Gastric Bypass surgery, one of the methods that attract attention with its successful results in obesity surgery, is the most preferred obesity surgery in the world after stomach reduction surgery. This operation is generally performed on people who cannot get results with diet and exercise and whose weight begins to seriously affect their health. The purpose of the operation is; It is different from sleeve gastrectomy surgery. While gastric sleeve surgery achieves results by reducing the stomach capacity, Gastric Bypass surgery aims to achieve results by both shrinking and reducing absorption.

Gastric Bypass surgery; It is a morbid obesity surgery and is performed on patients with a body mass index over 40 or over 35 but with comorbidities. Different tests are used to make sure that Gastric Bypass surgery is a suitable procedure for the person. A person’s medical history, as well as their body mass index and personal weight loss goals, are important factors in determining whether they are a suitable candidate for Gastric Bypass. Gastric Bypass surgery can also be performed as revision surgery on patients who have previously undergone obesity surgery.

Physiology

Gastric bypass surgery, one of the methods that attract attention with its successful results in obesity surgery, is the most preferred obesity surgery in the world after stomach reduction surgery. This method helps lose weight by reducing the size of the stomach by over 90 percent. A normal stomach can sometimes expand up to 1000 ml. The gastric bypass pouch is 30-40 ml in size. The gastric bypass pouch is generally created in the least flexible upper part of the stomach. Increasing the functional capacity of the pouch over time is to ensure that the low weight is maintained after weight loss occurs.

How Much Weight to Lose?

Gastric bypass surgery, one of the most effective methods in the treatment of morbid obesity, is one of the procedures that causes the most and best weight loss among all obesity surgery. After gastric bypass surgery, weight loss occurs gradually, most rapidly in the first months. It may take 1.5 to 2 years for maximum weight loss. Approximately 70 – 80 percent of excess weight is lost during this period.

Gastric Bypass Surgery Before and After

Many obese patients consider obesity surgery as an option when they cannot get results from pre-operative treatments in losing weight. In this context, Gastric Bypass surgery is one of the treatment options.

Patients who are planned to undergo surgery first undergo a detailed evaluation. In addition to physical examinations, each patient is evaluated in detail by endocrinology and psychiatry specialists before surgery.

After surgery, patients generally stay in the hospital for 3-4 days and are kept under the supervision of a doctor. At discharge, a nutrition program is planned by the dietitian until the first check-up. During the first year, they are followed closely by endocrinologists, psychiatrists and dietitians, in addition to the obesity surgeon.

Gastric Bypass Results

Hyperlipidemia, popularly known as high cholesterol, improves in more than 70 percent of patients.
Hypertension improves in more than 70 percent of patients, and the remaining need less medication.
Sleep apnea begins to improve with weight loss.
Type 2 diabetes improves in more than 90 percent of patients. Multicenter 10-year data resulted in the same direction. (Rubino F et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomized controlled trial. Lancet. 2021 Jan 23;397(10271): 293-304).
After surgery, gastroesophageal reflux begins to improve in almost all patients.
Symptoms of venous thromboembolic disease, such as leg swelling, typically improve.
Waist and joint pain in patients disappears.

Living with Gastric Bypass

Gastric Bypass imposes some emotional and psychological burdens on the individual. Many people who undergo surgery may become depressed in the months following the operation. This depends on the role food plays in making people feel emotionally good most of the time. Many morbidly obese patients use food as an emotional escape.

It may take up to 3 months for the emotional level to return to normal.

Muscle weakness is common in the months following surgery. This can be caused by many factors such as restriction in protein intake, loss of muscle mass and decrease in energy levels. All of these problems disappear by balancing food intake.

How is Gastric Bypass Done?

The entire Gastric Bypass procedure is performed by laparoscopic surgery. Laparoscopic surgery, which is performed by making small incisions, has two stages.

In the first stage, a large piece is cut off, leaving a little stomach in the part of the stomach where it meets the esophagus. Thus, a small stomach bag is created. The remaining stomach volume is approximately 30 – 50 ml. In this operation, unlike gastric sleeve surgery, no part of the stomach is removed. Hand tools are allowed to reach the abdomen through ports placed through the incisions. One of these ports is for a surgical telescope connected to the video camera, and the other is for the entry of specialized surgical instruments. The image obtained by the camera is projected on a screen and the surgeon can perform the surgery by monitoring it without any problems. Since no part is removed from the body, it is possible to restore the digestive system to its previous state.

In the second stage of the surgery, the small intestines are connected to the small stomach bag with a volume of 30-50 ml, adjusted to the appropriate length according to the technique, that is, anastomosis is performed.

As a result, weight loss is achieved easily as a result of both eating less due to the volume restricting effect of the foods we eat and being less absorbed due to this newly created shortcut. However, as a result of decreased absorption, the necessary nutrients and minerals are partially excreted into the body, and lifelong supplementation may be required.

What are the risks of surgery?

