Combined gastric bypass surgery
Gastric bypass surgery is a combined procedure that involves the reduction of both the stomach size and the digestive tract. The reduction of the stomach size by nearly 90% considerably decreases the amount of food to be eaten at one sitting and results in an early feeling of fullness and satisfaction. The reduction of the digestive tract allows the food to bypass the larger portion of the stomach and the upper part of the small intestine, i.e., food travels a shorter way, and thus the absorption of nutrients is reduced.
The following special criteria are applied for the surgical treatment of obesity:
- BMI ≥ 40 kg/m2;
- BMI ≥ 35 kg/m2 with comorbid diseases (type 2 diabetes mellitus, hypertension, sleep apnea, arthrosis, infertility);
- Conservative weight loss methods applied were not effective;
- No history of endocrine disorders, which can cause obesity.
How Is the Surgery Performed?
The patient is operated on under general anesthesia. During the surgery, a laparoscopic approach is employed. A small incision at the belly button is placed, and a tiny laparoscopic video camera (laparoscope) is inserted through this incision. To introduce and manipulate surgical instruments, a few small additional incisions are placed. The abdominal cavity is inflated with CO2 gas, which creates a working space for the surgeon. The surgeon performs all surgical manipulations while watching them on a video screen.
During this procedure, a small stomach pouch (15–30 mL) is created from the upper portion of the stomach by stapling. The small intestine is surgically divided in a certain area, and the middle portion of the small intestine (jejunum) is brought up to connect it to the newly formed stomach pouch. This allows bypassing the remaining larger portion of the stomach and the upper part of the small intestine (duodenum). The length of the small intestine to be bypassed depends on the patient’s BMI.
What Should Be Known After the Surgery?
- It is very important to follow special eating guidelines, especially during the first days, as well as to have regular follow-up visits during the postoperative period;
- this surgery allows the patient to lose 65% to 85% of excess body weight on the average.