What Is A Gastric Bypass?
A gastric bypass is a surgery in which the stomach is reduced and the digestive tract is rearranged. Literally, the term bypassing the stomach. This intervention can be dealt with severe forms of obesity, especially the so-called morbid obesity. The surgery is complicated and far-reaching, but can often be done laparoscopically. The stomach is reduced, sometimes up to only 10% of its original size, and further connected to the small intestine.
This procedure goes beyond a gastric bypass, in which only the stomach is reduced and there may be placed a gastric band.
Gastric Bypass Indications
Obesity may be associated with all sorts of additional ailments. These can be as threatening to the life expectancy of a patient that it is justified to carry out a gastric bypass. Examples of diseases caused by obesity, or may be aggravated:
- Cardiovascular diseases such as stroke and heart attack
- Type 2 diabetes mellitus (diabetes)
- Extreme Hypertension
- Obstructive sleep apnea
- Reflux and Heartburn
- Gallbladder disease
- Hepatology
- Thrombosis or deep vein thrombosis
- Degeneration of the intervertebral discs of the spine
- Degenerative joint disease (osteoarthritis), especially knees and hips
Contraindications
Patients to be added to one or more of the following criteria are in principle not eligible for the procedure.
- Pregnancy.
- A person with Crohn's disease may also have problems.
- Psychiatric illness (relative).
- Heavy heart, lung or vascular disease (risk of anesthesia).
- Body Mass Index under 35 anyway not eligible.
What Is Gastric Bypass Surgery ?
There are multiple ways to perform this surgical procedure can be performed. But, in essence, each procedure consisting of the following:
- From the upper part of the stomach is called a mini-made stomach with a volume of about 15-30ml (1-2 spoons), this effectively limits the amount of food that can be ingested. The stomach can be reduced by physically separating, or by partitioning using surgical staples. Usually, is selected for the physical separation in order to prevent the stomach itself, and restores the operation as such undo.
- After the stomach, the small intestine, the stomach, and is separated in any other way attached to the small intestine. The "new" stomach is then connected directly to the small intestine. However, the amount of small intestine that is used depends on the method chosen, and ultimately affects the amount of nutrients that are absorbed by the body (can be).
Gastric bypass, Roux en-Y (proximal)
This is the most common form of gastric bypass, this method has by far the least complications and the least loss of the necessary absorption of nutrients. Approximately 45 cm below the stomach is detached, the small intestine, and is fastened on top of the place where he has just been disconnected. Then the new stomach by means of a Roux-part fastened in a Y-connection on the small intestine. In the procedure, the upper proximal part of the small intestine is used (80-150 cm) in order to secure the bypass. This prevents a shortage of uptake of essential nutrients. The patient now has faster feeling satisfied with a meal and will develop a degree of indifference towards food.
Gastric bypass, Roux en-Y (distal)
The small intestine is 6 to 10 meters in length, so if the Y-connection is fixed on a lower time to the small intestine (distal), the amount of remaining intestine to absorb nutrients proportionally decreased. To be able to book the shorter term larger results is sometimes made the connection in the lower part of the small intestine (100-150 cm before the beginning than the large intestine). The disadvantage is that unresolved fats in the foods that are not included in the colon by bacteria to produce a noisy and smelling gas. This method is less frequently used, as are outweighed the disadvantages against only a slight increase in the weight loss.
Looped gastric bypass ("mini-gastric bypass")
When the first applied gastric bypass in 1967, use was made of a loop of small intestine rather than the Y-connection. Although simpler to make, this has the disadvantage that enzymes of the pancreas and bile from the small intestine in this way coming into the esophagus. This might or might not cause severe inflammation and / or ulcers in the stomach and esophagus. This method is not active anymore applied since 1970, there was the risk of too high in relation to the result.
A gastric bypass the digestive system and this also changes the way people react to food. It can occur that a patient experiences a phenomenon called dumping, which is caused by the ingestion of sugars, other carbohydrates, however, also be able to achieve this effect. The digest of sugars in the body normally goes together with an increase in the percentage of moisture in the circulation, however, in a patient's gastro-intestinal, this can cause a shock-like state. The situation in which the patient is similar to a hyper-insulin reaction. In addition to carbohydrates, high salt intake is also sometimes the cause of dumping syndrome.
Some symptoms of dumping are:
- overall weakness
- palpitations
- paleness
- dizziness
- perspire
- nausea
- pass out
- stomach cramps
- tinnitus
- diarrhea
- very small portions to eat
- not to drink at dinner
- avoid sugary products
- use "slow carbs"
- often eat in a day
Gastric Bypass And Pregnancy
Someone who has undergone a gastric bypass can still be fine pregnant. The gynecologist, however, should be in the beginning of pregnancy to be explicitly informed. It may be that dietary changes necessary; above a dietician can be enabled.
Gastric Bypass Complications And Mortality
Like any other (surgical) intervention also has a gastric bypass complications which can occur during or after surgery. The mortality rate is about 1 in 350 operations, which does not deviate from the mean with respect to other operations on patients with obesity. A number of known complications are explained below.
Wound Infection
Contamination or infection of the surgical wound. This operation is a chance of 2% and 3% on a light on a serious wound infection.
Leakage
It is possible that an internally of the compounds can leak, statistically there is a probability of less than 2%. Leaks are generally the most common around the stomach; mostly by consuming too much.
Scar Rupture
A wound or scar is a weak spot in the skin; As a result, there is a risk, especially considering the (morbidly) obese persons are concerned that the skin at the place of the scar may crack. This risk is approximately 5%.
Gallstones
The likelihood of developing of gallstones is significantly higher, 5-50%. This complication is due to the fast way to lose weight. Some surgeons remove the gallbladder preventively on each gastric bypass surgery.
Advisories
If a patient has undergone a gastric bypass there are some general tips and advice that will be given in addition to the patient's specific recommendations.
Limit volume
After surgery the stomach is significantly reduced, content usually no larger than 1 or 2 tablespoons. after six months to a year, this may be the contents of about a coffee cup amounts referred stabilized growth. This means that someone with a gastric bypass relatively little food can obtain. The most important is the "full full" feeling not ignore anymore, and prefer to stop all this. They eat too much one may be sick here with this forthcoming inconveniences that entails.
Slowly consuming
If the meal is consumed slowly, one will have more satisfaction of the meal, and can be felt earlier when the stomach is full. This prevents the stomach is stretched and one again can consume more than desired.
Food Choices
There can be consumed less, it is important to adopt a balanced diet, since the patient still get all the vitamins and minerals is to get inside. The consultation with a dietician is therefore recommended.
Meal Frequency
Regularity is a key factor, so breakfast, lunch and dinner meals in metered size and solid food only. In addition, healthy snacks like a bowl of yogurt, some fruit, cracker also permitted during the morning and afternoon. Adequate fluid intake is also very important, but in small quantities. Drink it promotes washing down food into the small intestine. When food is not sufficiently washed away problems may arise in the small intestine. The use of as much as possible healthy products, coffee, tea, milk, mineral water, etc. is recommended. Carbonated and artificially sweetened products should be avoided as much as possible.
Vitamin B12
The inclusion of the important vitamin B12 may be disturbed. The inclusion of this vitamin is effected by means of Intrinsic factor, which is made in the stomach wall. Vitamin B12 is then incorporated into the final stretch of the small intestine.