What is gastric bypass surgery?
Gastric Bypass (RGB) was developed by Dr Edward E. Mason, of the University of Iowa, based on the observation that females who had
undergone partial gastrectomy for peptic ulcer disease, tended to remain underweight following the surgery, and that it was very difficult to achieve
weight gain in this patient group. He therefore applied the principles of partial gastrectomy to obese females, finding that they did indeed lose
weight. (Mason and Ito 1967) With the availability of surgical staples, he was able to create a partition across the upper stomach using staples,
and did not require removal of any of the stomach. Subsequent modifications of the technique include a pouch of 50 ml or less, a
gastro-enterostomy stoma of 0.9 mm, use of the Roux-en-Y (RNY) technique to avoid loop gastroenterostomy and the bile reflux which may
ensue. Lengthening of the Roux limb to 100-150 cms to include a greater element of malabsorption and improve long term weight loss results.
Staple line failures have been found to occur many years after the procedure, in consequence surgeons have responded by use of techniques
designed to prevent this. These include transection of the stomach, in which the staple line is divided and the cut ends oversewn. An alternative
technique using superimposed staple rows is claimed to exert its effect by crushing the stomach tissue causing firm scarring along the staple line.
Gastric Bypass has also stood the test of time, with one series of greater than 500 cases, followed for 14 years, maintaining 50% excess weight
loss.
The complications of gastric bypass are much less severe than those of Intestinal Bypass, and most large series report complications in two
phases, those which occur shortly after surgery, and those which take a longer time to develop. The most serious acute complications include
leaks at the junction of stomach and small intestine. This dangerous complication usually requires that the patient be returned to surgery on an
urgent basis, as does the rare acute gastric dilatation, which may arise spontaneously or secondary to a blockage occurring at the Y-shaped
anastomosis . Then there are the complications to which any obese patient having surgery is prone, these including degrees of lung collapse
which occur because it is hard for the patient to breathe deeply when in pain. In consequence a great deal of attention is paid in the postoperative
period to encouraging deep breathing and patient activity to try to minimize the problem. Blood clots affecting the legs are more common in
overweight patients and carry the risk of breaking off and being carried to the lungs as a pulmonary embolus. This is the reason obese patients are
usually anticoagulated before surgery with a low dose of Heparin or other anticoagulant. Wound infections and fluid collections are quite common
in morbidly obese patients, hardly surprising when you realize there may be five or six inches of fatty tissue outside the muscle layers of the
abdomen.
Complications which occur later on after the incision is all healed, include narrowing of the stoma (the junction between stomach pouch and
intestine), which results from scar tissue development. Recall that this opening is made about 10 mm in diameter, not much wider than a dime.
With an opening this small, a very little scarring will squeeze the opening down to a degree that affects the patients eating. Vomiting which comes
on between the 4th and 12th week may well be due to this cause. The problem can be very simply dealt with by stretching the opening to the
correct size, by Endoscopic balloon dilatation, which usually involves a single procedure on a outpatient basis to correct the problem. Wound
hernias occur in 5-10% and intestinal obstruction in 2% of patients an incidence similar to that following any general surgical abdominal procedure.
Another late problem which is fairly common, after gastric bypass is anemia. Since the stomach is involved in iron and Vitamin B12 absorption,
these may not be absorbed adequately following bypass. As a result anemia may develop. The patient feels tired and listless, and blood tests
show low levels of hematocrit, hemoglobin, iron, and Vitamin B12. The condition can be prevented and treated, if necessary, by taking extra iron
and B12. Since the food stream bypasses the duodenum, the primary site of calcium absorption, the possibility of calcium deficiency exists, and
all patients should take supplemental calcium citrate to forestall this.
Dumping is often mentioned as a complication of gastric bypass, but it really is a side effect of the procedure caused by the way the intestine is
hooked up. Dumping occurs when the patient eats refined sugar following gastric bypass, this causes symptoms of rapid heart beat, nausea,
tremor and faint feeling, sometimes followed by diarrhea. Of course no one likes these feelings, especially patients who love sweets! The upshot
is, of course, that sweet lovers avoid sweets after gastric bypass and this is a real help to them in their efforts to lose weight. It should be noted
that a few surgeons, experts at endoscopic/laparoscopic surgery, are performing Gastric Bypass using laparoscopic techniques.
All information in this site comes from sources deemed reliable and informative. As always, please consult with your surgeon or doctor for specific medical advice related to your situation. The webmaster/owner cannot provide specific medical advice for your situation. The information provided herein is for INFORMATION purposes only and should be utilized as such.
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