What is Gastric Bypass Surgery?
The Gastric Bypass is considered as the “gold standard” of Weight Loss Surgery by the American Society of Metabolic and Bariatric Surgeons (ASMBS). Roux-n-Y Gastric Bypass Surgery (RYGB) is the most commonly practiced weight loss surgery world wide.
The Gastric Bypass is also considered by the SAGES and ASMBS as the most complex and technically challenging procedure to be done by laparoscopy and requires a large number of operations to achieve competency.
Open RYGB as treatment for obesity was introduced by Dr. Mason and Dr. Ito in 1967. The first Laparoscopic RYGB was performed in 1994 by Dr. Wittgrove following the surgical steps of the open surgery.
The Simplified Gastric Bypass was developed by Dr. Almino Ramos in Sao Paulo, Brazil and was called Simplified Laparoscopic Gastric Bypass consisting in simplifying and standardizing the surgical steps of the traditional Gastric Bypass in a way that it can be done in the superior half of the abdomen easily, by trained Bariatric Surgeons with less operative time (average of 75 minutes) and with more efficiency. Today, thousands of patients are operated by this technique all over the world.
The Simplified Gastric Bypass technique involves a gastric stapling, and its division (forming the gastroplasty, new gastric chamber or pouch), lowering the gastric capacity by 90% (20-30cc). The Gastric Bypass is done ante-colic (the open way was retro-colic, meaning that was done behind the transverse colon) and as far as 1.5 to 2 m (the small bowel has 4 to 7 m in length). At the end of the procedure, the gastroplasty is connected with the deviated intestinal limb (gastrojejunostomy) by stapling and suturing them, to allow the food to pass again.
What are the Risks of Gastric Bypass Surgery?
International literature describes an average of 10% of cases with complications (morbidity), and a 2% mortality rate. Anastomotic leak is the most serious complication of gastric bypass procedure and is associated with increased morbidity and mortality. The ideal treatment is prevention by meticulous operatory technique and pre and postoperative care. The leaks that are likely to result in mortality (about 15%) are those for which the patient manifests a high systemic inflammatory response, and is closely related with a high BMI, with fever, increased leukocyte count and heart rate and also signs of organ failure.
How does the Gastric Bypass Work?
This operation involves two effects: predominant gastric restriction, and intestinal malabsorption. The food arrives at the new stomach (gastroplasty) and promotes distention on the walls of the pouch, inducing satiety and fullness with small amounts of food. Then the food passes slowly through the calibrated gastrojejunostomy of 11 mm and proceeds for digestion (1.5 to 2m after the new formed gastric pouch). When the fullness sensation of the small chamber is exceeded, pain or vomiting can occur.
After a Gastric Bypass, the liquids with high concentration of carbs will not be totally absorbed, especially during the first year. This may result in “dumping syndrome” where the food moves too quickly into the small intestine. Symptoms include bowel irritation, abdominal pain, diarrhea, and increased heart rate with palpitation and sweating.
What happens post-op (after surgery)?
Most of the patients are discharged from the hospital within 48 to 72 hours after the operation. The complete return to normal activities occurs in about one week. During 4 weeks following the operation, the patient should consume a liquid diet, and advance in a stepwise way to a puree/baby food type diet for one or two additional weeks, eventually evolving to an almost normal diet by the fourth week. In this operation there is a need to supplement vitamins and minerals. Iron must be followed by regular I.V. tests and reposition is usually needed.
Who would benefit from a Gastric Bypass?
- Patients with a metabolic disease (Type 2 diabetes, high blood pressure, hyper-lypidemia)
- Persons with any degree of binge eating disorder
- Moderate risk patients (few co-morbidities)
- High expectations (those who need to lose weight, up to 80% EWL [excess weight loss])
- Low to moderate patient commitment