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In Gastric Bypass surgery, there is both a stomach reduction process and the rate of absorption is reduced by reducing the way the food travels in the intestines. First of all, the stomach is reduced to a size of approximately 30 cc (a coffee cup) to remain a pouch. Afterwards, the duodenum and the first 50-75 cm of the small intestines are disabled, that is, bypassed. Thus, patients both eat less due to mechanical restriction and change their appetite and food perceptions because intestinal-origin hormonal traffic changes. However, since the parts of the intestine that can absorb some of the eaten food are disabled, there is a moderate malabsorption.
In this surgery, the esophagus and a small part of the stomach are preserved, and the part of the intestines called the jejunum is sewn directly to the stomach. Patients switch to liquid foods first, then pureed foods and then solid foods. It may take up to 1 month for patients to switch to pureed foods. After this surgery, there will be a serious weight loss in patients, especially in the first year. However, it is also reported that the gastric pouch enlarges, especially after the 5th year, and a significant portion of the patients need correction surgeries.
This surgery is the most used method in bariatric surgery today. Post-surgery patients may need to take vitamin supplements for life. This situation is stated to the patients by the doctors and the operation decision is taken after that.
The biggest side effect of the surgery is vitamin deficiency. In addition, diarrhea and smelly gas problems can also affect socialization. All these problems are problems that can be regulated by medical treatment.
How is Gastric Bypass Surgery Performed?
Gastric Bypass is applied with laparoscopic surgery method. The closed operation is performed by opening many small incisions. Ports are placed through incisions so that the hand tools reach the abdomen. One of them is the surgical telescope connected to the video camera and the others are for the entry of specialized surgical instruments. The doctor watches the operation on a video monitor. An experienced laparoscopic surgeon can perform many procedures closed, just like open surgery.
Gastric Bypass surgery performed in 1967 for the first time in history and laparoscopic gastric bypass (Roux-en-Y) surgeries performed in 1993 have taken their places in history as the most difficult operations to be performed due to the limited surgical technologies of the time. Although it is a difficult operation to perform, Gastric Bypass has become very popular due to the use of this method and the shortening of the hospitalization period thanks to this operation, less scarring and reduced possibility of surgical site hernia.
A small stomach part is left on the side of the esophagus from the uppermost part of the stomach where it joins with the entrance, and it is closed and cut off in such a way that almost 90% of the stomach is disabled. In this way, an area smaller than 30 mL is created in the proximal gastric, that is, at the entrance of the stomach, and this area is called the stomach pouch. This newly created stomach pouch has a volume of almost less than 1 tea glass. In this surgery, the stomach is left in place and no part is removed. By creating a gastric pouch, the existing stomach is excluded and thus the food is ensured to reach here.
It is taken from the distal part of the small intestines (large intestine) and cut about 50-75 cm and associated with the new stomach pouch created. The end of the small intestine, which is at the back and continues to come from the inner part of bile and pancreatic fluid, is brought together with the intestine again. All these cutting, separating, joining and flaring applications are carried out with high-tech, disposable special tools known as “stapler”.
How Does Gastric Bypass Surgery Work?
With Gastric Bypass Surgery, it limits both food intake and food absorption. Almost 95% of the stomach, duodenum and upper part of the small intestine are disabled, thus reducing the stomach. Gastric bypass reduces stomach size by over 90%. The normal stomach may enlarge, sometimes up to 1000 ml. The gastric bypass pouch is 15-30 ml in size. The gastric bypass pouch, that is, the area created for the stomach, is created in the upper part of the stomach, which can stretch very little, and thus, there is no significant increase in the volume of the pouch in the long term.
The first reaction that occurs when the patient ingests a certain amount of food is the stretching of the wall of the stomach pouch, triggering the nerves that inform the brain that the stomach is full. The patient feels full as if he had eaten a large meal, whereas he ate only a few spoonfuls. Many people do not stop eating when they feel full. But patients learn very quickly that they need to eat their next bite very slowly and carefully to keep themselves away from increasing discomfort or vomiting. Weight loss is higher than restrictive methods. The total energy intake of the individual is less and the tendency to show food intolerance is higher. For this reason, the patient loses weight both because he eats less and because what he eats enters the intestine directly towards the end of the intestine, not the beginning of the stomach.
For Which Patients Can Gastric Bypass Surgery Be Applied?
It can be applied to patients who cannot get rid of obesity and regain their form despite struggling, or who have complaints such as diabetes resistance and joint disorders along with excess weight. Gastric Bypass, which was the most widely used surgical method until almost five years ago, decreased as sleeve gastrectomy became more common. It is a method that is applied as a second surgery (revision surgery) in patients who have regained weight after sleeve gastrectomy surgery. It can be performed not only on sleeve gastrectomy, but also on all patients who have had gastric banding, gastric folding, or vertical gastroplasty. All of these procedures are performed by laparoscopic method.