Gastric bypass - Medical specialists

The gastric bypass is a surgical procedure in bariatric surgery. According to WHO criteria, obesity is diagnosed when the BMI is 30 or more. It is used for weight reduction in cases of extreme overweight - so-called obesity permagna or morbid obesity (BMI over 40). Further information can be found below.

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Gastric bypass - Further information

According to studies, a large number of the accompanying diseases of obesity can be improved or prevented by a gastric bypass. In particular, diabetes mellitus can be improved or even reduced by a gastric bypass in over 80 percent of cases.

When is a gastric bypass surgery performed?

If there is a risk of accompanying diseases or if there are already serious impairments of the general condition in people with extreme obesity, bypass surgery may be an option. The choice of procedure is always an individual decision and depends on the following factors:

  • Existence or threat of a serious accompanying illness or with a BMI of 35 or more
  • Completion of conservative therapy: If all conservative measures have been exhausted, a gastric bypass represents a treatment option of bariatric surgery.
  • Motivation and cooperation by the person concerned: The success of a gastric bypass depends entirely on the motivation and cooperation of the person concerned, which is why a reasonable doubt is a exclusion criterion here.
  • Suitable age: Gastric bypass surgery is usually performed between the ages of 18 and 65.

In addition, a gastric bypass is generally not recommended in cases of poor general health, malignant disease (malignant tumour), addiction, unstable mental illness, untreated eating disorders and severe liver disease.

The surgical procedure for a gastric bypass

A gastric bypass is created as a so-called Roux-Y gastric bypass. The surgery is performed in two steps. First, the stomach is reduced in size by separating the preceding stomach from the remaining stomach. The affected person can only eat small amounts of food, as saturation is signalled earlier.

In a second step, a short-circuit connection is made between the artificially reduced stomach and the small intestine using a small intestine loop (bypass). In this way, the food paste is led past the remaining stomach and duodenum directly into the small intestine.

A second connection to the small intestine is then established, through which the food liquids are mixed with the food paste. By shortening the intestinal segments, less nutrients can be absorbed by the intestinal mucosa.

Another procedure is the mini gastric bypass, in which only one connection between the remaining gastric pouch and the small intestine is created. It is a variation of the Roux-en-Y method and is also called Omega Loop Bypass.

After the surgery

After the surgery, intensive monitoring is necessary, which is why the patient is first checked in the intensive care unit. On the first day after the surgery, the patient is mobilised to prevent pneumonia and the formation of dangerous blood clots. In support of this, a blood-thinning medication (heparin) is injected daily. On the second day after the surgery, an X-ray examination with gastrographine swallow (swallow of contrast medium) is performed to detect possible weak points or constrictions. If there are no complications or medical concerns, the patient can be discharged from hospital after one week. If the procedure goes well, the patient can leave the hospital after 4 to 5 days. An incapacity certificate is issued for a total of 4 weeks.

Risks and complications of gastric bypass surgery

A gastric bypass is a major procedure that is associated with an increased risk of complications, particularly due to obesity and accompanying diseases. In order to assess the individual risk, a detailed screening is therefore carried out prior to the surgery. However, as with any surgery in the abdominal cavity, complications such as adhesions in the abdominal cavity, infections, formation of blood clots or bleeding and post-operative bleeding may occur. Risks specifically associated with gastric bypass surgery are:

  • The sutures don't hold.
  • constrictions
  • injuries to adjacent structures such as the esophagus, liver, spleen, or stomach
  • allergic reactions
  • perforation oft he stomach
  • inadequate connection between the operated organ parts

The surgical elimination of residual stomach, duodenum and the upper parts of the small intestine also results in the risk of early dumping syndrome. In early dumping syndrome, the food paste moves too quickly from the stomach into the small intestine. The undigested and osmotically effective paste is emptied into the small intestine, where it leads to a loss of fluid, as fluid flows from the surrounding intestinal tissue. This leads to a so-called lack of volume, which manifests itself in nausea and vomiting, sweating, drop in blood pressure, tachycardia and a feeling of fullness. In addition, gastric bypass surgery can cause the following long-term complications:

  • alcohol intolerance
  • gallstones and kidney stones
  • Inflamation oft he peritoneum (peritonitis)
  • deficiency syndromes such as iron and vitamin B12 deficiency

Diet after gastric bypass surgery

In the first 48 hours after the gastric bypass surgery, the affected person may only drink some non-carbonated water or other clear fluids to allow the sutures to heal. Afterwards, a slow and gentle food build-up in four phases takes place over several weeks:

  • First phase (in the first two weeks) with low-fat milk and dairy products, yoghurt or fine vegetable soups.
  • Second phase (after that for two to three weeks) with mashed foods with low fat and sugar concentration.
  • Third phase (if phase 2 is well tolerated) with protein-rich food with low sugar and fat concentration.
  • Fourth phase ( if phase 3 is well tolerated) with mainly protein-rich food, avoiding foods rich in sugar and fat, with gradual transition from soft to solid food.

This takes place within the context of outpatient or inpatient rehabilitation, during which the affected persons also learn to change their diet so that no deficiency symptoms occur. The gastric bypass specifically reduces the intake of fats and carbohydrates. Since the desired reduction in intake is not selective, deficiency symptoms may occur. In order to avoid these, those affected must take in sufficient proteins.

In addition, the so-called intrinsic factor, which is required for the absorption of vitamin B12 and is formed by the gastric mucosa, must be supplied for the rest of one's life. Iron, vitamin B12 and folic acid should also be checked regularly after the surgery and if necessary be supplemented.

Cosmetic effects after gastric bypass surgery

As a result of the considerable weight loss within a short period of time, the skin cannot recede quickly enough and it hangs on various parts of the body. Among other things, it leads to a so-called abdominal apron and sagging breasts. In many cases these are corrected during plastic surgery. Until then, good skin care is very important, especially for larger skin folds.

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