Roux-en-Y gastric bypass

In a gastric bypass, the stomach volume is greatly reduced and a rerouting of the digestive tract is created. The procedure is performed by keyhole surgery (laparoscopy) or with the robot. The surgeon creates a small pouch stomach at the transition from the oesophagus to the stomach. The large remnant stomach is preserved, so this procedure, unlike the sleeve gastrectomy, is reversible. The pouch stomach is then connected to the small intestine so that the large remnant stomach is bypassed. This section of the small intestine is called the alimentary limb. Finally, the outlet of the large remnant stomach is connected to the alimentary limb at a lower level. It is at this level that the digestive juices first come into contact with the food.

The gastric bypass is the most frequently performed bariatric operation in Belgium. It is often regarded as the gold standard among bariatric procedures. The gastric bypass works restrictively as well as malabsorptively and hormonally. The amount of food one can eat during a meal is greatly limited without a feeling of hunger in return. In addition, the absorption of fats is limited. Eating high-calorie food, in particular sugars, can give an unpleasant feeling. This is called dumping syndrome. It can be accompanied by palpitations, sweating, dizziness and nausea. It keeps the patient away from eating sugars and can therefore contribute to better eating habits after the operation.

Patients undergoing this procedure are usually admitted on the day of the procedure. A few hours after the operation, the patient may already drink a few sips of water and carefully get out of bed. The next day, a liquid diet can be started and the patient may go home again. The length of the hospital stay can of course vary depending on the clinical circumstances.

Results

Studies show that after a gastric bypass, patients can expect a loss of 80-90% of their excess weight. The weight loss usually occurs in the first 12-18 months after the procedure, the majority of it during the first 6 months. These values can vary from patient to patient and depend on lifestyle, age, adherence to the post-operative guidelines, comorbidity and genetic predisposition.

A gastric bypass not only leads to substantial weight loss but also has a major influence on comorbidity. Diseases such as diabetes, sleep apnoea and high blood pressure can improve considerably or even disappear as a result of this procedure.

Complications

Every operation can be accompanied by complications. People who are overweight have a greater chance of complications than people of a normal weight. There are standard post-operative complications that can occur after any operation, such as bleeding, infection, abscess formation, incisional hernia, thrombosis of the leg or a pulmonary embolism.

The most common risks directly associated with a gastric bypass are:

• Stomach ulcer (greatly increased risk in smokers).
• Vitamin or iron deficiency (supplements will be prescribed for this).
• Hair loss (this is caused by the weight loss and is temporary. The hair loss remains limited and the hair grows back completely).
• Dumping (mainly caused by eating sugars, which is strongly discouraged after a procedure).
• Internal herniation (to reduce this risk, at Obesity Clinic Dendermonde the spaces that arise after a bypass are closed).
• Chronic unexplained abdominal pain.
• Leakage or bleeding along the staple line.
• The remnant stomach is difficult to reach after the operation for any possible future examinations.