What is Gastric Bypass Surgery?
Gastric Bypass Surgery (RYGB or Roux-en-Y Gastric Bypass) is one of the most common methods of obesity surgery in the USA and Turkey. Gastric bypass procedures are a group of similar operations that are used to treat morbid obesity, which consists of excessive accumulation of excess weight in the body as fat tissue and causes serious health problems. Bypass in general terms; “bypassing a section on the normal transmission path (without stopping there)” and thus ensuring continuity. When we talk about “gastric bypass” methods in obesity surgery; in addition to stomach reduction; at least 1 meter of the small intestine (the upper part of the stomach) is bypassed by surgical method is in question.
How is Gastric Bypass Surgery Performed?
Gastric bypass surgery is usually performed by laparoscopic method like other obesity operations. Surgery is performed by entering small incisions in the abdomen. Thus, the patient is also largely protected from possible risks such as wound infection and hernia that may develop after surgery. This surgery basically gives people weight loss through two mechanisms. Firstly the stomach; The upper part of the junction of the swallow tube is closed and cut to leave a small stomach (5-10% of the whole stomach) on the side of the swallow tube. In this operation, any part of the stomach is not removed and left in place, unlike “tube stomach” surgery. The connections of both pouches to the small intestine are then rearranged. In surgery, a small stomach volume is created, however, the small stomach then connects to the small intestine by bypassing the large stomach to bypass the large intestine to work. The main purpose is to provide a shortcut in the digestive system and to reach the end of the food without being fully digested. Through gastric bypass surgery, nutrients are bypassed from the beginning of the stomach to the middle of the small intestine. In this way, almost 95% of the stomach, the duodenum and the first 1 meter of the small intestine are disabled, ie, medically “bypassed”. These parts are turned into a dead end, with the upper end closed and the lower end leading to the active digestive tract. They just put their secretions into the system. Foods pass through here without ever going into a little digested and thrown. In this operation, as in other obesity surgery operations, it is aimed to reduce the volume of the stomach and to exclude a portion of the intestines and to remove some of the consumed food without being absorbed. In this way both saturation with less nutrients can be achieved and a significant portion of the nutrients cannot be digested since a very long section is disabled.
Who is Gastric Bypass Surgery Suitable for?
Gastric bypass surgery may be appropriate for patients who eat bulky and are consuming excess carbohydrate pastry. It is the body mass index that needs to be considered when deciding on this surgery. Gastric Bypass Surgery may be preferred in cases of severe obesity (BMI> 60 – “super obesity”) or in patients with type 2 diabetes who are very old and “old” and now have to use “insulin” for a long time. This is because if this operation fails and weight gain is started again, it cannot be converted to another operation. In an other saying; While it is almost impossible to apply another attempt in the following years to someone who has been bypassed as the first operation, it is easily possible to convert it to bypass if the first operation is a tube stomach.
In other words, for obese patients, this operation should be either a last resort or no other option than to be successful in the first attempt.
What are the advantages of gastric bypass surgery?
Gastric bypass is easy for the surgeon and the operation time is short. The main reason for the most common operation is the ease of gastric bypass surgery.
What are the disadvantages of gastric bypass surgery?
This type of operation, due to its content, is an extremely volume limiting process. Thus, even with very small stretching of the formed small stomach volume, a decrease in efficiency is readily apparent. Especially in patients above a certain body mass index, the efficiency can be reduced to 40%. Although not preoperatively, some patients may have a tendency to eat sweet after gastric bypass. This is an uncontrollable problem for gastric bypass. The most ideal and permanent weight control can be achieved by Duodenal Switch operation in cases of weight gain after such gastric bypass.
In addition to these, some anatomic problems may occur in gastric bypass operations. In these operations, the vagus muscle is cut and the pyloric muscle, which controls the outflow of the stomach and the entire stomach, loses its effectiveness. Pyloric muscle It is a kind of safety system that prevents uncontrolled emptying of the stomach. Thanks to this muscle system, bile from the small intestine cannot enter the stomach. This causes gastric emptying out of control. Gastric bypass operation is divided into two parts of the stomach, the remaining part of the connection with the esophagus is removed and nerve stimulation occurs.
In addition, since there is no chance of endoscopy in the remaining stomach, there are no options for early diagnosis and treatment of risks such as ulcers, gastritis or cancer in this area.