Gastric Bypass Surgery

Overview

Indications

Process

Complications

Overview

Gastric bypass surgery is a restrictive/ malabsorptive surgical procedure. It restricts the amount of food the stomach can hold and thereby affects how food and calories are absorbed into the blood stream. It has the highest success rate for weight loss. It involves a reduction in the stomach size which causes early satiety. As a portion of the stomach is removed, the patient feels less hungry. Bypassing part of the stomach, intestine has a limited absorption of calories. The surgery can cause ‘dumping syndrome’ in which foods high in sugar and fat are not tolerated well by the body, which leads to behaviour changes. Most patients lose 60 to 70% of body weight after the procedure. The weight loss is permanent, unlike dieting and exercise. Patients even report of improved self-confidence. Risk of obesity- related diseases is reduced.

Gastric Bypass Surgery Indications

Body Mass Index (BMI) between 30 to 39.9 is considered as obese. It refers to increased body weight with respect to height. BMI above 40 is referred to as morbid obesity. Obesity can be due to overeating and lack of exercise, genetic factors, environment and psychological factors. Patients who are obese or morbidly obese are prone to major health risks like shorter life expectancy, breathing difficulties, heart problems, high blood pressure, diabetes, psychological problems, fertility issues etc. They even face day to day difficulties of getting tired easily, movements are difficult, public transportation seats of buses or cars are smaller, difficulty in maintaining personal hygiene. When all other weight loss techniques fail and the patient is facing health risk due to obesity they are recommended to undergo a gastric bypass surgery.

Gastric Bypass Surgery Process

The anesthesiologist will administer anaesthesia through the IV line which will make the patient sedated throughout the surgery. Once the patient is asleep, an endotracheal tube will be placed through the mouth to help to breathe. The most common type of gastric bypass surgery is the Roux-En-Y surgery. It can be done by creating a keyhole size incision on the abdominal wall or by a larger open incision. The operating surgeon will decide which is the technique best suited for the patient. The surgeon staples the upper part of the stomach to form a small stomach pouch. A new opening is created from the stomach pouch. The small intestine is cut into two sections; the lower section is attached to the opening created in the stomach pouch which is referred as 'roux limb'. The upper part of the small intestine which contains all the digestive juices is attached to the distal part of roux limb. The roux limb enables food to bypass the lower part of stomach, duodenum and a small part of small intestine. After the surgery is completed internal incisions are closed with absorbable sutures, while external incisions are closed with sutures, staples or steri-strips based on surgeon’s choice.

Gastric Bypass Surgery Complications

As with any surgery, there are potential risks involved. The decision to conduct the operation is made by the benefits required. Specific complications of gastric bypass surgery are deep vein thrombosis, leakage of digestive juices from staple line can cause severe infections, narrowing of the opening between the stomach and small intestine, abdominal hernia, bleeding ulcers, dumping syndrome (vomiting, reflux and diarrhoea due to food moving too rapidly through small intestine).
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Frequently Asked Questions

  • What are the procedures before the surgery?
    At the initial visit, the doctor notes down all the health history. Patient will be recommended a dietitian who will guide on the dietary modifications best suited to the patient before and after surgery.  Investigations like routine blood test, electro cardiogram (ECG), Helicobacter pylori test (H. Pylori) detection tests, Thyroid stimulating hormone (TSH) will be carried out to assess patient fitness for a major surgery like this. Patient might be asked to stop certain medications like blood thinners that might cause complications during the surgery. Hospital admission is needed about 24 hours prior to surgery to start certain medications via an IV drip. The patient will not be allowed to eat anything till a few hours post surgery.

  • What will be the instructions given post surgery?
    Once the surgery is completed, the patient will be transferred to another room till discharged to go home. Once the vital signs are stable, the nursing staff will assist in getting out of bed and to start slow movement. The patient will have to stay in hospital for at least two nights, but further stay  would depend on patient's recovery and condition. “Gas” pain is common in the first few days post surgery. The patient will be encouraged to take small walks frequently and do breathing exercises to speed up the recovery process, reduce gas pain, and prevent blood clots. The pain medications will be continued through an IV line for at least 2-3 days, until patient is ready to take food and medicines orally. Before discharge, home care instructions and medications will be prescribed and a follow up visit will be scheduled for after 1-2 weeks.

  • What will be the recovery time after the surgery?
    Patient is advised to resume their daily activities of walking, bending, lifting, exercise as tolerated after 2-3 weeks, if there are no complications. Movement is must for faster recovery, do not sit for longer than 1 hour at a time, keepimoving about.