Gastric Bypass Surgery: Purpose, Procedure, Benefits and Side Effects

Gastric bypass, often known as bariatric surgery, is often performed to treat obesity and assist someone in losing weight. Obesity can raise the chance of developing diabetes, rheumatoid arthritis, high blood pressure, heart disease, and other illnesses. To improve general health, medical specialists advise weight loss.

Even though food and exercise are frequently the first methods suggested for weight loss, they are not always effective. A doctor could advise surgery when lifestyle adjustments are ineffective.

These techniques typically function in one of three ways;

• Restrictive: A surgeon reduces the size of the stomach
• Malabsorptive: Reduced passage of food through the small intestine by a surgeon results in malabsorptive conditions
• Mixed: These methods reduce meal intake and impair food absorption, resulting in weight loss.

Different types of gastric bypass surgery include-

• Biliopancreatic diversion with duodenal switch - a biliopancreatic diversion is done with a duodenal switch but is a less common procedure.
• Sleeve gastrectomy- Around 80% of the stomach is removed during this treatment.
• Gastric bypass (roux-en-Y)- A tiny pouch from the stomach is removed during a gastric bypass (roux-en-Y), which then directly connects the newly formed pouch to the small intestine.

One of the restrictive weight loss procedures is the laparoscopic adjustable gastric band (LAGB) which is occasionally referred to as a gastric sleeve.

Through a series of tiny incisions in the upper abdomen, the surgeon inserts a device called a laparoscope before wrapping an adjustable band around the top of the stomach to form a tiny pouch. As a result, despite eating less, the person feels more satisfied.

The least invasive stomach operation is LAGB. When necessary, the surgeon can modify the band to allow for an increased or decreased food intake.

The technique known as ' stomach stapling' is now frequently referred to as vertical sleeve gastrectomy (VSG). In this procedure, a portion of the stomach will be surgically removed that will permanently reduce the amount of food that may be consumed.

The surgeon will also remove the mucous membrane layer of the stomach's ghrelin-producing cells completely to reduce the production of the hunger hormone that is secreted by ghrelin, resulting in reduced appetite.

The remaining pieces of the stomach will be connected by the surgeon using surgical staples.

A surgeon shrinks the stomach to about the size of a golf ball during a Roux-en-Y gastric bypass (RYGB). To do this, a tiny pouch of the stomach is separated from the remainder by a pair of staples, and this pouch is then joined to the Roux limb, a segment of the small intestine. The roux limb is connected to the upper or remaining portion of the small intestine, which makes up the duodenum. The complete arrangement corresponds to the letter Y.

The bottom portion of the small intestine will receive food directly from the small pouch. This method is malabsorptive because the body absorbs less food the shorter the meal stays in the small intestine.

Summary- Different types of bariatric surgery- LAGB, Roux-en-Y gastric, vertical sleeve.

Long-lasting weight loss can be achieved by gastric bypass surgery. The type of surgery you undergo and the modifications you make to your lifestyle will affect how much weight you lose. Within two years, you might be able to reduce half or perhaps more of your excess weight.

In addition to helping patients lose weight, gastric bypass surgery has been shown to improve or treat a number of disorders linked to obesity, such as:

• Heart condition
• Elevated blood pressure
• Obstructive sleep apnea
• Type-2 diabetes
• Nonalcoholic steatohepatitis (NASH) often known as nonalcoholic fatty liver disease (NAFLD)
• Disease of the gastroesophageal reflux (GERD)
• Osteoarthritis or joint discomfort

Additionally, gastric bypass surgery might increase your capacity for common everyday tasks, which may enhance your quality of life.

Summary- By modifying how your stomach and small intestine process food, gastric bypass helps people lose weight. Your stomach will be smaller after surgery.

