Simplified Gastric Bypass
The Gastric Bypass is considered by the American Society of Metabolic and Bariatric Surgeons (ASMBS) as the gold standard of Weight Loss Surgery.
Roux-n-Y Gastric Bypass Surgery (RYGB) is the most commonly practiced weight loss surgery world wide.
The Gastric Bypass is also considered by the SAGES and ASMBS the most complex and technically challenging procedure to be done by laparoscopy and requires a large number of operations to achieve competency.
Open RYGB as treatment for obesity was introduced by Dr. Mason and Dr. Ito in 1967. The first Laparoscopic RYGB was performed in 1994 by Dr. Wittgrove following the surgical steps of the open surgery.
The Simplified Gastric Bypass was developed by Dr. Almino Ramos in Sao Paulo, Brazil and was called Simplified Laparoscopic Gastric Bypass consisting in simplifying and standardizing the surgical steps of the traditional Gastric Bypass in a way that it can be done in the superior half of the abdomen easily by trained Bariatric Surgeons with less operative time (average of 75minutes) and with more efficiency (now days thousands of patients are operated by this technique all over the world).
This technique involves a gastric stapling and its division (forming the gastroplasty, new gastric chamber or pouch) lowering the gastric capacity in 90% (20-30cc). The Gastric Bypass is done ante-colic (the open way was retro-colic, meaning that was done behind the transverse colon) and as far as 1, 5 to 2m (the small bowel has 4 to 7m in length). At the end of the procedure the gastroplasty is communicated with the deviated intestinal limb (gastrojejunostomy) by stapling and suturing them to allow the food to pass again.
What are the risks in Gastric Bypass Surgery?
International literature describes an average of 10% in complications (morbidity) and a mortality rate of 2%.
Anastomotic leak is the most serious complication of gastric bypass procedure and is associated with increase morbidity and mortality. The ideal treatment is prevention by meticulous operatory technique and pre and postoperative care. The leaks that are likely to result in mortality (about 15%) are those for which the patient manifests a high systemic inflammatory response and is closely related with a high BMI, with fever, increase leukocyte count and heart rate and also signs of organ failure.
How does it Work?
This operation mix gastric restriction with intestinal malabsorption and the restriction is predominant over malabsorption.
The food arrives at the new stomach (gastroplasty) and promotes distention on the walls of the pouch inducing satiety and fullness with small amounts of food. Then the food passes slowly trough the calibrated gastrojejunostomy of 11 mm and goes to make the digestion 1.5 to 2m after the new formed gastric pouch.
When the fullness sensation of the small chamber is exceeded pain or vomiting can occur.
After a Gastric Bypass the liquids with high concentration of carbs won’t be totally absorbed especially during the first year and can cause dumping syndrome with bowel irritation, abdominal pain and diarrhea, increase in heart rate with palpitation and sweating.
How is the post-op?
Most of the patients are discharged from the hospital within 48 to 72 hours after the operation.
The complete return to normal activities occurs in about one week.
During 4 weeks they will go on a liquid diet and advance in a stepwise way to a puree/baby food type diet for one or two additional weeks and evolving to an almost normal diet after that.
In this operation there is a need to supplement vitamins and minerals. Iron must be followed by regular I.V. tests and reposition is usually needed.
Who should have the Gastric Bypass done?
- Patients with Metabolic disease (Type 2 diabetes, HBP and hyper-lypidemic)
- Sweet eaters
- Any degree of binge eating disorder
- Moderate risk patients
- High expectations / needs to loose weight, up to 80% EWL (excess weight loss)
- Low / moderate patient commitment
- Not that close follow-up
- Total Patient Care (T.P.C.) at the beginning
Arturo Rodriguez, MD