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Gastric Bypass Surgery

The Roux-en-Y Gastric Bypass, often called “gastric bypass”, has been applied for over 50 years, and the laparoscopic approach has been refined since 1993. It is one of the most commonly performed surgeries within the scope of obesity surgery. The main reason for this is that it is an effective treatment method for obesity and obesity-related diseases.

Gastric bypass surgery shows its effect in several different ways. As is the case with many bariatric surgical procedures; in gastric bypass surgery, the newly formed gastric pouch is smaller, which means there is less food-holding volume. The natural result of this is to eat less food and take in fewer calories. 

In addition, after gastric bypass surgery, food does not come into contact with the first part of the small intestine. This reduces absorption. Above all, changing the flow of food through the gastrointestinal tract, reducing the feeling of hunger, and increasing the feeling of being full which is longer has a significant effect on reaching a healthy weight and maintaining this weight.

The effect of gastric bypass surgery on hormones and metabolic health can often help improve adult-onset diabetes, even before any weight loss occurs. On the other hand, gastric bypass surgery may also contribute to the improvement of symptoms for reflux patients.

What Is Gastric Bypass?

Gastric bypass is a weight loss surgery performed for people with an obesity rate above 40 and who do not have conditions that will prevent life. Along with this operation, it is aimed to reduce the calories that a person receives in their body.

 

Gastric bypass surgery basically involves bypassing a large part of the stomach. A small volume of stomach is prepared with this process, and this part is sewn into the small intestine. This surgery is a method often used in general obesity surgery. As with all obesity surgeries, the aim is to reduce the stomach, disable part of the intestines and remove some of the foods consumed from the body without being absorbed. In this way, patients get a feeling of satiety by consuming less food, and only part of the food they consume is absorbed. This, in turn, prevents weight gain.

 

Gastric bypass is an operation in which surgical procedures are used to create a small pouch at the top of the stomach. The pouch is then attached to your small intestine and the rest of the stomach is used as the residual part. This means that it takes less food to make you feel full, and you will absorb fewer calories from the foods you eat.

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How Is Gastric Bypass Performed?

Gastric bypass surgery is performed by removing a large part of the stomach. Along with this operation, the stomach is reduced

 

This operation is performed under general anesthesia. Gastric bypass surgery consists of 2 important parts: in the first step, the stomach is reduced. The surgeon performs the procedure to separate the stomach into a small upper section and a larger lower section. The upper part of the stomach (called the pouch) is where the food you eat will go. The pouch is approximately the size of a walnut. Because of this, you eat less and lose weight.

 

The second step is the bypass Phase. The surgeon connects a small part of the small intestine to a small hole in the sac. The foods consumed go from the pouch to this new opening and into the small intestine. As a result, the calories that the body will take for it will absorb less food will also be less.

 

Gastric bypass can be done in two ways. By open surgery, the surgeon makes a large surgical incision to open the person’s abdomen. The bypass is performed by studying the stomach, small intestine and other organs.

 

Another way to do this surgery is to use a small camera called a laparoscope. This camera is placed in the patient’s abdomen. The operation is called laparoscopy. This camera allows the surgeon to see the inside of the abdomen.

 

 


In this operation:

The surgeon makes 4 to 6 small incisions in the patient’s abdomen. The tools needed to perform the operation are inserted through these cuts. The camera is connected to a video monitor in the operating room. This allows the surgeon to see the inside of the patient’s abdomen while performing the operation.

 

Who is Eligible for Gastric Bypass Surgery?

Gastric bypass surgery can be applied to people who have excess weight but cannot get rid of these weights with regular diet and exercise. The conditions sought in patients who can undergo gastric bypass surgery can be listed as follows:

 

  • Having a body mass index of 40 and above;

  • Although the patient’s body mass index is between 35 and 40, the presence of secondary health problems such as obesity-induced type 2 diabetes, sleep apnea, and hypertension;

  • The need to experience dramatic weight loss in a short period of time.

How Long Does Gastric Bypass Surgery Take?

