What Is Gastric Bypass?
Gastric bypass is a viable surgical strategy used to treat obesity and obesity-related diseases. The procedure
reduces stomach volume and reroutes part of the intestines. As a result, patients feel full with less food and a
portion of the calories consumed are excreted without being absorbed.
There are two essential mechanisms of action:
– Restrictive: A small stomach pouch is created, providing a feeling of fullness with smaller portions.
– Malabsorptive: The initial part of the small intestine is bypassed, reducing the absorption of calories and
nutrients.
This results in sustained weight loss and significant improvement in obesity-related conditions such as type 2
diabetes, hypertension, and sleep apnea.
Who Is a Candidate for Gastric Bypass?
The following individuals may be considered suitable candidates for gastric bypass:
– Those with a Body Mass Index (BMI) of 40 or higher
– Those with a BMI of 30 or higher and comorbidities such as diabetes, hypertension, insulin resistance, or
sleep apnea
– Individuals who have failed to lose weight through diet, exercise, and medication
– Adults aged 18-65 with no contraindications for surgery
– Individuals who are motivated and able to commit to long-term lifestyle changes
Who Is Not a Suitable Candidate?
Patient Selection Criteria
Proper patient selection is crucial for successful results. The evaluation includes:
– Body Mass Index (BMI) and weight history
– Existing comorbidities (e.g., diabetes, hypertension, sleep apnea)
– Presence of acid reflux (may influence the type of bypass selected)
– Psychological readiness and motivation
– Eating habits and ability to comply with follow-up
– Previous surgical history
Types of Gastric Bypass
a) Roux-en-Y Gastric Bypass (RYGB):
– A small stomach pouch is created
– The first part of the small intestine is bypassed
– Two surgical connections (anastomoses) are made
– Considered highly effective for type 2 diabetes and reflux
b) Mini Gastric Bypass (OAGB):
– A single anastomosis is created
– The stomach is shaped into a long, narrow tube
– The procedure is simpler and shorter
– Higher risk of bile reflux compared to RYGB
– Provides strong weight loss and diabetes control
How Is the Surgery Performed?
The surgery is performed laparoscopically (minimally invasive). Small incisions are made in the abdomen,
allowing access to the stomach and intestines with surgical instruments.
– The procedure takes approximately 1.5 to 2 hours
– Hospital stay is typically 2-4 days
– Patients are usually encouraged to begin walking on the same day
Important Considerations
– Dumping Syndrome: Occurs when sugary or fatty foods rapidly empty from the stomach, causing symptoms
like sweating, low blood pressure, and weakness
– Vitamin/Mineral Deficiencies: Lifelong supplementation is required
– Protein Deficiency: Adequate protein intake is essential to prevent muscle loss
– Gallstones: May develop due to rapid weight loss
– Pregnancy Planning: Should be postponed for at least 12-18 months after surgery
– Emotional Changes: Psychological support is recommended if needed
Postoperative Period
Early Stage (First Month):
– Liquid and puréed diet is followed
– Goal: 60-80 grams of protein per day
– Temporary side effects: nausea, fatigue, gas
– Light walking begins during the first week
Mid-Term Stage (1-3 Months):
– Gradual transition to solid foods
– Period of rapid weight loss
– Eating behavior begins to change
– Vitamin and mineral supplements started (B12, iron, vitamin D, zinc, calcium)
Long-Term Stage (After Month 3):
– Continued weight loss and body transformation
– Establishment of a regular exercise routine
– Psychosocial adaptation becomes important
– Blood tests are recommended at 6 months and annually thereafter
