What is a Gastric Bypass
Gastric bypass has been available for more than 35 years and is still a commonly-used procedure in the United States.
Gastric bypass surgery was traditionally done with a long incision in the abdomen, but now is usually performed laparoscopically. It involves cutting the stomach off near the top so that a smaller pouch may be made, which is reconnected to the small intestine. The procedure is essentially irreversible.
The two commonly used gastric bypass techniques are Roux-En-Y bypass and Single Anastomosis "Mini" Gastric Bypass.
Roux-En-Y bypass involves creating a small stomach pouch which is then attached to a Y-shaped section of the small intestine. With this method, most of the stomach and top portions of the small intestine are bypassed. This procedure reduces the absorption of nutrients and therefore calorie intake. It is done through a major opening of the abdomen, requires staples, and is irreversible.
Roux-En-Y Gastric Bypass
First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the absorption of nutrients and thereby reduces the calorie intake.
- 'Dumping syndrome' if sweets and chocolates taken
- Good operation for sweet eaters
- Long track record
- Tend to lose a little more weight than gastric band
- Longer recovery time
- Difficult to reverse
- Staple line leak
- Minor late weight regain 10-20% after 2-5 yrs
- Nutritional/ mineral supplements required
Bilio Pancreatic Diversion BPD
These operations combines removal or exclusion of 2/3rds of the stomach along with a long intestinal bypass which significantly reduces the absorption of fat. The capacity to eat is greater than with the other operations, and the eventual weight loss is the best of all the operations, but if fatty foods are overeaten e.g. a hamburger and fries, then diarrhoea and foul flatus will result.
- Open operation (usually), therefore greater operative risks e.g infection, bowel leak, clots to legs and lungs, wound infection and hernia, chest infection. Risk of death is 1:200
- Malabsorbtion to some minerals vitamins and protein. Patients must commit to taking lifelong supplements of the fat soluble vitamins (A, D, E, K) Calcium and sometimes Iron.
- Risk of deficiency state e.g. Iron deficiency (anaemia), or osteoporosis if supplements not taken
- Take longer to recover ( 6-8 weeks off work)
- Requires removal of Gallbladder because of high incidence of stone formation
- Increased stool frequency 2-4/day
- Flatulance if fatty foods eaten