Laparoscopic Gastric Bypass

LAPAROSCOPIC GASTRIC BYPASS

Gastric Bypass Surgery

What is Gastric Bypass Surgery?

A small stomach pocket (30 ccs) is formed and is recombined with the stomach in about one-third of the small intestine such that food is not digested. Like other metabolic surgeries, the amount of food consumed in a meal is reduced and the food consumed does not digest in about one-third of the intestines. Also, the digestion of food in the last part of the small intestine with a large amount of obesity that leads to breaking the vicious cycle of hormones begins to secrete.

A small stomach pocket is created and the remaining stomach volume is deactivated. The small intestine is combined with the stomach pocket to divert the digestive tract. Inactivated gastric fluids, bile, and pancreatic fluids initiate digestion beyond the small intestine.

How to Lose Weight?

A small stomach pocket (30 ccs) allows feeding into smaller pieces so that fewer calories are taken.

Foods consumed due to the bypassed small bowel segment cannot be fully digested. Ghrelin secretion is reduced in the disabled stomach

Hormonal activation begins again as undigested foods come to the last part of the intestines more.

Re-secreted hormones include GLP-1, PYY, TGR5, PTP1B, FXR, FGFR4.

Also, a number of hormones from the liver and pancreas begin to re-secrete.

What are the Health Benefits of Gastric Bypass Surgery?

Clinically, patients have been shown to provide a great number of postoperative benefits.

• • 70-85% of the excess weight is lost.
• • Significant improvement in type 2 diabetes (75%), hypertension (90%), sleep apnea (75%) and hyperlipidemia (95%).
• • Increase in physical activity, productivity, well-being, economic opportunities, and self-confidence.
• • > 10 years of permanent weight loss
• • Short hospital stay due to the closed method

After gastric bypass surgery, many diseases may improve or heal completely.

• • Type 2 Diabetes (%60-85)
• • Hypertension (>%90)
• • Hyperlipidemia (%95)
• • Sleep apnea (>%75)

 Advantages and Disadvantages of Gastric Bypass Surgery

Advantages:

• • Causes long-term apparent weight loss (EWL 70-85%)
• • Improvement in obesity-related comorbidities (85 to 90% of comorbidities depending on the type, duration, and damage to the organ in which it occurs)
• • As in the stomach band, a foreign object is not used.
• • The amount of food consumed in a meal is reduced.
• • There is a decrease in hunger sensation due to hormonal changes and the increase in metabolism is higher than sleeve gastrectomy surgery.

Disadvantages: 

• • A proper nutrition program and routine exercise program should be continued throughout life.
• • Gastric bypass is a more complex surgery than sleeve gastrectomy.
• • Revision surgery in case of weight gain again is a very complex and high complication surgery.
• • Vitamins and mineral deficiencies are seen and lifelong vitamin, mineral, and protein support are required.
• • Due to Dumping syndrome complications, some foods are not allowed to be consumed.
• • There is no endoscopic access to the remaining stomach tissue.

Possible Complications

• • Associated with obesity (possible complications when performing any surgery in each obese patient regardless of the operation)
• o Deep vein thrombosis (thrombosis of leg veins)
• o Pulmonary embolism (thrombosis of the lungs)
• o Wound site infection
• o Lung infection
• o Anesthesia complications
• o İncisional hernias
• • Surgery related (complications specific to this surgery)
• o Bleeding (3-5%). Blood thinners may be caused by cuts of the stomach or other organs in the abdomen.
• o Leakage (3-5% in old technology stapler group, 0.1% in new technology stapler group. More than 90% of patients can be treated with endoscopic stent implantation and feeding tube insertion)
• o Vitamins, protein and mineral deficiencies (Patients begin life-long protein, vitamin supplementation)
• o Dumping Syndrome (rich in carbohydrates and nausea, vomiting and discomfort if ingested)
• o Ulcer

Risks

Obesity and metabolic surgery is a safe surgery. It is as safe as other surgical procedures, such as gall bladder surgery. Inexperienced obesity and metabolic surgery specialists, the life-risk associated with obesity surgery is about 0.13%, while the life-risk of gall bladder surgery in an obese individual is 0.4%.

All surgical methods include risks. These risks vary according to weight, age, and comorbidities. Each patient should have a specific risk assessment. A clearer interpretation cannot be made until the patient and the physician come together and make a preliminary assessment interview and conduct an examination evaluation.

But safe surgery is based on three main points.

1. Preoperative Evaluation: This includes routine blood tests, ultrasonography, endoscopic examination, chest disease evaluation, and cardiology evaluation. The patient should not be operated on unless the deficiencies (diabetes control, iron deficiency, vitamin B12 deficiency, vitamin D deficiency) that affect wound healing are eliminated. Smoking should be discontinued. A preoperative diet should be applied.

2. Surgery: The appropriate surgical procedure should be selected for the patient. Surgical experience is required. The most current stapler technology should be used during surgery. Preventing clotting in the operating room measures should be taken.

3. Postoperative: A good follow-up after surgery is very important for complication management.

Before - After Photos