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procedures
Gastric Bypass
Mixed bariatric surgery procedure (restrictive and malabsorptive) designed for weight loss and control of diseases associated with obesity, such as diabetes, high blood pressure, sleep apnea, fatty liver, dyslipidemia.
Quick Facts
| Weight loss | Loss of 60-80% of excess body weight within 12 to 18 months. |
| Surgery time | 1.5 hours |
| Hospital stay: | 2 days |
| Recovery time: | About 2-4 weeks |
Find answers to your questions
Consult our Frequently Asked Questions to obtain detailed information and clarify your doubts. We are here to help you make informed decisions.
Introduction
Gastric bypass is a surgical intervention used to treat morbid obesity and improve the quality of life of patients suffering from this condition (Angrisani et al., 2021). In this article, the procedure, its indications, benefits and risks are described.
Gastric Bypass Procedure
Gastric bypass is a bariatric surgery that combines restriction and malabsorption techniques to promote weight loss. The procedure is performed laparoscopically and involves the creation of a small gastric pouch, separated from the rest of the stomach, and its direct connection to the small intestine (Schauer et al., 2017). This redirection prevents food from passing through much of the stomach and small intestine, thus decreasing the absorption of calories and nutrients.
Indications and Contraindications
Gastric bypass surgery is indicated in patients with a body mass index (BMI) greater than or equal to 35 kg/m², or greater than or equal to 30 kg/m² with obesity-related comorbidities, such as type 2 diabetes, arterial hypertension, sleep apnea, and cardiovascular disease (SAGES, 2018).
In addition, patients must have tried unsuccessfully to lose weight through lifestyle changes and medical treatments.
There are absolute and relative contraindications for gastric bypass surgery. Absolute contraindications include the presence of uncontrolled psychiatric disorders, substance abuse, and noncompliance with previous medical recommendations (Buchwald et al., 2018).
Relative contraindications include serious diseases unrelated to obesity, such as active cancer, and previous abdominal surgeries that make the procedure difficult to perform.
Benefits and Risks
Gastric bypass surgery has been shown to be effective in long-term weight loss and improvement of obesity-associated comorbidities (Mingrone et al., 2021). On average, patients can lose between 60% and 80% of excess weight over a period of 12 to 24 months (Brethauer et al., 2013).
In addition, gastric bypass surgery can significantly improve patients' quality of life, reduce the risk of cardiovascular disease and decrease obesity-associated mortality (Adams et al., 2012). However, it also carries risks inherent to any surgical procedure, such as infections, bleeding, and anesthetic complications.
Long-Term Results
Numerous studies have demonstrated the effectiveness of gastric sleeve in weight loss and improvement of comorbidities associated with obesity. According to a meta-analysis study, the average weight loss after gastric bypass surgery is 58% to 65% of excess weight after five years (Clapp et al., 2018). In addition, significant improvement in comorbidities, such as type 2 diabetes, high blood pressure, and sleep apnea, among others, has been observed (Brethauer et al., 2013).
Complications and Risks
Although the gastric sleeve procedure is generally safe and effective, there are potential complications, such as bleeding, infections, gastric leaks, strictures, and deep vein thrombosis (Buchwald et al., 2014). Despite these risks, the rate of serious complications is low, around 2-5% (Gagner, 2016). It is important that patients are aware of these risks and discuss concerns with their medical team before undergoing the procedure.
Effectiveness of Gastric Bypass
Numerous studies support the effectiveness of gastric bypass in terms of weight loss and improvement in comorbidities. In a study by Mingrone et al. (2021), sustained weight loss over time and significant improvements in type 2 diabetes, hypertension and dyslipidemia were observed in patients undergoing gastric bypass compared to those treated with conventional medical therapies.
Another study by Schauer et al. (2017) compared gastric bypass with vertical gastrectomy, another bariatric surgery, and found that although both procedures resulted in significant weight loss, gastric bypass had higher rates of type 2 diabetes remission and improved lipid profile.
Complications and Follow-up
Despite its benefits, gastric bypass can have complications. Among the most common are anastomotic leakage, stricture, and ulcers in the gastric pouch or intestine (Buchwald et al., 2018). In addition, due to malabsorption of nutrients, patients may develop vitamin and mineral deficiencies, requiring long-term medical and nutritional follow-up (Mechanick et al., 2013).
Patients undergoing gastric bypass should follow a specific diet plan and receive education on lifestyle changes to ensure the success of the procedure and avoid complications (Aills et al., 2008). Regular follow-up with the medical and nutritional team is essential to monitor weight loss, adjust diet as needed, and assess the status of comorbidities.
Conclusion
Gastric bypass is an effective and safe surgical procedure for the treatment of morbid obesity and its associated comorbidities. Scientific studies demonstrate its effectiveness in long-term weight loss and in improving patients' quality of life. However, it is essential that patients are properly selected and receive rigorous medical and nutritional follow-up to ensure the success of the procedure and minimize complications.
References
Adams, T. D., Davidson, L. E., Litwin, S. E., et al. (2012). Health benefits of gastric bypass surgery after 6 years. JAMA, 308(11), 1122-1131. https://doi.org/10.1001/2012.jama.11164.
Aills, L., Blankenship, J., Buffington, C., Furtado, M., & Parrott, J. (2008). ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surgery for Obesity and Related Diseases, 4(5), S73-S108. https://doi.org/10.1016/j.soard.2008.03.002.
Angrisani, L., Santonicola, A., Iovino, P., Vitiello, A., Higa, K., Himpens, J., ... & Buchwald, H. (2021). Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2018. Obesity Surgery, 31(7), 3045-3057. https://doi.org/10.1007/s11695-021-05434-y.
Brethauer, S. A., Aminian, A., Romero-Talamás, H., Batayyah, E., Mackey, J., Kennedy, L., ... & Schauer, P. R. (2013). Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Annals of Surgery, 258(4), 628-637. https://doi.org/10.1097/SLA.0b013e3182a5034b.
Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2018). Bariatric surgery: a systematic review and meta-analysis. JAMA, 292(14), 1724-1737. https://doi.org/10.1001/jama.292.14.1724.
Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., ... & Kushner, R. F. (2013). Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity, 21(S1), S1-S27. https://doi.org/10.1002/oby.20461. https://doi.org/10.1002/oby.20461.
Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Leccesi, L., ... & Bornstein, S. (2021). Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5-year follow-up of an open-label, single-centre, randomised controlled trial. The Lancet, 386(9997), 964-973. https://doi.org/10.1016/S0140-6736(15)00075-6
SAGES (2018). Guidelines for Clinical Application of Laparoscopic Bariatric Surgery. Society of American Gastrointestinal and Endoscopic Surgeons. Retrieved from https://www.sages.org/publications/guidelines/guidelines-for-clinical-application-of-laparoscopic-bariatric-surgery/
Schauer, P. R., Bhatt, D. L., Kirwan, J. P., Wolski, K., Aminian, A., Brethauer, S. A., ... & STAMPEDE Investigators.(2017). Bariatric surgery versus intensive medical therapy for diabetes-5-year outcomes. New England Journal of Medicine, 376(7), 641-651. https://doi.org/10.1056/NEJMoa1600869
CONSULT
You may be a candidate for weight loss surgery.
You may be a candidate for weight loss surgery if you meet any of the following criteria:
Overweight
He weighs more than 20 kilos above his ideal body weight.
BMI
You have a Body Mass Index (BMI) greater than 30 kg/m².
Health
You suffer from obesity-related health problems, such as hypertension or diabetes.
Diets
You cannot achieve a healthy body weight, even with medically supervised diets.
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