Introduction
Gastric bypass is a combined procedure for weight loss which is regarded as the gold standard of bariatric surgery. This procedure has shown long term, excess weight loss of more than 70% for up to 15 years following the procedure with excellent resolution of associated medical illnesses.
Candidates for Surgery
Gastric bypass is indicated for patients with morbid obesity i.e. BMI > 35 kg/m2 with significant associated illnesses or those with BMI > 40 kg/m2 with or without illnesses. It can be performed for anyone between the age of 18 -65 years that fulfill these BMI criteria. The persons should have a clear understanding of the details of the procedure, its risks and benefits and be able to comply with the dietary and lifestyle modifications required following the surgery. It is contraindicated in people with serious addictions, uncontrolled depression or other mental illnesses and those who are not fit for general anesthesia.
Surgical procedure
The procedure involves converting the upper part of the stomach into a small pouch of around 25 -30 cc which decreases the amount of food which can be taken at one time. This pouch is then connected directly to the mid part of the small intestine. This new anatomy bypasses the remaining stomach and the proximal small intestine which delays the mixing of food with the digestive enzymes and hence results in malabsorption.
The procedure is performed under general anesthesia with the patient fully unconscious. The laparoscopic approach is used which means that there is no large incision but only small 4-5 cuts are made for placement of the ports and instruments. This reduces pain and chances for infections or hernia in the post-operative period. Laparoscopic staplers and ultrasonic energy devices are used for cutting the tissues which make the procedure fast and bloodless and reduce the chances of complications. The procedure takes around 90-120 minutes to perform and patient is required to stay in the hospital for 3-4 days.
Mechanism of action
The combined effect of restriction and malabsorption results in rapid and sustained weight loss. The direct contact of food with the small intestine results in release of hormones which stimulate the pancreas to secrete more insulin. This increases uptake of glucose into the tissues, increases the metabolic rate and helps to burn the stored fat inside the body. This not only decreases body weight but also helps in remission of metabolic diseases like diabetes and hyperlipidemia.
Post-operative diet
The patient is generally allowed to have sips of liquids the day following the procedure. The diet is generally increased as per the patient's tolerance but usually limited to liquids for 2 weeks. Only 40-50 cc is allowed at one time to avoid vomiting and bloating. After this, a soft diet is started and a normal diet is resumed one month after the procedure. The meals are small size and should be taken at least 5-6 times /day to avoid hypoglycemia. There are no restrictions as such but patients are told to avoid coffee, alcohol, aerated drinks and high calorie liquids as well as highly tough and fibrous foods.
Weight loss expectations
Gastric bypass has shown to cause 70-90% of excess weight loss within 1-2 years of surgery which is maintained over a long term period. Besides this, there is reduction in a majority of medical illnesses like diabetes, hypertension and sleep apnea.
Lifestyle and exercise
The patients can carry out their routine activities at home after being discharged and can usually resume work after one week. Light exercise such as walking is encouraged and gym can be started 2 months after the operation. Moderate weight training is preferred to increase muscle mass to replace the body fat which is lost. This prevents looseness and sagging of skin.
This article written by Dr Anirudh Vij, He is founder of Dioms (Delhi Institute of Obesity and Metabolic Surgery). He has been trained in advanced laparoscopic GI surgery at GEM Hospital by esteemed Dr C Palanivelu. For more information about Gastric Bypass, visit Us: Weight loss surgery in Delhi or Call Us: +91-9650075862.
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