What is gastric bypass? Gastric bypass, a type of bariatric surgery (surgery to lose weight), is a surgical procedure that alters the physiological process of digestion. Bariatric surgery is the only option that currently treats excessive obesity effectively, with long-term sustainability, in people who have failed more conservative measures such as diet, exercise, and medication. There are several types of gastric bypass procedures, among those that we perform in our center we have: Roux “Y” Gastric Bypass Gastric Bypass (BAGUA / OAGB) European technique Mini Gastric Bypass Gastric Bypass (SADIs) All of these procedures involve a greater or lesser degree of bypass of part of the small intestine. For this reason, these types of procedures are known as malabsorptive procedures, because they involve food bypassing a nutrient-absorbing portion of the small intestine. Some of these procedures also involve dividing the stomach with staples to create a small pouch that will act as a “new” stomach, or surgical removal of part of the stomach. Although a gastric bypass procedure is malabsorptive, it can also be restrictive, because the size of the stomach is reduced so that the amount of food eaten is “restricted” by the reduced size of the stomach. Although malabsorptive procedures are more effective in causing excess weight loss than merely restrictive procedures, they also carry higher risks of nutritional deficiencies. Types of gastric bypass, or malabsorptive, surgical procedures include: In some patients, Roux-en-Y gastric bypass may be performed with a laparoscope instead of through an incision. This procedure uses many small incisions and three or more laparoscopes – small, thin tubes with video cameras – to view the inside of the abdomen during the operation. The surgeon performs the surgery while watching a television monitor. This technique is not usually considered for people with a Body Mass Index (BMI) over 60 or those who have already had some type of abdominal surgery. The laparoscopic method allows the doctor to make a series of much smaller incisions. Laparoscopic gastric bypass generally reduces the length of hospital stay, the number of scars, and speeds recovery compared to surgical procedures using a scalpel. Digestion is the process by which food and liquids are broken down into smaller parts so that the body can use them to build and nourish cells. Digestion begins in the mouth, where food and liquids are taken in, and is completed in the small intestine. The digestive system is made up of a series of hollow organs united in a long, twisted tube that runs from the oral cavity to the anus. The three mechanical tasks of storage, mixing, and emptying occur in the stomach. Food is digested in the small intestine and dissolved by the juices of the pancreas, liver, and intestine, and the contents of the intestine are mixed and pushed forward to allow further digestion. Malabsorptive procedures alter this process in different ways depending on the type of procedure. Reasons for performing the procedure: Bariatric surgery is performed because it is currently the best treatment for achieving lasting weight loss in obese patients for whom non-surgical methods of weight reduction have failed. Potential candidates for bariatric surgery include: The long-term health benefits should be considered and determined to outweigh the risks, as surgery can have serious side effects. Although certain surgical techniques can be performed laparoscopically with less risk, all bariatric surgery is considered major surgery. Although all the risks of each procedure are not known, bariatric surgery does help many people reduce or eliminate some obesity-related health problems. You can contribute to: Surgery to lose weight is not a universal remedy, but these procedures can be very effective in people motivated to follow the guidelines indicated by their doctor on nutrition and exercise and to take nutritional supplements after surgery. Your doctor may also recommend gastric bypass for other reasons. Risks of the procedure: As with any surgical procedure, complications can arise. Some possible complications include, but are not limited to, the following: With Roux-en-Y gastric bypass procedures, malabsorptive symptoms may be more severe, leading to an increased risk of anemia and loss of fat-soluble vitamins (vitamins A, D, E, and K). Adequate amounts of iron, calcium, and vitamin B12 may not be absorbed. This can cause metabolic osteopathy and osteoporosis, this is prevented in the days before surgery and follow-up control after surgery for prevention. Stomach stricture occurs when there is a stricture (narrowing) of the opening between the stomach and intestine after a Roux-en-Y procedure. When this happens, vomiting may occur after eating and sometimes after drinking. Stomach stricture can be treated easily but must be done immediately. In addition, with these procedures, there is an increased chance of “dumping syndrome” because food moves from the stomach to the intestines quickly. Symptoms may include nausea, sweating, fainting, weakness, and diarrhea. There is a risk that the patient will need another surgery due to complications, including gallstones. One of the most serious complications of gastric bypass is a stomach spill that causes peritonitis. Peritonitis is an inflammation of the peritoneum, the smooth membrane that lines the cavity of the abdomen. Other risks may arise depending on your specific medical condition. Remember to consult all your doubts with your doctor before the procedure. Before the procedure: During the procedure: Gastric bypass requires hospitalization. Procedures may vary based on the type of procedure being performed and your physician’s practices. Gastric bypass is performed while you sleep under general anesthesia. Your doctor will explain this to you ahead of time. In general, gastric bypass follows this process: After the procedure: After the procedure, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are awake, you will be taken to your hospital room. Malabsorptive stomach surgery generally requires a 48-hour hospital stay. If necessary, you may be given pain medication, which can be administered by a nurse or by you through a device connected to your IV. You will be encouraged to move as tolerated while in bed, and then to get up and walk around