Gastric bypass is the most common surgical procedure used in our clinic. It is, in fact, an adaptation of the stomach surgeries, which have been in use almost for 100 years, to the obesity. We prefer the Roux-en-Y gastric bypass technique. You can watch a video of the surgery in our video gallery.
The technique decreases the size and space of the stomach into approximately 30-50 mililiters, which is less than a small glass of tea. This emphasizes restrictive feature of the procedure. The rest of the stomach remains passively unfunctional. In other words, the stomach is bypassed. Then, a new route is established between small intestines and the stomach. Bile and pancreatic juice are moved further depending on the weight of the patient to aid with malabsorption of nutrients. This new routes are called anastomosis, which may lead to leaks. We can immediately detect such leaks intraoperatively by endoscopic pneumatic testing (similar to the one carried out for tyres under water). Up to date, no leaks have been detected in our operation rooms. There is a risk of 3% for such a leak in this surgical technique. In such cases, patient stops eating and waits. Rarely, patient may undergo laparoscopy again.
Gastric bypass technique allows 70 to 80% loss in excess weight. For example:
If a patient who should have an ideal weight of 70 kg weighs 170 kg; then the excess weight=100 kilograms
The patient can lose up to 70-80 kilograms by bypass, resulting in an end weight of 90-100 kilograms. There are many patients who can do better than that. Those who achieved to give more weight are those who succeeded to make a change in his/her lifestyle. The weight loss usually occurs within one year.
A large portion of the stomach and almost 2 meters of the intestines are left unfunctional during the bypass surgery. Bypass serves to prevent absorption of the nutrients. Therefore, it may also prevent absorption of certain elements that are necessary for the body, which mainly include Vitamin B12, iron and calcium. Vitamin B12 requires intrinsic factor, a factor secreted from the stomach for absorption. This vitamin has to be replaced monthly by injections after the operation. And, patient should take daily vitamin supplement for the vitamins lost. Vitamin D levels should be monitored during follow-up, and patients should receive calcium. Such deficiencies do not lead to any problem in regularly monitored patients, and they are well-tolerated. However, patients who are followed by bariatric dietitians may experience protein deficiencies. Patients’ diet should be monitored very closely, particularly during early postoperative period.
None of the obesity surgery procedures can be 100% successful. Patients may begin to lose insufficent weight or stop losing weight due to some technical mistakes. Insufficient weight loss may be associated with a large amount of stomach space left unfunctional, very large passage from stomach to intestine, and a short bypass of intestine. Noncompliance is the most important cause of insufficient weight loss or regaining weight. Patients may regain weight due to some factors such as noncompliance with dietary programs, intake of excessive calorie and sedantary life.
It is considered as if there is no option left since bypass surgery is regarded as one of the most radical surgeries. New techniques help to further reduce the stomach, and narrow the intestinal passage. There are some other surgical interventions as well.