Gastric bypass Surgery

What is gastric bypass surgery?  

Gastric bypass surgery is a weight loss procedure. During the procedure, the surgeon modifies your stomach and small intestines to restrict the amount of calories you can take in.

The surgeon creates a small pouch from your stomach that is connected directly to your small intestine. After swallowing food, it enters this small pouch directly and goes into our small intestine.

The food bypasses the major part of your digestive system, primarily the stomach and part of the small intestine.

Since the portion sizes that you consume are limited, you end up losing weight. There is also a reduction in ghrelin or “hunger” hormone levels which further reduces your appetite.

Your physician is likely to recommend gastric bypass surgery if you have serious weight problems and exercise and diet have not worked for you.

Who may need gastric bypass surgery? 

The following are some reasons your physician may recommend gastric bypass:

• If you are extremely obese, that is a body mass index (BMI) above 40

• If you are obese, that is a BMI of 35-39.9 but have high blood pressure, sleep apnea, and type 2 diabetes

Gastric bypass surgery also helps to improve the following conditions:

• Hyperglycemia

• Heart diseases

• Osteoarthrosis

• Fatty liver disease

• Hyperlipidemia

• Infertility

• Stroke

• High cholesterol

Not everyone who is overweight can have gastric bypass. You must undergo a rigorous screening process to determine whether you qualify.

Types of gastric bypass surgeries 

The two main gastric bypass surgeries are:

Robotic surgery

In this procedure, the surgeon makes use of a technologically advanced surgical robot to administer surgery.

The robot acts as a surgical assistance tool. It gives the surgeon a 3D visualized and magnified image of the stomach.

The surgeon guides the robot via small incisions in your abdomen to get a clear view of your internal organs. Robotic surgery has a high level of efficiency and precision compared to laparoscopic surgery.   

Laparoscopic surgery

During laparoscopic surgery, your surgeon inserts a miniature video camera inside your abdominal wall through small incisions.

The image of your stomach and other organs is projected on a small screen to give your surgeon a better view of what he/she needs to operate on.

The surgeon separates the bottom part of your stomach from the top part by stapling the top portion such separation aids in creating a small pouch that limits food intake.

Preparing for gastric bypass surgery 

Before a gastric bypass procedure, your healthcare provider will schedule appointments with healthcare specialists for screening and counseling. The healthcare team will be interested in:

Checking your lifelong commitment to lifestyle change

Gastric bypass surgery is an effective weight loss program.

The success of this procedure will be determined mainly by your commitment to changing your lifestyle, and especially what you eat. Otherwise, you will start gaining weight again.

That you have attempted to lose weight through exercise or diet

If your gastric bypass surgery is being paid for by your health insurance, they may ask for evidence that the procedure is a medical necessity.

You could be asked to enroll in an exercise and a supervised diet program before undergoing gastric bypass surgery.

Your mental and physical ability to handle surgery

Your healthcare provider will order standard medical tests to ascertain the safety of gastric bypass surgery for you.

The medical specialist will undertake screening for alcohol, tobacco use, and mental health.

Some tests include:

• Electrocardiogram (EKG)

• Blood tests

• Chest x-ray

Procedure 

A gastric bypass surgery is administered under general anesthesia. The anesthesia will put you to sleep during surgery and you will feel no pain.

The procedure of gastric bypass will be determined by your surgeon’s practices and your individual situation.

Some procedures are performed laparoscopically while others rely on robotic surgery.

Laparoscopic surgery is the standard procedure for gastric bypass surgery. The surgeon starts by making a “keyhole incision” in your abdomen.

The goal of this keyhole is to allow the surgeon to inflate the abdominal cavity using carbon dioxide. The gas helps to separate organs from the abdominal wall. That way, the surgeon can see the organs.

The surgeon inserts a laparoscope via the keyhole to allow him to visualize your organs. This is a miniature video camera. The image from the laparoscope is projected onto a small computer screen.

The surgeon makes several other keyhole incisions to allow him to gain access to your organs.

The surgeon creates a small pouch by separating the bottom part of your stomach from the top portion using a surgical stapler. The rest of your stomach is connected to the small intestines.

Next, the surgeon connects the lower part of your small intestines with the new pouch. This allows food to bypass the larger segment of your stomach and small intestines.

Finally, the surgeon re-attaches the top part of your small intestines to the trunk beneath it. This creates two branches linked to the trunk.

The first branch originates from the newly created stomach punch and the second one originates from the remainder of the stomach.  This creates a “Y” shaped branch.

The left side of this branch transports digestive juices that mix with food while the right side permits the passage of food.

After surgery

Gastric bypass surgery may take 2 to 4 hours.

After a gastric bypass procedure, the surgeon will restrict your intake of solid food. This is to allow time for the healing of your stomach and intestines. That means you can only take liquids.

You will work with a nutritionist who will prescribe a special diet plan for you. You will slowly graduate from liquids to pureed foods.

Once the nutritionist has ascertained that your body can handle firmer foods, you can start eating them.

You will still have limits on the amount of liquids to drink or food to eat.

Your surgeon may recommend mineral and vitamin supplements after a gastric bypass procedure.

Your surgeon will discharge you from the hospital after ensuring you are stable and that you can move around comfortably without any help.

You are likely to feel moderate pain a few days post-surgery. For this, your surgeon will prescribe pain medication. This is administered intravenously.

