Gastric bypass is a surgical operation to reduce stomach volume and change the food system. It is a type of bariatric surgery to treat some cases of severe obesity.
Although life expectancy is increasing steadily in Europe the rising prevalence of overweight and obesity is considered as a major social problem with many complications, including cardiovascular disease, hypertension, and diabetes. Overweight is defined by calculating the body mass index, BMI. Gastric bypass surgery is a relatively new method of treatment. Previously vertical banded gastric surgery was used, which operated in an elastic band around the stomach but now gastric bypass is more prevalent as a method. Other methods are sleeve gastrectomy used for easy obesity and duodenal switch used in patients with a BMI above 50.
Gastric bypass implies the intervention to reduce, by laparoscopy, the volume of the stomach and change the food system. This technique consists of a vertical cross-section of the proximal stomach creating a small pouch capacity in which the food arrived, connected directly to the jejunum.
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The food does not pass through the stomach and the upper part of the digestive tract; it goes straight into the middle part of the small intestine.
The surgery can be performed either as standard open surgery where surgeon opens the abdomen between the breastbone and the navel or through keyhole surgery. A small pocket in the upper part of the stomach is sewn to a size of about 1-1 ½ decilitre. Then small intestine is cut and stitched to the new stomach pouch. The duodenum is then sewn fixed about 1-1 ½ feet down by the small intestine. The surgery takes 1-3 hours to complete. The gastric bypass is a method that can be reversed only if necessary. Comfort food is better than gastroplasty as vomiting are common. Eating habits must be changed during the first three months, it is often advisable to take three meals and two or three snacks.
Sugary snacks are poorly tolerated because of the dumping syndrome. The gastric bypass requires regular monitoring by a multidisciplinary team and supplementation with vitamins and minerals for life.
Like any surgical procedure, a number of more or less serious complications exist: bleeding, surgical site infection, risks of anesthesia itself.
Specific to the tubular gastrectomy risks are:
- The wound infection requiring revision surgery to perform drainage.
- Fistula (communication between the gastric lumen and the rest of the abdominal cavity) may lead to the formation of an abscess, peritonitis or a severe sepsis. The treatment of the fistula is a total fast for several days, the administration of intravenous antibiotics or temporary installation of a stent. This is the most dreaded complication of the tubular gastrectomy, its occurrence can prolong hospitalization for several weeks and take months to heal.
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