Article by Panagiotis Glentis MD, Bariatric Surgery.
Laparoscopic Gastric Bypass
Laparoscopic Roux en Y gastric bypass is a combined restrictive and malabsorptive operation.
That is, it restricts the amount of food that can be consumed by the person and also a portion of this food is not absorbed during digestion.
It has been first described as a bariatric operation in USA in 1993.
Since then, gastric bypass has become one of the most popular operations in USA for the treatment of morbid obesity.
Approximately 100000-200000 such operations are done every year in the United States.
Gastric bypass is a major bariatric operation compared to gastric banding, gastric plication and gastric sleeve and it is used in more severe situations of morbid obesity.
The technique in gastric bypass, which can be done both laparoscopically or robotically, is to create a small gastric pouch 15-30 cc in capacity from the upper stomach, and also to bypass the remaining portion of the stomach and the portion of the first part of the small intestine.
There are two separate techniques in gastric bypass:
Short limb gastric bypass
In this technique, we bypass the first 80-150 cm of small intestine, and the food is only absorbed by the remaining small intestine.
Long limb gastric bypass
In this procedure, we bypass all the small intestine except the last 100-150 cm of it, where the food is been absorbed.
The small gastric pouch makes possible that after consuming a small meal, the patient has the sensation of satiety, stops eating and stops being hungry.
The food that goes through the gastric pouch to the small intestine is not immediately absorbed. It bypasses a portion of the small intestine and it is absorbed in the rest of it.
So we achieve that the small meal consumed, is partialy digested and absorbed.
Among weight loss operations, gastric bypass has very impressive results.
With gastric bypass we can achieve a 90-100% loss of the excessive body weight and a permanent long term outcome.
After gastric bypass a lot of morbid conditions are very well arranged.
High blood cholesterol and hyperlipidemia are corrected in 70% of the patients and hypertension is arranged in 70% of the patients, meanwhile in the rest 30% we achieve a decrease in antihypertensive treatments.
The procedure also can reduce sleep apnea and snoring during sleep.
Another great advantage of gastric bypass is that it can control diabetes in 90% of the patients and this can be achieved from the first days after the operation.
Gastroesophageal reflux is corrected in all patients
In laparoscopic gastric bypass there is a need for a long term medical observation and follow up, because of the malabsorption that this operation brings.
Some patients have low calcium absorption that can lead in hyperparathyroidism, lower absorption of ferrum and B12 vitamine that can lead in anemia, lower absorption of thiamine and fat soluble vitamins mostly vitamin A.
That’s why a close medical follow up is needed not only for the period of weight loss but also for the rest of the patient’s life.
Why choose gastric bypass
The great advantage that laparoscopic gastric bypass has to offer in obese patients, is that it gives a great help to patients that have a tension to consume sweets and snacks.
Of course there are some dietary restrictions after the operation, which if not followed, diarrhoic and malabsorption syndromes may happen, that make everyday life of the patient quite difficult.
Also it’s a great operation for patients with severe gastroesophageal reflux (GERD) and esophagitis.
Because it’s a major operation, it has to be chosen with strict criteria by the surgical team and the patient has to be fully informed about the benefits the risks and the long term post-operative consequences that this operation will bring to his life.
Bariatric Surgeon – certified under the EAES (European Association for Endoscopic Surgery) in the fields of Upper & Lower GI Laparoscopic Surgery and Laparoscopic Bariatric Surgery.
Dr. Glentis operates at Bioclinic Athens