You will also be given pain medication to take as you recover at home. The pain will be gone within a few days.

During the first few months after gastric bypass surgery, your healthcare provider will arrange regular medical appointments to assess your overall health.

These medical checkups may include blood work and other exams.

During the first three to six months post-surgery, you will experience certain changes.

Some of these changes include:

Fatigue – This could be because you are not getting enough energy due to a restricted diet.

Mood changes – Weight loss is often accompanied by hormonal changes. These will affect your mood.

Poop changes – The smell and consistency of your poop changes because of the inability of your small intestines to absorb water or digest food like before.

The restricted dietary intake and rapid weight loss in the first few months after gastric bypass surgery can lead to:

• Hair loss

• Cold

• Body aches

Benefits of gastric bypass surgery

Gastric bypass surgery success rate is very high for weight loss.

The procedure also helps to resolve or improve other health conditions such as:

• Obstructive sleep apnea

• Type 2 diabetes

• High blood pressure

Most people stop taking medication for the above conditions after a successful gastric bypass surgery.

Risks/Complications

Gastric bypass surgery comes with certain risks both in the short-term and long term.

The short-term possible risks of gastric bypass surgery are:

• Excessive bleeding

• Infection of the incision site

• Reaction to anesthesia

The following complications are also likely to accompany gastric bypass surgery:

• Anastomotic leaks – This could happen in case of leaks in one or more of the connection points in your small intestines. When this happens, it could cause an abdominal cavity infection

• Hernias – A hernia happens in case an organ(s) pushes via a gap in the muscle wall

• Small bowel obstruction – Scar tissue may lead to obstruction or narrowing of the small intestines

In the long term, gastric bypass surgery can manifest in the following complications:

Malnutrition and malabsorption

The gastric bypass procedure deliberately causes malabsorption in the small intestines. The aim is to minimize the absorbed calories.

Gastric bypass procedures may also induce nutritional deficiencies. For that reason, your doctor will prescribe nutritional supplements.

Gallstones

During the period of significant weight loss, your liver is bombarded with large quantities of cholesterol that need processing.

The bile transported to your gallbladder contains additional cholesterol that accumulates in your gallbladder. This develops into gallstones.

Gallstones can be problematic especially if they obstruct your bile ducts. Your surgeon will prescribe medication to avoid the formation of gallstones.

Dumping syndrome

Dumping syndrome refers to symptoms that manifest after the fast dumping of food from the stomach into the small intestines.

Examples of dumping symptoms include hypoglycemia, diarrhea, nausea, and abdominal cramping.

Dumping syndrome is short-lived. Your doctor will provide specific dietary guidelines to mitigate or avoid dumping syndrome.

Bile reflux

Surgery may interfere with the functioning of your pyloric valve. This is the small opening that connects your stomach with the small intestines.

A malfunctioning pyloric valve will lead to bile reflux. This may trigger the development of stomach ulcers or gastritis due to the erosion of your stomach lining.

Weight regains

You could still put on more weight after weight loss surgery if you are not disciplined enough to follow a prescribed dieting and exercise program.

If you eat more food than is necessary, the small punch will expand to accommodate extra food.

A weight regain may cause another gastric bypass surgery to redo or repair your pouch.

Ulcers

A gastric bypass procedure predisposes you to duodenum or stomach ulcers. If you are on any non-steroidal anti-inflammatory drugs (NSAIDs) or are a smoker, your doctor will ask you to stop doing it to minimize the risk of ulcer development.

Other risks include:

• The staple line may fall apart or break down

• Nutritional deficiencies

• Pouch stretching

Stomal stenosis

The part that connects your small intestine and the stomach could get narrowed. When this happens, it will lead to such symptoms as vomiting and nausea.

You may also have a hard time eating. A stomal stenosis calls for a dilation of the narrowed connection.

Cost of gastric bypass surgery in India  

The cost of gastric bypass surgery in India ranges between Rs. 2,50,000 and Rs. 6,00,000.  

The table below outlines the price range for gastric bypass surgery in various cities across India:

The cost difference depends on the following factors:

Surgical technique used

Laparoscopic surgery is slightly more expensive in comparison with open gastric surgery.

Surgeon’s fee

An experienced surgeon charges more for a gastric bypass procedure compared to a less experienced surgeon. This will impact the overall cost of surgery.

Patient’s overall health

Each patient differs in terms of their overall health. If you have an underlying health condition, you are highly prone to risks and complications. That means a rise in treatment costs.

Location

The cost of gastric bypass surgery will be determined by the city where the procedure takes place. Metropolitan cities such as Mumbai, New Delhi, and Bangalore charge more than Tier-1 or Tier-II cities like Kochi and Jaipur.

Hospital chosen

Private hospitals charge more for a gastric bypass procedure than government hospitals.

Diagnostic tests and procedures

You will have to undergo a battery of tests so that your surgeon to determine that you are a suitable candidate for gastric bypass surgery. Tests like ultrasound, chest x-ray, and ECG add to the overall cost of your treatment.

Hospital-related costs

These include the cost of the admission fee, room, meals, and nursing care. The total cost of the hospitalization expenses depends on the duration of your hospitalization.

Post-surgical care

Any consultation with your doctor post-surgery will add up to the overall cost of gastric bypass surgery.

References

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