ROUX-EN-Y GASTRIC BYPASS

During a Gastric Bypass Bariatric Surgery procedure, a small pouch of stomach is created with a stapling device with keyhole surgery. This pouch is then connected to the small bowel a bit lower down, bypassing approximately the first third of the small bowel.


Gastric Bypass (also called a Roux-en Y Gastric Bypass) is more invasive and more complex than either Gastric Banding or Sleeve Gastrectomy as it combines reducing the size of the stomach with bypassing part of the small bowel.



Gastric bypass allows you to eat much less and absorb fewer calories, but to still enjoy your food and feel satisfied by:


  • Portion control: the pouch has a restrictive effect that allows you to feel full and satisfied with smaller meals and prevents overeating.

  • Hunger control: you feel less hungry in between meals. This operation not only reduces the stomach capacity but also alters appetite by changing the patient's biochemical response to food.

  • Healthier food choices:it changes the way the gut handles sugary and fatty foods, causing reduced desire for these foods and making healthier food choices easier

  • Altered metabolism: it changes the blood levels of metabolically active gut hormones and affects the complex biochemical pathways regulating appetite and metabolism. For example, this leads to changes in blood sugar metabolism independent of weight loss.

  • Reduced absorption: the bypass component reduces the amount of calories and nutrients absorbed from food.


Patients typically lose 65-70% of their excess body weight.


By comparison, non-surgical weight loss options achieve an average weight loss of 10%.


Keep in mind; these are only the average weight loss figures.


The best results are achieved when a multidisciplinary team supports patients though both surgical and lifestyle options.

WHAT ARE THE POTENTIAL BENEFITS OF CHOOSING A GASTRIC BYPASS?

It is an effective weight loss operation, with patients losing more weight after a gastric bypass than after a gastric band
It effectively resolves obesity related health problems A gastric bypass causes rapid resolution oftype 2 diabetes in 80% of patients by the time they are discharged from hospital, and long before significant weightloss occurs. For this reason it is also the best option for people with type 1 diabetes
It is the best weightloss option for people with severe preexisting gastro-oesophageal reflux disease, especially those with Barrett's oesophagus.
It has been the most commonly performed bariatric operation in the United States for last 20 years. Therefore it has a proven track record with long term outcome data being available.

WHAT COULD BE POTENTIAL DISADVANTAGES WHEN CHOOSING A GASTRIC BYPASS?

It requires frequent follow up appointments over the short and long term. A gastric bypass carries a higher risk of postoperative complications and long term nutritional deficiencies than does a gastric band or sleeve and therefore requires more frequent monitoring to identify and manage complications early.
A gastric bypass also carries the risk of developing complications down the track (such as dumping syndrome, peptic ulcers and internal herniation of bowel), which do not occur after a sleeve gastrectomy or gastric band.

WHAT IS THE POSTOPERATIVE COURSE LIKE?

n laparoscopic surgery the postoperative recovery is short as the bodily pain from the abdominal wall is minor due to the absence of a long incision. Low doses of painkillers are usually sufficient. Also the inner organs start their work and recover sooner after laparoscopic procedure, which allows quick re-alimentation and an early discharge from hospital.


Nausea and vomiting are usual in most patients during the first couple of postoperative days.

At night after the operation and the first day after the Gastric tea, water and liquids only are offered, on the second day soup and yogurt. 

Usually one night after the operation is spent at the ICU, hospitalization at the ward lasts a further two days.


The removal of external stitches (10th- to 20th day) could be done either by a family doctor (GP) a NHS Walk-in Centre or at the surgical outpatient department. You will be given a letter for your GP explaining him/her your surgery. It is recommended that patients should visit their GP for a blood test and general health check twice at least in the first year, to ensure there are no problems with mineral and vitamin deficiencies which could possibly occur during any period of rapid weight loss. Thereafter it is recommended that an annual test should be carried out. Some nutritional supplements of some minerals esp. calcium and iron and vitamins, especially B, D and folic acid are suitable in form of one multivitamin tablet a day especially within first months after the surgery. We strongly suggest Gastric patients take 1 x multivitamin with minerals and iron, 1 x calcium (not at the same time as the iron), and 1 x Vitamin B12 supplement daily after surgery

At least written email, text message or telephone information on post -operative weight loss and progress has to be sent to BodyClinique, for onward transmission of statistical data to Dr M.Cierny.

Immediate check-up is necessary anytime in case of any problems either at home country or in Breclav Hospital.

WHAT IS THE LENGTH OF THE HOSPITALISATION?

The operation is scheduled to be performed by a minimally invasive approach, therefore if everything goes normally the discharge should be on the third postoperative day.

ARE THERE ANY SIDE EFFECTS?

Heartburn and other signs of gastro-oesophageal reflux occur frequently and have tendency to decrease. The lifelong change in eating habits has to be accepted and kept, otherwise some deglutination problems may occur. Within the phase of rapid weight loss especially within the first year after the WLS it is recommended to women not to become pregnant. Some temporary hair loss can be quite common during periods of rapid weight loss (whether the weight loss is as a result of surgery or “conservative” means). These effects can be minimised or avoided by following a protein-rich diet and ensuring daily oral vitamin & mineral supplements are taken.

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