Laparoscopic gastric bypass is one of the standard procedures in bariatric surgery. It is a minimally invasive gastric operation for the treatment of morbid obesity.
Below you will find further information on laparoscopic gastric bypass and specialists for this operation.
If conservative measures for obesity do not help or are not sufficient, surgical procedures are used. The two most common obesity surgery procedures in Germany are gastric bypass and sleeve gastrectomy.
In gastric bypass, the stomach is reduced in size and the small intestine is shortened. This means that the patient can absorb less food and it is not fully utilized. This also has a positive effect on the hormone balance.
A gastric bypass can therefore contribute very effectively to weight reduction. It also alleviates or completely prevents concomitant diseases such as diabetes mellitus.
Almost 99 percent of gastric bypass operations are performed laparoscopically(minimally invasive). This requires only small incisions through which the surgeon inserts tiny instruments. The wounds heal faster than with a large, open operation and leave only very small scars.
Doctors speak of morbidobesity when the body mass index is over 35, which is roughly double the normal weight. In such cases, conservative treatment approaches very often no longer bring the desired success. These include a change in diet and lifestyle. Doctors then often recommend surgical treatment.
A gastric bypass is frequently used, especially for diabetics. Diabetes can be positively influenced by the results of the gastric bypass.
The procedure is much more extensive than gastric banding and gastric sleeve surgery. A satisfactory general physical condition is therefore a prerequisite. Accordingly, doctors rarely recommend gastric bypass for patients who are extremely overweight, i.e. from a BMI of around 50.
Bypass means something like "bypass". During a gastric bypass, the surgeon closes
from the digestion of food.
To do this, the surgeon cuts through the stomach just below the entrance to the stomach. The lower, larger part of the stomach is shut down. No more food can enter it. He then cuts through the small intestine below the duodenum in the area of the jejunum.
The severed lower part of the small intestine is connected to the upper part of the stomach, into which the oesophagus opens. The food therefore passes from the esophagus into a very small stomach and from there directly into the small intestine. It thus bypasses most of the stomach.
The duodenum and a section of the small intestine are attached to the remaining stomach. This part of the stomach and the duodenum continue to produce digestive secretions that are needed for digestion. The surgeon therefore joins this loose end of the intestine with the small intestine, which comes off the upper part of the stomach. The connection point is about one meter of small intestine away from the upper part of the stomach.
This creates a Y-shaped branching of the small intestine. The procedure was developed by the Swiss doctor César Roux and is medically known as the Roux-en-Y bypass.
The consequence of this procedure is, on the one hand, a greatly reduced capacity of the small residual stomach. In addition, digestion can only begin where the digestive secretions are directed into the intestine. Accordingly, the body absorbs fewer nutrients due to the shortened passage of food through the intestine.
Left: The digestive system before the procedure. Right: The Roux-en-Y gastric bypass performed © bilderzwerg | AdobeStock
As a rule, a bariatric surgery center performs the gastric bypass. The laparoscopic procedure is performed under general anesthesia and takes around 60 to 90 minutes.
The operation proceeds as follows:
Surgeons distinguish between two types of gastric bypasses:
Thedistinguishing criterion is the length of the remaining small intestine available for digestion. This refers to the section of the small intestine between the opening from the lower residual stomach to the transition into the large intestine.
The standard procedure is the proximal gastric bypass with a section of small intestine around 2.5 meters long. The more extreme distal gastric bypass with only about one meter of small intestine is used less frequently.
A special case is the omega-loop gastric bypass, also known as a mini-bypass. In this case, the slightly longer remaining stomach is connected to the lower section of the small intestine without cutting through the small intestine. Instead of two artificially created connections (anastomoses), the surgeon creates just one.
You will stay in hospital for five to seven days after the operation. During the first three days, you may only have small sips of tea and water. After that, you will be given three liquid meals a day.
You will still have to eat pureed food for some time after discharge. As part of the necessary change in diet, you will now eat small meals more often. The stomach can no longer absorb large quantities.
Some patients no longer tolerate certain foods well after the operation, such as sweets or milk. Try out what tastes good and is good for you!
Three weeks after the operation, you will usually be able to work again.
The first follow-up appointments in the outpatient nutrition clinic usually take place after one, three and six months. This is followed by an annual appointment. These follow-up appointments serve
Gastric bypass is a significant intervention in the digestive system. Due to the shortened passage through the small intestine, not all food components can be utilized. This inevitably leads to a deficiency supply of
You have to take these vitamins and trace elements in the form of food supplements for the rest of your life. Nevertheless, gastric bypass patients suffer relatively frequently from iron deficiency anemia (anemia).
A relatively large number of gastric bypass patients are prone to so-called dumping syndrome. If they eat too large a meal, the remaining stomach empties into the small intestine. This, and the subsequent stimulated absorption of water from the blood, stretches the small intestine considerably. Soon after the meal, the stretching stimulus triggers
diarrhea. The drop in blood pressure caused by the loss of fluids can also lead to
and fatigue.
Critical for this dumping syndrome are in particular
The usual risks of major surgical procedures include
The mortality rate from the procedure is low. It is less than 0.05 percent, i.e. one death per 2000 operations.
In the medium term, the staple suture between the two separated parts of the stomach can become permeable. This allows food to enter the entire stomach again.
Furthermore, the sutures between the sutured sections of the intestine can become leaky. There may also be a narrowing of the connection between the remaining stomach and the small intestine. Such complications can be corrected by a second operation.
The long-term consequences of a gastric bypass also include an increased tendency to form kidney stones.
The proximal gastric bypass leads very reliably to
On average, patients lose around 60 to 90 percent of their excess weight within the first two years after the procedure. Even after five years, weight remains reduced by an average of around 60 percent of the original excess weight.
Figures on diabetes remission show similarly positive long-term results: Even after five or more years, the remission of diabetes mellitus remains stable in around 75 percent of cases.
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