as your strength returns. At first you will receive fluids through an IV. In the first 24 hours, a study will be carried out with water-soluble material to corroborate the permeability of the intestinal junction and that there are no leaks. Later, liquids will be given, such as Isopure Zero Carb, broth or juice, to drink. As you begin to tolerate liquids, you will be given thicker liquids, such as pudding, milk, or cream soup, followed by foods that you don’t have to chew, such as hot cereal or purees. Your doctor will tell you how long you will need to eat purees after surgery. You will likely be able to eat solid foods within a month of your surgery. You will be told what nutritional supplements you should take to replace the nutrients lost due to the reconstruction of the digestive system. Before you are discharged from the hospital, a follow-up visit will be arranged with your doctor. In the house: Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you precise instructions on how to bathe. Your doctor will remove the stitches or surgical staples during your follow-up visit. You may feel pain in your incision and abdominal muscles, especially with deep breathing, coughing, and straining. Take a pain reliever, as recommended by your doctor. Aspirin or other pain medications can increase the chance of bleeding. Be sure to take only the medications your doctor has recommended. You should continue the breathing exercises you did in the hospital. You should gradually increase your physical activity. It may take several days or two weeks for it to return to its previous resistance levels. You may be instructed to avoid heavy lifting for several months to prevent stress on your abdominal muscles and the area of the surgical incision. Surgery to lose weight can be emotionally difficult because you will have to adapt to new eating habits and a new body in the process of change. You may feel especially tired for a month after surgery. Exercise and attending support group meetings can be beneficial during this time. Notify your doctor of any of the following symptoms or signs: After gastric bypass surgery, your doctor may give you additional or alternative instructions depending on your situation. Do not think twice if you have a degree of obesity and serious medical problems, contact us and tell us your questions to provide you with timely information. Duodenal switch or Duodenal switch: The duodenal switch or biliopancreatic diversion with duodenal switch, consists of the combination of two techniques: the gastric sleeve or tube, and the biliopancreatic bypass. The gastric sleeve or tube provides the restrictive component (the size of the stomach is reduced and, with it, the amount of food that the patient can ingest), while the biliopancreatic bypass provides the malabsorptive component (the effective length is reduced of the intestine and, with it, the absorption of nutrients). The restrictive component (sleeve or gastric tube) consists of a reduction of the stomach in which the pylorus (valve that regulates stomach emptying) is preserved. On the other hand, the malabsorptive component (biliopancreatic bypass) consists of dividing the small intestine into two segments of different sizes that join in a common channel. The digestive segment is responsible for carrying food from the stomach to the common channel, while the biliopancreatic segment transports bile and pancreatic juice to the common channel. Thus, total digestion is carried out in the common channel which, because it is shorter, allows patients to absorb only 30% of fats and 80% of carbohydrates. When is the duodenal switch indicated? The duodenal switch is indicated in the following cases: Expected results The percentage of excess weight loss can be greater than 85% at two years. The greatest decrease occurs in the first months after the intervention, and then decreases progressively, until reaching the so-called “ideal weight”. Advantages of the duodenal switch Disadvantages of the duodenal switch Intervention, postoperative and follow-up The duration of the intervention is variable, depending on the characteristics of each patient. It can go from an hour and a half to three hours. The patient spends the first hours in the resuscitation unit or ICU, moving to her room afterwards.</ P> Twenty-four hours after the intervention, a radiological control is performed, before restarting the progressive oral diet according to the bariatric surgery protocol. Discharge occurs after 3 days. With strict observations. After 8 days the patient can return to their usual activity, as long as they do not make physical efforts. After a month you can make physical efforts and play sports. The diet is carried out in phases that go from liquids, blenders and soft drinks, to a varied diet but always in smaller amounts. Carbonated beverages should be avoided, and chew slowly. It is prescribed in the first month, in addition to the gastric protector, a multivitamin, a protein supplement and, for 3 weeks. In this technique, which has a greater malabsorption aspect, the need for more continuous supplements of fat-soluble vitamins and minerals is more common. Monthly check-ups and follow-ups during the first six months and then annually, with the pertinent analytical studies. Observations Using this technique, not a single centimeter of the small intestine is removed, so the malabsorptive component of the duodenal switch is reversible.
GASTRIC BYPASS
Roux-en-Y gastric bypass, the most frequently used bariatric procedure, being the gold standard of weight loss surgeries , this procedure is considered restrictive and malabsorptive. This surgery can cause a loss of two-thirds of the additional weight in two years. The procedure involves dividing the stomach with staples to create a small pouch to hold less food, and then shaping part of the small intestine into a “Y” shape. The “Y” part of the intestine is then connected to the stomach pouch so that when the food is digested it goes directly to the lower part of the small intestine, bypassing the first part (the jejunum) and the first leg of the second section of the small intestine (the duodenum). The effect of a bypass on these organs is to restrict the amount of calories and nutrients that the body absorbs.
Normally, the following occurs:
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