When you have a very high BMI and the majority of dietary restrictions have not worked for you, a gastric bypass operation is an efficient and straightforward procedure that can help you attain your weight objectives. A Gastric bypass surgery is performed to assist you in losing extra weight and lower your risk of serious, maybe fatal, weight-related health issues, such as:

• Heart disease
• High blood pressure
• High cholesterol
• Severe sleep apnea
• Type 2 diabetes
• Stroke
• Infertility

Usually, a Gastric bypass surgery is only performed after you've made an effort to lose weight by changing your eating and exercise routines. Not everyone who is really overweight is eligible to have a Gastric bypass surgery. You'll probably go through a rigorous screening process to discover if you qualify. After careful consideration, your doctor will advise you to have this procedure. Following criterias will be used by your doctor to make a decision;

• Your medical history: You might need to have surgery if you have sleep apnea, cardiac problems, liver disorders, kidney stones, or blood clots.
• Your psychological health: Obesity can occasionally be a symptom of certain psychological conditions. Before you undergo surgery, a doctor will make sure that these conditions are taken care of.

Additionally, you must be prepared to commit to long-term adjustments for a better lifestyle both before and after surgery. Long-term follow-up strategies that keep an eye on your diet, way of life, and medical issues may be part of this.

Summary- Gastric bypass surgery is advised to treat various disorders.

Gastric surgery has a number of benefits, but it is a serious procedure with some risks and side effects. Similar to every serious medical procedure, gastric surgery includes important short- and long-term health risks;

• Excessive bleeding
• Infection
• Adverse reactions to anesthesia
• Blood clots
• Lung or breathing problems
• Leaks in your gastrointestinal system
• Dehydration
• Dump syndrome
• Constipation
• Block opening of stomach pouch

Despite the risks, the gastric bypass surgery can be a good choice for people who are overweight and obese. The chances of countering the risks can also be ignored or reduced if the surgery is done by an expert gastro surgeon, bariatricians, or bariatric surgeons at Pristyn care.

Summary- Gastric bypass surgery often accompanies some side effects like constipation, blood clots, dehydration, etc.

Speak with a reputable healthcare professional of Pristyn care before the procedure to receive detailed instructions on how to get ready for the surgery. Your medical professional might be able to provide you with information about the pre- and post-surgery preparation and treatment that may include;

• Information of any medications you are taking, including over-the-counter medicines and dietary supplements, should be disclosed to your doctor. These drugs will likely need to be stopped in the days leading up to the surgery
• If you take aspirin or other blood-thinning medications, you may need to discontinue taking them a few days before surgery
• To lower the chance of infection, give up smoking at least 4 weeks ahead
• If you believe you could be pregnant, tell your doctor right away
• Talk about any potential bleeding disorders or other health issues you may have such as allergies, anesthesia reactions, previous surgeries
• Switch to healthy diet weeks before undergoing the surgery
• If you've had any recent operations, have allergies, let your doctor know
• Follow your doctor's advice about what to eat and drink before surgery. The night before surgery, you should probably avoid eating or drinking after midnight. Ask your doctor or nurse for instructions if you typically take your medication in the morning
• As gastric bypass surgery may require you to stay for one to two nights in the hospital, pack necessary items in your hospital bag such as; a toothbrush, robe, and slippers, to make your stay more comfortableLast but not least, arrange for dependable transportation to and from surgery. After having a gastric bypass surgery, you won't be allowed to drive.

Summary- Before commencing gastric bypass surgery, a patient needs to follow some simple rules to get prepared.

Because the gastric bypass procedure is done under general anesthesia, you will be asleep the entire time and experience no pain. The operation is carried out laparoscopically. A scope and delicate surgical instruments are inserted into the abdominal cavity through very small incisions. By giving the surgeon real-time views from inside the body, the camera directs the operation. The wound heals more quickly and without leaving any scars after laparoscopic gastric surgery.

Your surgeon may occasionally decide to perform an open procedure in which a sizable incision is made to access the stomach.

