Gastric Bypass Surgery (Roux en Y Gastric bypass)
Introduction
One of the most common bariatric surgeries in Delhi is gastric bypass, which is
a combined procedure which causes both restriction of food intake as well as malabsorption.
It is regarded as the gold standard bariatric procedure and was the most commonly
performed bariatric surgery until recently sleeve gastrectomy took this place. Long
term data of 15 years has shown excess weight loss more than 80% along with excellent
remission of comorbidities.
How does a gastric bypass work?
In this procedure, the upper part of the stomach is converted into a small pouch 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 lower part of stomach and the first part of the small intestine which delays the mixing of food with the digestive enzymes and hence results in malabsorption.
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 increase the metabolic rate and burn fat. This not only decreases
body weight but also helps in remission of metabolic diseases like diabetes and
high blood cholestrol.
FAQs
Q1. How much weight can you lose with gastric bypass surgery?
A person is expected to lose 75-90% of their excess weight in 12-18 months following gastric bypass surgery. This means that for a person who weighs 120 kgs before the surgery with an ideal weight of 70 kgs is expected to lose 38-45 kgs after the surgery in 12-18 months. This weight loss is gradual and the person loses 5-7 kgs/month in the first 6 months and 2-3 kgs/month thereafter.
Q2. How fast do you lose weight after gastric bypass surgery?
The weight loss after gastric bypass surgery is divided into two phases - initial phase of rapid weight loss lasting 3-4 months and the second phase of more gradual weight loss lasting for next 6-12 months.>
Q3. Which is better gastric bypass or gastric sleeve?
Both operations have their own pros and cons and the surgeon has to decide which operation would be better suited for a particular patient. Whereas gastric sleeve surgery is technically easier and faster to perform with potentially less long term malabsorption, gastric bypass has more profound weight loss with better resolution of diabetes and metabolic syndrome. Gastric sleeve surgery is preferred for younger patients with lower BMI and few obesity related comorbidities whereas as gastric bypass is opted for patients who are older with higher BMI and also for patients with diabetes and severe metabolic syndrome.
Q4. Is gastric bypass surgery a major surgery?
Gastric bypass is a major abdominal operation which is done by the minimally invasive route. Since the surgery is performed using high end mechanical stapling devices which make it fast and bloodless, the postoperative complications are few and recovery is rapid after gastric bypass. However, the risks and benefits have to be clearly weighed and understood by each patient before proceeding with this surgery.
Q5. Gastric bypass surgery recovery
The recovery after gastric bypass surgery is rapid and the patient is allowed a liquid diet within a few hours following the surgery. The patient can sit up and walk after regaining consciousness and can be discharged on the second or third day. Most patients are able to resume their normal routine within and week and start exercising within 15 days.
Gastric Bypass Surgery
Q6. What are gastric bypass surgery types?
The classical gastric bypass which is the gold standard of bariatric surgery is the Roux en Y gastric bypass. This gastric bypass has undergone several modifications and changes over time. The most popular alternative to the classical gastric bypass is the mini gastric bypass or MGB in which a long and narrow gastric pouch is created and connected to a loop of intestine 150-200 cm distal to the DJ flexure. This makes the procedure technically easier to perform with more profound malabsorption while decreasing the restriction making it easier for people to consume food post surgery. Other variants are the long limb gastric bypass, duodeno-jejunal bypass and proximal jejuna bypass.
Q7. Do you lose more weight with bypass or sleeve?
Gastric bypass is a combined procedure which has both restrictive and malabsorptive effects as compared to gastric sleeve which is a purely restrictive operation. Hence, the effects on weight loss are slightly better after gastric bypass as compared to gastric sleeve but this comes at a cost of greater long term malnutrition and vitamin and protein deficiency.
Q8. Gastric bypass surgery side effects
Gastric bypass surgery can be associated with immediate, short term and long term side effects. The immediate side effects may occur at the time of surgery which include bleeding, stapler failure, injury to vital organs, infection, vomiting, etc. The short term complications include difficulty in swallowing food, vomiting, diarrhoea, oily stools, etc. Long term side effects may include hair fall, skin loosening, protein deficiency and excess weight loss.
Most of the immediate and early side effects can be avoided with careful patient selection, proper work up and meticulous operating technique. The long term side effects can be minimised if the patient take proper supplements and attend regular follow up visits with their doctor.
Q9. Gastric bypass surgery price
The cost of gastric bypass surgery in Delhi varies from 2.5 to 4 lacs INR depending upon the hospital, operating surgeon, the quantity and type of staplers used during the procedure and the type of gastric bypass procedure. The cost would increase if there are any anticipated complications during the procedure and there is increase in the hospitalisation or ICU stay.
Q10. Gastric bypass surgery diet
The diet after gastric bypass surgery follows 4 phases like other bariatric surgery types
- Phase 1 (0 - 5 days) - Clear Liquid diet
- Phase 2 (5 - 15 days) - Full liquid diet
- Phase 3 (15 - 30 days) - Pureed diet
- Phase 4 (30 - 45 days) - Soft diet
After 45 days of surgery, the person can take a normal diet. The meals have to be very small in quantity with increased frequency of around 6-8 meals per day. The person is instructed to eat slowly and chew thoroughly. Water should be taken either 1 hour before or 1 hour after the meal but not with food. The person should avoid high calorie beverages, aerated drinks, black tea/coffee and alcohol.