WHAT DOES A GASTRIC BYPASS MEAN?
A keyhole bypass operation means that a small pouch of stomach is created by stapler guns leaving the remaining detached stomach internally. This pouch is then connected surgically to a length of diverted bowel to impair food absorption. So a combination of restriction and decreased absorption is achieved. This operation has become the most common weight loss procedure in some countries due to its effectiveness and long term success. Nutritional supplements are required following surgery.
MECHANISM OF ACTION
As depicted in the video above, a bypass procedure has several mechanisms of action. The first is restriction, achieved by creating a small pouch of stomach which limits the amount of food that can be eaten. This pouch is then connected to a diverted segment of bowel. This limits the absorption of food from two parts of the bowel (blue and yellow on video), whereby absorption is facilitated only when both colours mix together further down (green). Weight loss is triggered from the day of surgery, will slow down after several months and plateaus at 18-24 months after surgery.
Furthermore, this procedure has been shown to alter the chemical signals arising from the bowel to help reduce food craving and increase the sensation of early fullness.
Out of the 4 common interventions, bypass has the greatest and most sustained weight loss effect. It is a bigger operation, with limited risks and will require intake of a multi-vitamin tablet on a daily basis. Follow up is essential, as with all these procedures, and is mostly limited to checking levels of minerals and vitamins in the blood on a regular basis for top-ups if necessary.
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- Follow ups with surgeon and dietician
- Two night hospital stay
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The whole procedure is performed through keyhole surgery and usually takes 2 hours to perform. All being well, individuals are discharged with anti-acids and 5 days of blood thinner, following a 2 night stay in hospital. Most individuals are able to return to work 2-3 weeks later and will mostly remain on a soft, mashed diet for a few weeks prior to building up their diet.
As with all the procedures, the recommendation is to eat slowly and chew food well.
As with any surgery, the possible complications are bleeding, infection or clots forming in leg veins or moving to the lungs. With this surgery, albeit small, the main risk is leakage from the joins (see video) between bowels and stomach. If it does happen, a return to surgery is required to deal with the problem. Other risks, such as internal hernia formation are much less common. Dumping syndrome and nutritional deficiencies can occur. Failure to lose weight or weight regain is dependent on the individual and their adherence to the program.