The procedure is divided into two main stages:

• In order to reduce the size of the stomach, the surgeon divides it into two sections and staples them together. Your stomach's pouch, which is its uppermost portion, will hold the food you eat. You are compelled to consume less than usual because your upper stomach has been limited to a maximum capacity of 28 grams. You will slim down thanks to this.
• The bypass procedure is the next stage. The little hole in the pouch is used by the surgeon to connect the pouch to the small intestine after it has been formed. Food will enter the small intestine from the pouch this manner. 3–4 hours are needed for the procedure. Within a few days of observation, you'll be allowed to leave the hospital and go home after a week.

  Here are what happens right before, during or after your gastric bypass surgery in the hospital;

• The patient is brought to the operating room on the day of surgery well in advance of the scheduled procedure time
• Prior to the surgery all clothes and surgical instruments are cleaned to eliminate any bacteria and germs
• The patient is changed into a fresh surgical gown
• An anti-blood clotting medication, may be given as a pre-operative dosage
• A thorough physical checkup is performed before the procedure. Vitals such as the heart rate, blood pressure, body temperature, and breathing rate are monitored
• Patient's height and weight is measured in order to map BMI changes. The BMI adjusts in line with changes in weight
• The cardiovascular system is examined to look for indications of aberrant cardiac functioning
• A dietitian will assess the patient's nutritional state and previous diet compliance attempts
• General anesthesia is used for gastric bypass surgery to be performed in a hospital.

Gastric bypass surgery cannot be performed if certain medical problems exist. These include bleeding problems, gallstones, and kidney stones. Prior to the procedure, they must be treated if they are found.

In the process of a gastric bypass, there are two steps:

The first step involves the process of making your stomach smaller. Your stomach is divided into a smaller upper region and a larger lower section using staples by your surgeon. The food you eat will go into the upper part of your stomach, which is referred to as the pouch and is capable of holding roughly 1 ounce (oz) or 28 grams (g) of food. As a result you will eat less and lose weight.

The next step is a bypass in which jejunum, a small portion of your small intestine, is connected to a tiny hole in your pouch by your surgeon. This new opening will now allow food to pass from the pouch into your small intestine. Your body will therefore absorb less calories as a result.There are two ways to do a gastric bypass;

• Open bypass surgery: In which your stomach is exposed after making a significant surgical incision. In open bypass surgery, the surgeon has access to your stomach, small intestine, and other organs.
• Laparoscopic bypass surgery: A surgical procedure that leads to the creation of a gastric pouch. In individuals who are extremely obese, it is done to produce long-lasting and considerable weight loss.

Occasionally, if the situation calls for it, the technique will be changed from laparoscopic to open during surgery. Usually, only the patient's safety or the efficiency of the procedure justifies doing this.

• Once the surgery is done you will be taken to the postoperative recovery area, where you will stay till the effect of anesthesia wears off and you are awake
• During that time the medical staff will monitor your vitals such as breathing, heart rate, and blood pressure
• Any pain or discomfort will also be addressed at this stage
• Once you are awake, you might be encouraged to do some simple movements like sitting in a chair, walking
• It is required for the patient to stay in the hospital for roughly two to three days while being closely monitored
• Depending on how well they heal, they could be released sooner or later
• About 3–4 weeks are needed for full recovery following surgery
• Following gastric bypass surgery, the patient and doctor must work together to lose the targeted amount of weight and keep it off.

The cost of gastric bypass surgery is usually high-priced. Its price may range from 43,000-52,000 rupees. However, it may vary in different hospitals.

To combat gastric bypass surgery, we must involve nutritious foods in our everyday diet like-

• Lean-meat
• Fish
• Cooked cereal
• Skim milk
• Cottage cheese
• Rice

Summary- Eating these foods helps to tackle gastric bypass surgery.

Gastric bypass surgery has been recorded as one of the least dangerous surgical operations and is found to be safe with a low risk of morbidity and mortality rate. The surgery can help morbidly obese individuals lose weight permanently while also significantly improving their co-morbidities and quality of life. Given the range of obesity-related illnesses that affect several organ systems, gastric bypass surgery may be the most safe alternative for many people who are extremely fat.

Summary- Gastric bypass surgery is usually considered a safer surgical procedure.