As with every surgical procedure, there are potential risks and complications in Gastric Bypass surgeries. Therefore, choosing the right doctor is very important both before and after the surgery. While some complications are common with all abdominal surgeries, some are specific to bariatric surgery. Every patient who decides on bariatric surgery should be informed about these risks.

Complications of Abdominal Surgery

Infection: Wound infections or intra-abdominal infections may occur due to the release of intestinal bacteria during surgery.
Bleeding: Many blood vessels must be cut to divide the stomach and mobilize the intestine. Any of these may subsequently bleed into the abdomen or intestine. In such a case, blood transfusion or re-operation may be required.
Abdominal Hernia: A hernia is an abnormal opening inside the abdomen or outside the abdominal muscles. Internal hernia is due to surgery and redesign of the intestines and is very important in causing intestinal obstruction. With laparoscopic surgery, the risk of abdominal wall hernia is minimized.
Intestinal Obstruction: Abdominal surgery always causes intestinal adhesions. An internal or external hernia can also often cause this.
Venous Thromboembolism: Any injury, such as surgery, can lead to increased blood clotting. If a clot breaks off and travels to the lungs and blocks a vein there, it causes a very dangerous situation called pulmonary embolism. Blood thinners are usually administered before surgery to reduce the possibility of such complications.

Complications of Gastric Bypass

Anastomotic Leak: Anastomosis is the surgical connection between the stomach and the intestine or two sections of the intestine. The surgeon attempts to make a watertight connection between the two organs by using stitches or staplers that create holes in the intestinal wall.

It is working. If, for any reason, this coating fails, fluids from the digestive system leak into the abdominal cavity, causing infection and abscess formation.
Anastomotic Stenosis: As the anastomosis heals, the development of a tissue called scar, which naturally tends to shrink, causes the passages to narrow. This phenomenon is called stricture in the medical literature.
Complicated Marginal Ulcer: Marginal ulcer; It is a peptic ulcer that occurs in the mucosa at the edge of the gastrojejunal anastomosis. It can be seen early or late after gastric bypass. Generally, 50 percent of it is located in the anastomosis and 40 percent is located in the jejunum.
Dumping Syndrome: The pyloric valve, located at the lower end of the stomach, regulates the passage of food into the small intestine. When gastric bypass patients eat sugary foods, the sugar quickly passes into the intestines, causing a physiological condition called dumping syndrome. Dumping Syndrome is not a life-threatening condition.

Nutritional Deficiencies

Hypoparathyroidism: May occur in 100% of gastric bypass patients due to inadequate absorption of calcium. Many patients can achieve adequate calcium absorption by taking vitamin D and calcium citrate supplements.
Iron: It is often a serious deficiency, especially in menstruating women, and must be replaced. Ferrous sulfate can cause significant digestive upset in normal doses.
Vitamin B-12: Intrinsic factor secreted from the gastric mucosa is required for its absorption. It may not be absorbed even if given orally in patients with a small stomach pouch.
Thiamine Deficiency: It is rarely seen due to bypass of the jejunum, which is the absorption area. It is also known as Beriberi. Deficiency may occur due to not receiving adequate nutritional support after the surgery.
Protein Malnutrition: Some patients cannot eat enough, experiencing severe vomiting after surgery until their digestive systems adjust to the situation. Many patients need protein supplements to prevent excessive muscle mass loss in these early periods of rapid weight loss.

Nutritional Effects

After surgery, patients begin to feel full by consuming small volumes of food. After a while, this satiety turns into a loss of appetite and total food intake begins to decrease significantly.

Proteins: Protein is the most basic food ingredient. Due to the restriction in food intake, patients with gastric bypass should primarily focus on meeting their protein requirements at each meal. If this simple precaution is followed, protein deficiency is rare in proximal gastric bypass.
Calorie Intake: Profound weight loss after bariatric surgery involves taking in much less energy each day than the body needs. To eliminate this deficit, fat tissue must be burned. This is how weight loss occurs.
Vitamins: Vitamins are normally found in foods and can be taken as medicine. Since food intake decreases significantly in GBP, vitamin content also decreases proportionally. Therefore, vitamin supplements should be taken to meet daily vitamin and mineral needs. While the absorption of many vitamins is not seriously affected after proximal GBP, vitamin B12 may not be absorbed sufficiently in some patients. Since absorption problems are greater in distal GBP, level monitoring and support of vitamins and trace elements should be done more carefully.

What is the Approach to Gastric Bypass Surgery?

Many obese patients consider obesity surgery as an option when they cannot lose weight from pre-operative treatments. In this context, Gastric Bypass surgery is one of the treatment options.

Enables patients interested in Gastric Bypass treatment to learn about available procedures by listening to their general health goals,
In cases where the patient’s general health condition does not allow surgery, he/she provides information about pre-operative treatments and gives necessary guidance.
Thanks to our dietitian service, we help patients make the diet choices that are right for them and provide the necessary psychological support regarding the treatment process.