Gastric bypass surgery is completed in an average of 1.5 to 2 hours. After gastric bypass surgery, patients should restrict heavy physical activities during the recovery period. They should not drive for the first 2 weeks after the surgery and should not lift heavy loads for 6 months.

 

The return time of the patients to work may differ depending on the recovery process, which may vary for each patient, the patient’s job, and working conditions. People who do not require physical activity and have comfortable and calm working conditions can usually return to work 2 or 3 weeks after the operation. In cases of intense physical activity, it may take 6 to 8 weeks to return to work. In addition, a doctor’s approval must be obtained for each patient before returning to work.

 

After gastric bypass surgery, patients experience gradual weight loss. Although the period with the highest weight loss is the first months, a maximum of 1.5 – 2 years may be required for the patient to experience the maximum weight loss. On the other hand, patients can lose an average of 70% to 80% of their excess weight during this period.

 

After gastric bypass surgery, patients should follow a balanced and healthy diet with 3 main meals and 3 snacks a day. The nutrition program to be followed after the surgery has 4 stages, and the transition speed between the stages may vary depending on the patient’s recovery speed and the ability of the stomach and intestines to adapt to changing eating habits.

 

The first step of the nutrition program to be applied is liquid nutrition. The next steps will be purees, foods, and moving on to a healthy and normal diet. Patients who have undergone gastric bypass surgery should pay attention to certain points during the whole process in order to take adequate vitamins and minerals and reach their weight goals in a healthy way.

 

The first of these points is the slow consumption of food and drinks. Food and drink entering the small intestine faster and more than normal can cause vomiting, nausea, sweating, headache, diarrhea, and abdominal pain. To prevent dumping syndrome, foods and beverages with low fat and sugar content should be preferred. 

 

The patient should drink and eat slowly and chew thoroughly. Lamb, veal, chicken, and fish, as well as legumes, must be included in the diet program. Foods high in sugar and fat are difficult to tolerate. Therefore, excessively fatty foods and sweets should be avoided.

 

Water should be drunk for 6 to 8 minutes a day, but should be consumed between meals. Care should be taken not to drink water with meals. A nutrition program with low-fat and high-protein foods should be applied.

 

What are the Types of Gastric Bypass Surgery?

One of the most frequently applied obesity surgical procedures, gastric bypass surgery focuses on the stomach and intestines. Thus, the intake and absorption of all nutrients that will enter the stomach are restricted. The purpose of this procedure is to enable the patient to lose weight. With gastric bypass surgery, 95% of the stomach, the duodenum, and an average of 2 meters of the small intestine are disabled. After this stage, a stomach pouch, which can stretch the least, has a volume of 15 to 30 ml, and prevents food from entering the stomach, is formed. With the minimal expansion of the stomach, it is aimed for the patient to feel full and convey this message to the brain.

 

There are three different types of gastric bypass surgery depending on the way it is applied:

In the Roux-En-Y (Proximal) technique, the new stomach is eliminated in the pouch by cutting 50 to 75 cm from the intestines. The other part of the small intestine, where pancreatic fluids are located, is fixed to the intestines at its end. Since Roux-En-Y (Proximal) is the method that causes the least nutritional problems, it is often preferred to be applied at the same time. Since most of the absorptive functions of the small intestine are preserved, the patient feels full in a very short time every time they eat after the surgery.

By targeting the small intestine in the Roux-En-Y (Distal) technique, the end that brings the bile from the small intestine, which is 6000 to 1000 cm long, is combined with the stomach at a higher level, so that fewer calories are taken from the food. Thus, foods that can cause weight gains, such as starch and fat, pass into the large intestine and help to lose weight quickly. In the method for changing the structure of the small intestine, nutritional effects come to the fore more.

The loop gastric bypass technique is less applicable than other techniques, as the patient’s bile and pancreatic enzymes may disturb the stomach. As part of the loop gastric bypass technique, it is possible to connect the intestine directly to the stomach without dividing it into two.



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