The gastric bypass was first performed many decades ago and quickly became the gold standard in bariatric surgery. This was due to the excellent safety profile, combined with very good long-term weight loss and disease improvement results. The gastric bypass, while not the most popular bariatric surgical procedure anymore, does offer exceptional benefits to many patients, especially those who suffer from uncontrolled diabetes or acid reflux.
How It Works
Gastric bypass is a two-part procedure with the first part being restrictive, mechanical reduction of the size of the stomach pouch. Dr. Higa will cut away approximately 85% of the stomach leaving a small pouch that approximates the size and volume of a golf ball. This becomes the new, primary receptacle for food. However, unlike the gastric sleeve, the portion of the stomach cut away during the gastric bypass is not removed from the abdomen and continues to produce and deliver gastric juices further down in the intestinal tract.
Once the new pouch has been created, Dr. Higa will bypass a portion of the small intestine to reduce the amount of intestinal surface area that food comes in contact with. This reduces the number of calories that can be absorbed into the body, adding yet another mechanism by which you can lose weight. Gastric juices and food take a separate track and meet at the Roux-en-Y further down the small intestine.
Procedure Details and Recovery
The gastric bypass is performed in a minimally invasive or laparoscopic manner. This requires only 4-5 small incisions in the abdomen. Dr. Higa also performs this procedure with the assistance of a surgical robot. This new technology allows for more precise movements within the abdomen and better visualization of the surgical field. Patients will be under general anesthesia for the procedure and the entire surgery takes about an hour to an hour and fifteen minutes.
Patients will then spend 1 to 2 nights in the hospital recovering before they are discharged home. While in recovery at the hospital, patients will be started on a clear liquid diet for the first several days after surgery. They will slowly progress through a range of diets, including full liquid, soft food, and modified solid food over the next several weeks.
Advantages of the Gastric Bypass
- The gastric bypass is the gold standard in bariatric surgery and remains the procedure with the greatest potential for excess body weight loss that we perform. Patients may lose upwards of 80% of their excess body weight.
- Since the procedure can be performed in a minimally invasive manner, the risks of incisional hernia, infection, significant pain, and blood loss are much reduced versus open surgery. Robotic surgery may further improve these outcomes in some patients.
- The diseases associated with morbid obesity, including type-2 diabetes, sleep apnea, high cholesterol, high blood pressure, and even acid reflux, are significantly improved in a vast majority of patients. In fact, for patients who have been unsuccessful in treating their type-2 diabetes or asthma reflux, the gastric bypass may be the best bariatric option.
Risks and Considerations of the Gastric Bypass
- As with any surgical procedure, there are inherent risks which include blood loss, prolonged pain, infection, reaction to anesthesia, and very rarely, death. While extremely rare, there is the possibility of injury to nearby organs and an incisional hernia.
- Although rare, the staple line used to separate the stomach pouch may leak and cause gastric juices to enter the abdominal cavity, which can cause significant infection. This will require corrective surgery.
- Due to the limited number of calories and nutrients being absorbed into the small intestine, many gastric bypass patients experience vitamin and mineral deficiencies including vitamin D, vitamin B12, calcium, and iron. All gastric bypass patients will require a daily multivitamin for the rest of their lives. Depending on the results of blood panels, some patients may require additional supplementation.
- A relatively unique condition known as dumping syndrome may occur after a gastric bypass. Also known as rapid gastric emptying, this is when patients eat too quickly, and eat high-fat or high-sugar foods or drinks along with their meal. Dumping syndrome can cause symptoms similar to that of hypoglycemia and is very uncomfortable. While on the surface this is a negative, it trains the patient on what they can and can’t eat and forces them to eat slowly and appropriately.
- Due to the rapid emptying of stomach contents into the small intestine, alcohol is not metabolized in the same way as before surgery. Patients may become inebriated more quickly after a gastric bypass. While drinking alcohol is not recommended due to irritation of the stomach pouch and its caloric value, patients who do wish to drink alcohol must acclimate to this new reality.
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To learn more about the gastric bypass, we encourage you to schedule a consultation with Dr. Higa. During this conversation you will learn more about how these benefits and risks may apply to your particular situation and, if indeed, the gastric bypass is right for you.