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Gastric Bypass
Roux-en Y gastric bypass or gastric bypass is an established surgical treatment for morbid obesity. This is usually performed with laparoscopy or “key-hole” surgery. It involves partitioning the stomach into a small pouch and re-arranging part of the small bowel. The small stomach pouch, about the size of one’s thumb, is fashioned with a surgical stapler and separated from the remainder of the stomach. The upper half of the small bowel is sectioned and re-arranged into 2 limbs – Roux or the ‘food’ limb and biliopancreatic or “ digestive enzyme” limb. The “food” limb is then connected to the small stomach pouch to restore the continuity of gut and the “digestive enzyme” limb connected to the “food” limb downstream to allow digestion of food and absorption of nutrients in the “common” limb. With gastric bypass, patients feel full and satisfied with a small portion of food. In addition, the re-arrangement of the small bowel triggers hormonal changes that suppresses hunger and improves diabetes.
The advantages of gastric bypass are:
- Gastric bypass has a proven track record (> 30 years) with consistent results, it is the most commonly performed weight loss surgery worldwide.
- It achieves greater weight loss than gastric sleeve and gastric band.
- It improves or cures diabetes.
- Despite smaller food portions, patients can still enjoy a wide variety of foods and a good quality of eating.
- Gastric bypass can cure reflux disease or ‘ heartburn’.
- No post-operative adjustment required.
- It can also be a ‘salvage’ procedure for other ‘failed’ or complicated bariatric surgery.
With gastric bypass, patients can lose 60-80% of their excess body weight.
- Risks of gastric bypass
- Gastric bypass is a more complex and longer surgery than gastric band and sleeve, and hence its risk is slightly higher. However it can be performed safely with key-hole surgery and overall risk of potential significant complication is <5%.
- The main peri-operative risks are 1)leakage from joint from gastric pouch to small bowel (2%), 2)bleeding from staple line (1%) and 3) bowel injury. Sometimes gastric bypass can only be done with open incision.
- Longer operating time (2-3 hours for primary gastric bypass and up to 6 hours for revision gastric bypass) and longer hospital stay (4-5 days)
- Not easily reversible
- Greater nutritional surveillance required including blood tests.
Weight loss
You would lose most weight in the first 6-9 months and it will slow down after 1-1.5 years before plateauing.
Heartburn
It should resolve immediately after surgery. However you will continue anti-acid medication for 4 weeks after surgery to help with healing of gastric wound.
Diabetes
There will be immediate improvement of blood sugar level after surgery due to hormonal changes in the body that stimulates the release of insulin. Your blood sugar level will be closely monitored and medication may need be adjusted or reduced accordingly. With further weight loss, your diabetes may continue to improve or resolve completely.
Yes, long-term follow up is mandatory.
6 to 12 monthly nutritional surveillance with blood tests to ensure adequate nutritional health.
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