Gastric Bypass

Gastric Bypass – What Is It?

Gastric bypass is considered the gold standard in bariatric surgery as a result of exceptional outcomes both in terms of disease resolution and weight loss combined with the safety of the procedure.. Ever-improving surgical techniques and medical devices have significantly reduced the risk of surgery over the past several decades.. Gastric bypass was first performed in 1967 and has remained as one of the most popular weight loss surgical procedures today. It is classified as a combination of restrictive and a malabsorptive procedure. It offers a combination of restriction of dietary intake with some decrease in absorption. This laparoscopic procedure combines weight loss, disease resolution with safety and limited complications.

How the Gastric Bypass Works:

Five small 1/2 to 1 inch incisions are made in the abdomen through which a small camera and medical instruments are placed into the abdominal cavity.. The surgeon will then divide at approximately 90% of the existing stomach creating a small gastric pouch. The gastric pouch is often the size of a thumb or a small golf ball. The portion of the stomach that is divided is not removed but remains in the abdomen and provides gastric and biliary juices to a limb of intestine termed the biliopancreatic limb. The small intestine is measured 150 cm in length and divided. The distal end is pulled up to connect to the small gastric pouch and is termed the alimentary limb. The biliopancreatic limb is then sewn back into the intestine further down the intestine

The small gastric pouch and the connection to the alimentary limb create the restrictive component of the procedure. There are a number of hormones that are produced in the biliopancreatic limb that aid in digestion, insulin production, and metabolism. As food no longer passes this region, the hormone production changes resulting in correction or improvement of many co-morbid conditions almost immediately post procedure. The malabsorptive component is the resulting length of the alimentary limb which transports food to the exposure of gastric acids and bile when it connects to the biliopancreatic limb. Absorption of the nutrients from one’s diet occurs in the shortened common limb. The entire procedure takes approximately 1 to 1 ½ hours. 

Advantages of the Gastric Bypass Include:

• Excellent disease resolution outcomes, including the improvement or resolution of type 2 diabetes at a rate of over 90 %
  • Studies have shown that diabetes mellitus begins to correct as early as six days post-operatively
  • Many patients go home off of their injectable insulin for diabetic control
• High cholesterol, high blood pressure and sleep apnea are improved.
• As with all Laparoscopic (minimally invasive) procedures, a shorter hospital stay and recovery time are expected.
• No medical device is implanted in the abdomen
• Best procedure for treatment of gastroesophageal reflux disease as it eliminates all acid from the lower esophagus

Disadvantages of the Gastric Bypass:

• Vitamin deficiencies can occur due to the bypass of the duodenum and the shortened common limb
  • This often involves fat soluble vitamins and some minerals
• A multivitamin, B12, and Calcium supplement are suggested for life
• Complications unique to this procedure include staple line leaks (<1%) and internal hernias (lifetime risk of 1 -2 %) due to adhesions
• The procedure is not adjustable and often can not be revised without risk of major complications
• Not indicated for patients that smoke as the gastrointestinal anastomosis (stoma) will ulcerate, may bleed, or create stenosis with restriction of dietary intake