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Gastric Bypass

Gastric bypass is a surgery that helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, your stomach will be smaller. You will feel full with less food. The food you eat will no longer go into some parts of your stomach and small intestine that break down food. Because of this, your body will not absorb all of the calories from the food you eat.

There are two steps during gastric bypass surgery:

  • The first step makes your stomach smaller. Your surgeon will use staples to divide your stomach into a small upper section and a larger bottom section. The top section of your stomach (called the pouch) is where the food you eat will go. The pouch is about the size of a walnut. It holds only about 1 ounce of food
  • The second step is the bypass. Your surgeon will connect a small part of your small intestine (the jejunum) to a small hole in your pouch. The food you eat will now travel from the pouch into this new opening into your small intestine. Because of this, your body will absorb fewer calories

Gastric bypass can be done in two ways. With open surgery, your surgeon will make a large surgical cut to open up your belly. Your surgeon will do the bypass by working on your stomach, small intestine, and other organs. Another way to do this surgery is to use a tiny camera, called a laparoscope. This camera is placed in your belly. The surgery is called laparoscopy.

Most people lose about 10 to 20 pounds a month in the first year after surgery. Weight loss will decrease over time. By sticking to your diet and exercise early on you will lose more weight. You may lose half or more of your extra weight in the first 2 years. You will lose weight quickly after surgery if you are still on a liquid or pureed diet.

Roux-en-Y Gastric Bypass (RNYGB) has a physical and hormonal effect. Physically it restricts food intake; portions sizes after the RNYGB are much reduced with an early feeling of fullness. Over-eating causes abdominal discomfort and vomiting. While the majority of the reduction in a patient’s calorie intake is attributable to the restriction, initially there is also an element of mal-absorption of fat similar to the duodenal switch. Long-term mal-absorption is probably not important as the patient’s body adapts to the bypass. Nevertheless patients do need regular dietetic review and should be tested for anaemia annually after surgery.

RNYGB also reduces a patient’s appetite. The mechanism by which this occurs is not fully understood, but is related to a change in the normal gut hormonal patterns. Bypassing the first part of a patient’s small intestine affects the production of hormones which control appetite. After RNYGB most patients feel far less hungry, often forgetting to eat. Bypass surgery also affects the hormones that control blood sugar and consequently many diabetic patients become non-diabetic immediately after surgery.

Furthermore, banding the pouch in the gastric bypass has also been documented to enhance weight loss and weight loss maintenance. Adding a GaBP Ring to Roux-en-Y Gastric Bypass leads to significant improvement in excess weight loss.

The Mini Gastric Bypass (MGB) is a surgical procedure that can be performed by a minimally invasive surgical method. The procedure reduces food intake and reduces the absorption of nutrients from the food. Absorption of nutrients is limited because part of the intestines is bypassed and not used. A stomach sleeve is created and separated from the rest of the stomach which is retained in the body (like the RNYGB). The volume of the stomach sleeve after MGB is between 70-90 ml. The small intestine is anastomosed in continuity without disconnecting it (like in RNYGB) to the newly created stomach sleeve.

MGB is very successful (50-70% of excess weight loss) as a primary weight loss procedure especially in type II DM. it can be used on patients who failed restrictive procedures like balloon, banding and sleeve gastrectomies. It is suitable for those who are sweet eaters and patients with heartburn. The procedure has lower complication rate in comparison to RNYGB and is completely reversible surgery if done as a first procedure and also convertible to RNYGB or LSG at a later stage if required. After MGB, lifelong vitamin and mineral supplementation may not be required like in RNYGB.

Revisional Gastric Bypass

Revisional Bariatric Surgery is performed to alter or repair one of the many types of weight loss surgery for the treatment of morbid obesity. The two currently popular procedures, Roux-en-Y gastric bypass and Laparoscopic Adjustable Gastric Banding Surgery, while successful, also require occasional revision. In fact the revision rate for the Gastric Banding Surgery is more than 10% during the first two years for either device-related problems or unsatisfactory weight loss. Likewise, the revision rate for gastric bypass is roughly 5-10% after 5 years for either troublesome complications, (e.g., ulcer, etc.) or for unsatisfactory weight loss. If you have had poor weight loss/weight regain or complications of the original procedure, e.g., ulcers for RNYGB or slippage of the band, you may qualify for revisional bariatric surgery.

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