result from surgeries that alter your digestive system. Among them are:

• Malabsorption and malnutrition. Malabsorption in the small intestine is purposefully caused by gastric bypass surgery in order to lower the amount of calories you absorb. If you’re not careful, it might also result in nutritional deficiencies. To assist avoid this, your doctor will recommend nutritional supplements.
• Bile reflux. Surgical procedures that impact the pyloric valve, which is the passage connecting the stomach to the small intestine, can lead to its malfunction. Bile reflux may occur as a result of improper closure of the pyloric valve. This implies that bile that your gallbladder excretes to aid in food digestion may return to your stomach through your small intestine. Gastritis and stomach ulcers can result from bile reflux’s erosion of the stomach lining.
• Gallstones. Swiftly losing weight places a substantial load of cholesterol on your liver for processing. Extra cholesterol is sent by your liver with bile to your gallbladder. Gallstones made of cholesterol may develop in your gallbladder as a result of this excess cholesterol. Although gallstones don’t usually cause issues, they can be hazardous if they get lodged in your bile ducts. After surgery, your doctor might prescribe you a medicine to prevent gallstones.
• Dumping syndrome. A group of symptoms known as gas dumping syndrome can happen when food leaves your stomach and enters your small intestine too quickly. Following bariatric surgery, up to 50% of patients may experience some dumping syndrome symptoms. Hypoglycemia, cramping in the abdomen, diarrhea, and nausea are among the symptoms. Usually, they disappear with time. You will receive dietary recommendations from your doctor to help prevent or manage dumping syndrome as you heal.
• Ulcers. After undergoing gastric bypass surgery, there is an increased chance of duodenal or stomach ulcers. Your doctor will advise you to abstain from smoking and non-steroidal anti-inflammatory drug use going forward in order to prevent this.
• Weight regain. It is possible to expand your stomach once more if you do not make a commitment to altering your eating habits going forward. Over time, even the tiny pouch your surgeon made for you has the capacity to hold an increasing amount of food. Revision gastric bypass surgery is one viable course of action when this occurs. You might get your Roux-en-Y repaired or redone by your surgeon.

Before the procedure

The eligibility criteria for gastric bypass surgery are similar to those for other bariatric procedures. It is essential that a qualified medical professional recommends surgery for you. In general, you may be considered a candidate for gastric bypass surgery if:

• Have been identified as class III obesity. A body mass index (BMI) of 40 kg/m2 or more is considered class III obesity.
• Have at least one obesity-related condition and a BMI of at least 35.
• Have obesity-relatedtype 2 diabetes. If your type 2 diabetes is out of control and your BMI is 30 or higher, you may be a candidate for gastric bypass surgery as a means of improving blood sugar regulation.

In the event that you meet these requirements, surgery can be suggested. However, there will be further needs for your surgeon. You will have screening and counseling sessions with a group of medical professionals prior to the procedure. They’ll be curious about:

• That you are psychologically and physically prepared for surgery. It is probable that you will undergo certain basic medical examinations to ensure your safety during the surgery. You might also undergo testing formental health issues, as well as alcohol or tobacco use.
• Your dedication to making long-term lifestyle adjustments. Although surgery is an effective weight loss strategy, it won’t help if you don’t work with it. You will always need to adjust your eating habits. You risk gaining back the weight you lost if you don’t.
• That you’ve made various attempts to reduce weight. Insurance companies may need documentation proving that weight loss surgery is required for medical reasons. They could insist that you begin with a closely monitored diet and exercise regimen.

During the procedure

Every laparoscopic procedure starts with a single abdominal “keyhole incision.” Your abdominal cavity will be inflated with carbon dioxide gas by your surgeon using this keyhole. This helps to make everything more visible by separating your abdominal wall from your organs.

Then, via the keyhole, your surgeon will insert a tiny, illuminated video camera called a laparoscope to view your organs. A computer screen will be projected via the laparoscope. To access your organs, your surgeon will make more keyhole incisions.

Using a surgical stapler, the upper part of your stomach is separated from the lower part as the initial stage in the Roux-en-Y treatment. The resultant pouch has an approximate egg-sized size. Your small intestine is still connected to the remaining portion of your stomach.

The next procedure is to divide your small intestine in several feet down its length, raising the lower portion to join your newly created stomach pouch. From your stomach pouch, your food will now travel via this section of your lower small intestine.

Reattaching your small intestine’s upper branch to the trunk lower down is the last step. Two branches of your small intestine are now joined to the trunk: one originates from your stomach pouch, and the other from the remaining portion of your stomach.

The new branch, via which your food will travel, is located on the right side of this “Y.” Your small intestine’s original upper portion, or duodenum, is on the left side. This is the segment where the liver, gallbladder, and pancreas release their digestive juices. These juices will be transported via the left branch to your small intestine’s new trunk, where they will combine with meals. This will allow you to absorb less nutrients from your food due to your shortened intestinal tract, but it will still allow you to digest it adequately.

The actual treatment takes two to four hours to complete. You will most likely stay in the hospital for two days after that. Solid foods won’t be available to you quite yet.

After the procedure

You might only be able to eat liquids right after gastric bypass surgery while your intestines and stomach recover. After that, you’ll adhere to a unique nutrition plan that gradually transitions from liquids to pureed meals. After that, you can start with soft foods and work your way up to stiffer ones as your body can handle them.

After undergoing weight-loss surgery, you may encounter several dietary restrictions and limitations regarding your food and beverage intake. Your doctor will advise you to incorporate vitamin and mineral supplements into your daily routine, including a multivitamin containing iron, calcium, and vitamin B-12.

Additionally, during the initial months following the surgery, you will undergo regular medical checkups to monitor your overall health. These checkups may involve laboratory tests, blood work, and various examinations.

Outcome

After the surgery, you can expect to spend approximately one day in the hospital for recovery, followed by a few weeks of recuperation at home before you feel prepared to return to work. It is advisable to avoid strenuous activities for up to six weeks, and it could take as long as twelve weeks to resume your normal dietary habits.