What is Gastric Bypass Surgery?
Gastric bypass surgery is the gold standard against which all other obesity operations are judged. First performed as an open operation in 1967, it has stood the test of time. Now performed with laparoscopic surgery, patients stay in hospital for two nights and will usually return to work within two weeks. Weight loss with the gastric bypass is more reliable, than both the Lap-Band and the laparoscopic sleeve gastrectomy. In our hands, the risk of gastric bypass are lower than those published for the sleeve gastrectomy.
Using key-hole surgery, under general anaesthetic, a small rectangular, pouch is formed from the upper stomach. The remainder of the stomach is not removed; it remains healthy, with a good blood-supply, producing hydrochloric acid needed to sterilize food, enzymes needed to start digesting carbohydrates and a special protein needed to absorb vitamin B12. The small intestine is re-configured into a Y shape, using staplers to divide and join the intestine. The free end of the Y, is joined to the small pouch, with a one centimetre diameter join.
The small pouch reduces portion size dramatically; initially after surgery, patients can only eat very small portions. In the longer-term, most patients will be able to eat a child’s size portion.
After gastric bypass, food no longer passes through the stomach into the duodenum. Food bypasses the stomach, duodenum and approximately 80 to 150cm of the small intestine. Food still mixes with all the digestive juices produced by the liver, pancreas and stomach, but further down the bowel than before surgery. This bypassing of the stomach and small intestine, interferes with hormones produced by the gut that control appetite, so it is normal for patients not to feel hungry after surgery.
By, reducing portion size and decreasing a patient’s appetite, their daily calorie consumption is reduced to approximately 600 calories. Rapid, reliable weight loss occurs.
After surgery patients need to work closely with our dieticians, following a recommended diet, slowly building up too bigger portions and less easily digested foods such as meat and fish. Good follow up is essential, to ensure patients remain healthy and get a good long-term outcome. Research has shown that the most compliant patients get the best weight loss. Patients need to take a multi-vitamin each day; most medication can be taken as normal although it is sometimes necessary to break tablets. Annual blood tests are needed to ensure patients have the correct vitamin and mineral levels. Failure to comply, with dietary advice can cause malnutrition.
Weight loss after bypass surgery is affected by many patient factors including age, activity level and basal metabolic rate. But, on average, a typical lady who is 8 stone overweight will lose 6-7 stone.
Bypass surgery not only changes the hormones that control appetite, but also modifies the hormones that affect metabolic illnesses such as diabetes, high cholesterol and polycystic ovarian syndrome. For this reason gastric bypass is recommended for patients with metabolic illnesses.
- Raised blood cholesterol is normalised in over 70% of patients.
- High blood pressure is cured in over 70% of patients, with a reduction in medication for remainder.
- Obstructive sleep apnoea is resolved in 86% of patients, snoring improves for most patients
- Diabetes Mellitus is cured in up to 90% of patients, often within days of the surgery.
- Reflux of acid is usually cured by the surgery.
In our experience the gastric bypass is appropriate for:
- Higher BMI patients, BMI of more than 45kg/m².
- Older, less active patients, who struggle to lose weight.
- Patients who struggle to lose weight with moderately restrictive diets, like Slimming World or Weight Watchers, may be better suited to gastric bypass.
- Chocoholics and patients who cannot avoid crisps, biscuits, alcohol, sweets, ice cream. Liquid foods, which can sabotage weight loss with the gastric band or sleeve gastrectomy.
- Patients will experience very unpleasant symptoms, called the ‘dumping syndrome’, if they eat sugar. This can be a very useful deterrent for patients, with a sweet tooth, who favour sweets and chocolate!
- In our hands the gastric bypass, has proven to be very safe, with zero mortality. The published mortality rate in the UK is below 1 in 1000.
- The most serious complication is a leak from one of the staple lines or joins, which can make patients very sick with peritonitis and septicaemia. These will usually occur within the first day or two of surgery. With proper treatment, most patients will leave hospital within two weeks and go on to make a complete recovery.
- Complications are unusual after discharge, but a few patients will find eating difficult and need an endoscopy. In the long-term patients can get internal hernias, which may need further surgery. Streamline Surgical tries to minimise the risk of this long-term complication, by closing potential hernia sites during the original operation.
Contact us now to book a consultation to see if the gastric bypass is right for you.