Gastric bypass: specialists and information on bariatric surgery

According to studies, a large number of comorbidities associated with obesity can be improved or prevented by gastric bypass. Diabetes mellitus in particular can be improved or even reversed in over 80 percent of cases with a gastric bypass.

When is gastric bypass surgery performed?

Extreme obesity - so-called obesity permagna or morbid obesity (BMI over 40) - can cause damage to health. Concomitant diseases or serious impairments of the general condition often occur. In this case, bypass surgery may be an option.

The choice of procedure is always a case-by-case decision and depends on the following factors:

• Presence or threat of a serious concomitant disease or condition with a BMI of 35 or more
• Completed conservative therapy: A gastric bypass is a treatment option for bariatric surgery after all conservative measures have been exhausted.
• Motivation and cooperation of the person concerned: The success of a gastric bypass depends directly on the motivation and cooperation of the person concerned. Reasonable doubt about this is therefore a direct exclusion criterion.
• Appropriate age: Gastric bypass surgery is usually performed between the ages of 18 and 65.

Beyond this age

• Poor general health,
• the presence of a malignant disease (malignant tumor),
• an addiction,
• an unstable mental illness,
• an untreated eating disorder and
• severe liver disease

gastric bypass is generally not recommended.

Illustration of a gastric bypass according to Roux-en-Y © bilderzwerg | AdobeStock

The surgical procedure for a gastric bypass

A gastric bypass is performed as a so-called Roux-Y gastric bypass. The operation is performed in two stages.

First, the stomach is reduced in size by separating the forestomach from the rest of the stomach. The person affected can only consume small amounts of food, as satiety is signaled earlier.

The actual bypass is then performed in a second step. A small intestine loop is used to create a short-circuit connection between the artificially reduced stomach and the small intestine.

This allows the chyme to bypass the residual stomach and duodenum directly into the small intestine. A second connection to the small intestine is then established, through which the food juices are mixed with the food pulp.

By shortening the intestinal segments, fewer nutrients can be absorbed by the intestinal mucosa.

Another procedure is the mini gastric bypass, in which only a connection is created between the remaining gastric pouch and the small intestine. It is a variant of the Roux-en-Y method and is also known as the omega loop bypass:

After the procedure

Intensive monitoring is required after the procedure, which is why the patient is initially checked in the intensive care unit.

The patient is mobilized on the first day after the procedure to prevent pneumonia and the formation of dangerous blood clots. A blood-thinning medication (heparin) is injected daily to support this.

On the second day after the operation, the results of the operation are checked for the first time. The aim is to find possible weak points or constrictions. For this purpose, an X-ray examination with gastrography (swallowing of contrast medium) is carried out.

If there are no complications or medical concerns, the operated patient can be discharged from hospital after one week. If everything goes well, the patient can leave the hospital after 4 to 5 days.

A certificate of incapacity for work is issued for a total of 4 weeks.

Risks and complications of gastric bypass surgery

Gastric bypass is a comprehensive procedure. It is associated with an increased risk of complications, particularly due to obesity and concomitant illnesses. A detailed screening is carried out prior to the operation to assess the individual risk.

Nevertheless, as with any abdominal procedure, complications such as adhesions in the abdominal cavity, infections, the formation of blood clots or bleeding and secondary bleeding can occur. Risks specifically associated with gastric bypass surgery are

• Dissolution of the suture,
• constrictions,
• Injuries to neighboring structures such as the esophagus, liver, spleen or stomach,
• allergic reactions,
• gastric perforation and
• inadequate connection between the operated organ parts.

Several organs are completely or partially eliminated by the bypass:

• the residual stomach
• the duodenum and
• the upper parts of the small intestine.

This also results in the risk of so-called early dumping syndrome. In early dumping syndrome, food passes too quickly from the stomach into the small intestine. The undigested and osmotically active porridge is emptied into the small intestine. There it leads to a loss of fluid, as fluid flows out of the surrounding intestinal tissue.

This results in a so-called volume deficiency, which is characterized by

• Nausea and vomiting,
• sweating,
• drop in blood pressure,
• palpitations and
• feeling of fullness

manifests itself. The following complications can also occur in the long term as a result of gastric bypass surgery:

• Alcohol intolerance
• Gallstones and kidney stones
• Inflammation of the peritoneum (peritonitis)
• Deficiency syndromes such as iron and vitamin B12 deficiency

Slow diet build-up after gastric bypass surgery

In the first 48 hours after gastric bypass surgery, the focus is on healing the stitches. For this reason, the person affected may only drink some non-carbonated water or other clear liquids for this time.

This is followed by a slow and gentle diet build-up over several weeks in four phases:

• First phase (in the first two weeks) with low-fat milk and dairy products, yogurt or fine vegetable soups.
• Second phase (subsequent two to three weeks) with pureed foods with a low fat and sugar content.
• Third phase (if phase 2 is well tolerated) with protein-rich food with low amounts of sugar and fat.
• Fourth phase (if phase 3 is well tolerated) with mainly protein-rich food with a gradual transition from soft to solid food. Foods high in sugar and fat should be avoided.

Dairy products are used to build up the diet in phase 1 © beats_ | AdobeStock

This is done under supervision as part of outpatient or inpatient rehabilitation. Here, those affected learn to change their diet in such a way that no deficiency symptoms occur.

The gastric bypass specifically reduces the intake of fats and carbohydrates. As the targeted reduced intake is not selective, deficiency symptoms can occur. To avoid this, patients must consume sufficient protein.

The so-called intrinsic factor is required for the absorption of vitamin B12 and is produced by the gastric mucosa. This is no longer possible with a gastric bypass. It must therefore be supplied for life.

Also

• Iron,
• vitamin B12 and
• folic acid

should also be checked regularly after the operation and supplemented if necessary.

Cosmetic consequences after gastric bypass surgery

As a result of the pronounced weight loss within a short period of time, the skin cannot regress quickly enough. It therefore hangs down in various parts of the body. Among other things, this results in an abdominal apron and sagging breasts.

In many cases, these are corrected as part of plastic surgery. Until then, good skin care is very important, especially for larger skin folds.

Which doctors perform gastric bypass surgery?

Specialists in bariatric surgery are usually specialists in visceral surgery who focus on the surgical treatment of patients with obesity. Specialists in gastric surgery may also specialize in gastric bypasses.