Gastric Bypass Surgery & Weight Loss Surgery

Extensive Gastric Bypass, Banding & Roux-en-Y

Types of Bariatric Surgery
All types of bariatric surgeries are done under general anaesthesia. These are minimally invasive surgeries which require a short stay in hospital, recovery after surgery is faster and resumption of routine activities is also possible earlier. Since such procedures are as the name implies minimally invasive (key hole), there is usually less blood loss and damage to tissues, hospital stay is shorter (about 2-5 days) and no post-operative ICU stay or bed rest.

1. Gastric banding

A soft band is placed on the upper stomach which reduces the amount of food consumed at one time and provides a feeling of fullness for a longer time. Hence there is weight loss.

2. Laparoscopic Sleeve Gastrectomy

About two-thirds of the left side of the stomach is removed laparoscopically and makes the stomach look like a tube with a capacity of 60 cc to 150 cc. The part of the stomach that produces Ghrelin hormone, which stimulates appetite and promotes fat deposition in the body is removed.

Advantages of Laparascopic Sleeve Gastrectomy
  • Preservation of the stomach function
  • It does not require disconnecting or reconnecting the intestines
  • It is a technically simpler procedure than gastric bypass or duodenal switch (rarely done)
  • The stomach is reduced in volume but tends to function normally so most of the food can be consumed, albeit in small quantities
  • Eliminates the portion of the stomach that produces hunger hormone – Grehlin
  • No dumping syndrome because the pylorus is preserved
  • Minimises the chance of an ulcer occurring
  • By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage) anaemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated
3. Gastric Bypass

Size of the stomach is reduced and a part of small intestine is bypassed so that digestion process is altered and less food is consumed and absorbed.

Mini Gastric Bypass Procedure
The Mini-Gastric Bypass (MGB) is a type of obesity surgery which is simple, successful and an inexpensive technique in weight loss surgery. It is a hybrid procedure that has the advantages of a restrictive procedure (like Laparoscopic Sleeve Gastrectomy) and also the advantages of a mal-absorptive procedure (like Roux-en-y Gastric Bypass). It involves creating a long narrow tube of stomach along its right border and then joining it to a loop of small intestine about 180 cms from the starting point of the jejunum. The MGB is a viable and effective alternative to the Roux en-Y procedure due to the simple jejunal loop creation, thus reducing the morbidity and mal-absorption seen with a proper gastric bypass. MGB is fast becoming popular because of low risk of complications and good sustained weight loss. It has the effectiveness of sleeve and Roux-en-y gastric bypass without their complications or reflux problem.

In the MGB, restriction of stomach volume is achieved by surgically altering the stomach to make its size and capacity smaller as in sleeve gastrectomy. Mal-absorption is accomplished by looping and attaching the small intestine to the stomach tube bypassing about 150 to 180 cm of intestine as in Roux-en-Y gastric bypass.

Advantages of Gastric Bypass Surgery
  • Single stage permanent procedure
  • No resection or removal of parts stomach or intestine
  • No implants like a balloon or band
  • No reflux or acidity problem
  • Hunger is reduced 
  • Sustained long term weight loss
  • Easily reversible and revisable if necessary
  • No prolonged hospital stay
  • No major mal-absorption complications
Pre-operative Preparation for Bariatric Surgery
Before surgery the patient will undergo a complete health check. In addition, the medical and diet history will be taken into account to rule out:
  • Alcohol or drug abuse
  • Endocrine or hormonal cause for obesity
  • Serious psychological problems or mental illness
Seven days prior to surgery, the patient will be kept on a very low calorie, high protein liquid diet. This is done to reduce the swelling of the left lobe of the liver and also serves as a test for the patients’ commitment and readiness for the surgery and post-operative diet regimen.

Blood thinning medication is given to the patient to prevent blood clotting in the legs during surgery

Possible Immediate Risks
  • Anaesthesia complications
  • Bleeding from staple line
  • Injury to adjacent organs during surgery
  • Leak from staple line
  • Pulmonary embolism
  • Wound infection
  • Vomiting after surgery
Hospital Stay
  • Is usually 2-5 days
  • Patient should be able to take enough fluids and nutrients orally before discharge

Life After Bariatric Surgery
1. Diet
  • Immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or sugar-free gelatin desserts. This diet is continued until the gastrointestinal tract has partially recovered from the surgery. Diet is to be strictly followed and is tailor made for each patient
  • Food to be chewed thoroughly before swallowing
  • Avoid desert or sugary items, carbonated drinks, high fat food and high fibre food
  • Avoid alcohol and smoking
  • Limit snacking between meals
  • The diet plan is usually:
- Upto 2 weeks: liquid diet
- 4-6 weeks after surgery: 600-800 calories/day solid diet
- 1-2 months after surgery: 1000-1200 calories/day

2. Return to Work
  • This depends on the nature of work and associated co-morbid conditions
  • Most patients return to work after a week and full activity within six weeks of procedure
3. Birth Control and Pregnancy
  • It is preferable to avoid pregnancy for 12 -18 months following surgery
  • The reason being, pregnancy places additional demands on the body
Long Term Follow-up
  • Nutritional deficiencies may occur over the course of many years post-surgery
  • Anemia, Vitamin B12 deficiency, reduced folate and iron levels can occur
  • Follow up with the surgeon and blood tests are required every 3-6 months in the first year and then every 1-2 years for life
  • It is important to attend periodic support group meetings to remain committed to weight loss
Expected Results
  • Loss of 60-70 % excess weight by the end of 1-2 years
  • Improvement in associated diseases like diabetes
  • Greater capacity for physical activity
  • Improvement in quality of life and appearance
Patients who will benefit from Bariatric Surgery
  • Patient with BMI > 35 or > 32 .5 with co-morbid conditions
  • Multiple attempts of weight reduction by diet and exercises have failed
  • No treatable underlying endocrine disorder is found
  • No major psychiatric illness is found
  • Patient is committed to post-operative diet and lifestyle modifications
Health Benefits of Bariatric Surgery
  • In Type 2 diabetics, sugar levels are known to come down after bariatric surgery and in some cases the medications are no longer needed
  • Relief of sleep apnoea is seen and hence better of quality of sleep 
  • Hypertension improves and in some patients medication is no longer needed
  • Cholesterol level comes down drastically and patients can lower or stop lipid lowering medicines
  • Improvement in diabetes, hypertension and cholesterol levels has a direct effect on reducing the risk of heart diseases
  • Post-surgery patients are known to have fewer and less severe asthmatic attacks. There is increased efficiency of breathing and exercise tolerance
  • Those with Gastro Esophageal Reflux Disease (GERD) show relief of all symptoms of reflux within a few days
  • Stress incontinence responds dramatically to weight loss
  • Post-surgery, patients get tremendous relief from low back ache and joint diseases
  • Women with polycystic ovarian syndrome show a return to normal regular menstrual cycles after weight loss surgery. Further level of fertility also show improvement

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