Gastric Bypass

Gastric bypass is a procedure in which the stomach is divided into the upper small pouch of the size of an egg and the bottom section. Then the pouch is connected to the intestine and, as a result, the consumed food goes around the larger part of the stomach and intestine – they are excluded from the digestion and absorption process.

Who is the gastric bypass for?

Gastric bypass, similarly to the sleeve gastrectomy, is intended for individuals with III class obesity, i.e. with the body mass index greater than 40kg/m2 or between 35 and 40 kg/m2, if the obesity is accompanied by such diseases as: diabetes, hypertension, diseases of heart and joints or the sleep apnea.

To check your BMI use the calculator on the right side.

The course of the gastric bypass surgery

The sleeve gastrectomy is performed in a general anaesthesia. The patient is connected to numerous monitoring devices (cardiac monitor, monitor of oxygen and carbon dioxide concentration in patient’s breath, monitor of the oxygen saturation of the arterial blood), which are designed to control all necessary life parameters, and to a medical ventilator which provides breathing for a patient.

The surgery is commenced in the same way as with the sleeve gastrectomy, i.e. 5 small incisions are made on the patient’s stomach through which the laparoscopic instruments are inserted. Before the main part of the procedure the surgeon performs a visual inspection of the internal organs of the abdominal cavity. The first step of the surgery is to isolate a small pouch from the upper section of the stomach. It is performed by means of a line stapler (an instrument which simultaneously sutures the stomach and cuts between the sutures). The volume of the pouch usually equals to 20-30ml. Then a loop of the small intestine is measured out and it is connected to the small pouch (using a line stapler and absorbable sutures). Such connection is referred to as the gastrointestinal anastomosis. The larger part of the stomach, excluded from the digestion and absorption process, and first 75-150 cm of the small intestine are connected with the gastric loop passing the food from the upper section of the stomach to preserve the outlet for the digestive juices. Such connection (the gastrointestinal anastomosis) is made by means of the line stapler and the absorbable suture. After that, the intestine between the anastomoses (line staple) is excised which leaves a gastric loop of 75-150cm in length. The gastric loop, by connection to the enzyme loop, is transformed into so-called common canal (common loop) which is responsible for the digestion and absorption of the food. The suturing of the area potentially susceptible to internal hernia (Petersen’s area and intermesentric area) is an important stage of the surgery. After a thorough control of the homeostasis (inspection against bleeding), the wounds are sutured and the gas (carbon dioxide) is removed from the abdominal cavity.

Benefits of the gastric bypass surgery

1. No foreign bodies in the organism.
2. It is a reversible procedure.
3. Moderate number of follow-up visits.
4. Weight loss of up to 68% in the first year after the operation.
5. Increased chances for the diabetes to subside.
6. Lower frequency of the heartburn (the gastric bypass is considered an anti-reflux operation).
7. The operation discourages the patient from eating sweet food (it makes him/her feel sick).

Postoperative risk

Each interference with the human body entails certain risk. It also applies to the gastric bypass. The laparoscopic method, however, decreases the risk. The after-effects and threats related to the surgery include, for example:

1. Deficiency of vitamins B1, B6, B12, D3,calcium, zinc, iron, folic acid; the insufficient supplementation may involve anaemia, secondary hyperparathyroidism, neurological disorders.
2. Leaking in the excised areas of the stomach.
3. Clots or emboli in the blood vessels.
4. Dumping syndrome (sensations of full stomach, fatigue, increased heart rate, hyperhidrosis)– occurs after the consumption of monoses (e.g. very sweet tea), high-calorific liquids.
5. Frequent bowel movements and unpleasant odour of stool. It may be caused by diet rich in fat. With time, the frequency of bowel movementsdecreases.
6. Infection of the postoperative wounds and the operated area.
7. Narrowing of the gastrointestinal anastomosis.
8. Marginal ulceration in the anastomosis area.
9. Damage to the spleen, liver and intestine.
10. Heartattack,cardiovascularfailure.
11. Impaired wound healing, hypertrophic scars, hernia.
12. Intestinal obstruction possible even many years after the surgery.
13. Protein malnutrition.
14. Tendency to alcoholabuse.

Partial success of the surgery (loss of 50% of the overweight after 5 years) is usually associated with consumption of high-calorific liquids and must not be regarded as a postoperative complication.

After the surgery it is recommended that the patient strictly follow the diet and take multi-vitamin products. Due to the risk of deficiency of vitamins and minerals it is necessary to undergo medical examination and laboratory tests after 7 days, 1, 3, 6, 9, 12, 18 and 24 months, then once a year.