Globally, obesity has become an issue of great concern as a high percentage of population are affected by it. In a large number of cases restrictive measures like diet and exercise failed to address the problem. Surgeries were developed as an effective measure to tackle the problem of obesity. Bariatric Surgery or surgery for weight loss is performed by using two different approaches; one technique restricted intake of calories while the other focused on malabsorption. However these procedures resulted in nutritional deficiencies, major complications and side effects.
A number of combinational procedures like Roux-en-Y Gastric Bypass (RGB) and Extensive Gastric Bypass (or DISTAL Gastric Bypass) emerged. These procedures do not rely on just malabsorption but they also include restrictive intake techniques. By integrating the two approaches, surgeons can now bypass a minor portion of the intestines.
Why it is performed?
Weight loss surgeries may be a viable option if the patient is very obese and diet changes or exercise does not yield results. Gastric bypass Surgery is not an easy solution for obesity. Life after the procedure involves daily exercise and control over diet. If the patient fails to follow these measures, there may be post surgery complications and an overall poor weight loss.
Roux-en-Y gastric Bypass is the most common form of weight loss procedure as it is very reliable, comes with minimal side effects and acceptable risk factors. Nonetheless all weight loss procedures are major surgeries that can pose severe risks if the patient does not make permanent lifestyle changes to regulate and maintain the weight.
The doctors take into consideration the BMI and other health conditions like diabetes and blood pressure to determine whether the patient is fit for the surgery. Normal BMI is 18.5 to 25. Patients with BMI over 40 can opt for it. Patients with BMI over 35 who have a serious health condition (heart disease, diabetes, etc.) that might improve with weight loss can also undergo this surgery.
In this surgery the surgeon staples off a section of the stomach thus leaving a small pouch which is then connected to the small intestine. The patient will not be able to eat as much as before and as a result of reduced intake of food their body will absorb fewer calories.
What are the risks involved?
- Bleeding and leakage of stomach contents into the abdomen
- Breaking of staple lines
- Gastritis (inflamed stomach lining)
- Gastro-esophageal reflux
- Stomach ulcers
- Poor nutrition and Vitamin deficiencies
How it is done?
The patient is under general anesthesia and the whole procedure takes about 2-4 hours. First the surgeon makes the size of the stomach smaller using staples to split it into two sections: a smaller upper part and a larger lower portion. The smaller part (that is addressed as the pouch) is where the food goes. It can accommodate only an ounce (approx 28 g) of food. The second part of the surgery is the bypass; the surgeon connects the small intestine with the pouch. Thus the food will travel from the pouch into the small intestine.
Gastric bypass can be performed in two ways.
- Open surgery in which a large surgical incision is made to operate on the belly.
- Using a tiny camera (laparoscope) which is placed in the belly.
3-6 small incisions are made on the belly through which the scope and other instruments needed are inserted. The camera is connected to a monitor that helps the surgeon view the insides while doing the surgery.
Laparoscopic procedure is advantageous over open surgery as it guarantees shorter hospital stay and faster recovery alongside less pain. Small incisions mean smaller scars and low risk of infection or hernia.
Before the surgery, the patient has to undergo a complete physical exam along with a number of other tests. The doctors also suggest nutritional counseling. If the patient smokes, they should stop several weeks before they undergo surgery and are expected to not smoke even afterwards.
After the procedure:
Most patients stay in the hospital for up to 4 days after the surgery. The patient will be able to walk a little on the same day of the procedure. Catheters may be used to drain excess fluids from the stomach and for urine. The patient will not be able to eat for the first few days after which they can have liquids. The patients are given pain medications and other medications to counter any infections or blood clots.
Generally people lose weight drastically in the first year post surgery. On an average a patient may lose about 55% of the extra weight. Losing weight can improve health problems like gastro-esophageal reflux, asthma, high blood pressure, cholesterol, diabetes, etc.
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