No, gastric bypass surgery is not painful as it is performed under general anesthesia. However, there is only a little amount of postoperative pain associated with the treatment and can be felt where the incision was made. The post operative pain can be managed by the prescribed pain relief medications.

Summary- Gastric bypass surgery is the least painful as it involves anesthesia insertion.

Depending on the patient and the treatment type, the recovery following gastric surgery may vary, although today's less invasive laparoscopic techniques offer a quicker recovery with less risks. Recovery from your gastric bypass surgery usually takes about three to six weeks.

After some surgeries, patients might even be able to return home the same day. However, in some cases, patients may need to spend a total of two or three days in the hospital after surgery. You may need to avoid strenuous activity for up to six weeks, and it may take up to twelve weeks to resume a normal diet.

Summary- The recovery period is usually variable but it takes almost 1.5 months.

Just like any other surgery, gastric bypass surgery also comes with some side effects. The dangers of gastric bypass surgery are briefly described in the list that follows;

• Nutrient deficiency
• Malnutrition from protein deficit
• Vitamin deficiency
• Anemia
• Osteoporosis
• Night blindness
• Acid reflux
• Hernia
• Ulcer
• Gallstones
• Dumping Syndrome
• Bowel Obstruction

Summary- The above-stated adverse effects are often accompanied by gastric bypass surgery.

As gastric bypass surgery alters our digestive system, and also influences our food intake and drinking habits, here are some tips to be followed to take of our digestive health after surgery;

Diet
You will be given a diet chart by your dietician that is to be followed three to four months after your discharge from the hospital. Your diet will now consist of soft, light foods that are simple to digest as after gastric bypass surgery, dietary consumption substantially decreases due to the stomach's relatively limited capacity to store foodAlso limit how much food is eaten at each meal to achieve and maintain the desired weight loss following surgeryAlcohol and smoking should be avoided as much as possible throughout one's life. They could result in unwanted weight fluctuations

Keep hydrated
Due to a shortened stomach the water or any liquid consumption is restricted to 1.9 liters for a day which can increase your chance of kidney and bladder infection. To avoid dehydration consume enough waterIf you experience symptoms like dark color urine, fainting, nausea, dry mouth consult your doctor who can test your dehydration and replenish you through IV fluids

Nutrient replenishment
You will need to take vitamins and other nutritional supplements for the rest of your life since bariatric surgery alters the digestive system Take your vitamins and see your bariatric surgery team for routine follow-up visits and lab testing since vitamin deficiencies are both avoidable and manageable

Exercise
Another important factor in preventing weight gain is regular exercise. Both of them play a crucial role in your weightloss journey. The body naturally prefers to draw energy from muscles to compensate for the low calorie intake. That implies that maintaining a regular exercise routine after surgery is crucial A minimum of three times per week of exercise preserves lean muscle mass, burns fat, and improves your chances of long-term success

Wound care
Showering over the incisions is okay, but avoid submerging them in water until they are fully healed Your deep incisions will be sutured (stitches) while the top layer of skin may be held together using surgical glue. One to two weeks following the surgery, the adhesive starts to flake, and the sutures eventually fall out. Apply Vaseline or Aquaphor to the incisions as the adhesive comes off to keep the skin hydrated. This lessens scab formation and hastens healing

Follow ups
In the initial months following weight-loss surgery, you will also have routine medical examinations to track your health. You could require numerous checkups, blood work, and laboratory tests.

To treat flabbiness brought on by weight reduction, body sculpting surgeries could be necessary.

Summary- Proper aftercare is very important and it includes physical exercise, a nutritious diet, hydration, etc.

Gastric bypass surgery is by no means a ' simple fix,' since it necessitates numerous dietary adjustments in order to promote weight loss. For many people, it can be a big step towards maintaining a healthy weight.

Typically, the advantages of gastric bypass surgery exceed its disadvantages and by following proper postoperative routine many related illnesses like hypertension, high cholesterol, type-2 diabetes, heart condition, obstructive sleep apnea, GERD, osteoarthritis and fatty liver among several other health conditions can be managed and treated.