What is gastric bypass surgery?

Gastric bypass surgery is the most common bariatric procedure that helps in significant weight loss by altering the digestive system. It reduces the capacity of the stomach and rearranges the small intestine to limit food intake and nutrient absorption. This helps patients achieve and maintain a lower body weight.

It can be of two types:

1. Roux-en-Y Gastric Bypass (RYGB): The digestive tract is altered in two places. The upper portion of the stomach is attached to a part of the small intestine. Additionally, the top and bottom portions of the small intestine are connected together.
2. Mini Gastric Bypass Surgery: In this method, the digestive tract is modified in only one place (the tiny stomach pouch attached to the small intestine).

Conditions Treated With Gastric Bypass Surgery

Gastric bypass surgery makes long-term alterations to the metabolic system of an individual. This leads to the improvement of several obesity-related conditions. Some of the primary issues treated include:

1. Type 2 diabetes
2. Heart disease
3. Hyperlipidemia (high cholesterol)
4. Sleep apnoea (breathing repeatedly stops and starts during sleep)
5. Osteoarthritis

Who needs gastric bypass surgery?

RYGB surgery is recommended for individuals who do not achieve sufficient weight loss through diet and exercise. The general criteria for those who may need this procedure are as follows:

1. Extreme obesity (body mass index of 40 or higher)
2. Obesity (BMI between 35 and 39.9) with comorbidities like type 2 diabetes, high blood pressure, or severe sleep apnoea
3. Willing to commit to a healthier lifestyle, including diet modifications and regular exercise

Benefits of Gastric Bypass Surgery

RYGB procedure has a high rate of long-term successful weight loss. It offers various benefits to individuals struggling with obesity and its associated health complications. The primary advantages of the surgery include:

1. Minimally Invasive Options: Gastric bypass surgery can often be performed laparoscopically. It is less invasive than traditional open surgery. This approach results in smaller incisions, less pain, and a quicker recovery time.
2. Significant Weight Loss: The procedure results in substantial weight loss within the first two years. Patients can expect to lose approximately 70% of their excess weight.
3. Treatment of Comorbid Conditions: The surgery improves or resolves various obesity-related diseases, including type 2 diabetes, hypertension, high cholesterol, and sleep apnea.

Before and On the Day of Gastric Bypass Surgery

To ensure the success of gastric bypass surgery, patients must understand the preparatory steps required both before and on the day of the procedure. They must follow their surgeons instructions carefully.

Before Gastric Bypass Surgery

In the days leading up to gastric bypass surgery, patients will receive nutritional counselling and start a special guided protein diet to reduce their liver size and body fat. This diet is high in proteins and low in carbohydrates, fats, and sugars. Some other guidelines before the procedure are as follows:

On the Day of Gastric Bypass Surgery

On the day of the surgery, patients should arrive at the hospital or surgical centre well-prepared. They can expect the following before the final procedure:

The Procedure of Gastric Bypass Surgery

Gastric bypass surgery can be performed using traditional open surgery or the laparoscopic technique. Today, about 90% of procedures are performed laparoscopically. The complete operation takes about two to four hours and includes the following steps:

1. Anaesthesia: Patients are given general anaesthesia to make them unconscious.
2. Incisions: In the laparoscopic technique, four to six small incisions are made in the belly. The surgeon inserts a laparoscope and surgical instruments through these cuts. For open surgery, a large vertical incision is made in the abdomen, from the chest to the belly button. The rest of the procedure is similar in both techniques.
3. Creating a Small Stomach Pouch: The surgeon uses staples to divide the patients stomach into a smaller upper pouch and a larger lower pouch. The upper part is made to hold about 28 grams of food, significantly less than the normal stomach.
4. Dividing the Small Intestine: It is divided into two segments. The lower portion is brought up and connected to the newly created small stomach pouch. As a result, food bypasses a part of the stomach and small intestine, and the body absorbs fewer calories.
5. Rerouting the Intestine: The top portion of the divided small intestine is connected to a further down part of the intestine, creating a "Y" shape.
6. Closing the Incisions: The incisions in the abdomen are closed with sutures or surgical staples.

Note: The selection of treatment approach is based on the patients condition and the doctors opinion.

Alternatives to Bariatric Surgery

Patients can also opt for less invasive alternatives to bariatric surgery. These techniques use an endoscope inserted through the mouth into the stomach. The following are two common procedures for weight management:

1. Intragastric Ballooning: It involves placing a silicone balloon inside the stomach to occupy space and promote early satiety. The balloon is left in place for six months before being removed. It can help patients lose up to 15% of their body weight.
2. Endoscopic Sleeve Gastroplasty: During this procedure, a series of sutures are placed in the stomach to reduce its size by 70%. It helps patients lose up to 20% of their body weight.

Recovery After Bariatric Surgery

After weight loss surgery, recovery and post-operative care are critical to achieving long-term success. The following is what patients can expect during the recovery phase:

In Hospital Recovery

Depending on the type of surgery, patients may be hospitalised for 1 to 3 days. During this time, they are monitored for any complications.

• After surgery, the patient is shifted to the recovery room. The nurse monitors their breathing, heart rate, and blood pressure.
• Once their condition stabilises, they are moved to a general ward.
• The doctor prescribes antibiotics to prevent infections and pain relief medications for discomfort.

At-home Recovery

Patients can return to their normal activities 4 to 6 weeks after discharge. During this time, it is important to follow these instructions:

1. Diet: Adhering to portion control is vital to avoid regaining weight and to support nutritional health.
   • For the first two weeks, patients will follow a liquid diet (to thin soup).
   • During weeks 3 and 4, they will transition to pureed foods like yoghurt.
   • They can eat soft foods like mashed potatoes during weeks 5 to 8.
   • After that, return to a balanced diet can be achieved under medical advice.
2. Hydration: Staying hydrated is crucial to avoid nausea and vomiting. However, it is important to sip small amounts of fluids throughout the day to avoid filling the stomach too quickly. It is recommended that patients drink 1.5 to 2 litres of water every day.
3. Wound Care: It includes keeping the area dry, checking the surgical site for signs of infection, such as redness, swelling or discharge.
4. Physical Activity: Walking is highly recommended to improve circulation and promote healing. However, patients should avoid strenuous activities and heavy lifting for six weeks after surgery.

Follow-Up Appointment

The initial follow-up appointment will be scheduled with the healthcare team two to three weeks after surgery. After the initial visit, regular check-ups will be scheduled at three, six, nine, and twelve months post-operation. The patient will continue to see the doctor for extended check-ups after the first year post-operation. The surgeon and nutritionist will assess the need for removal of sutures, order the next phase of the diet, and monitor any other issues. The doctor may recommend laboratory tests, blood work, and other assessments.

Risk and complication of Roux-en-Y gastric bypass

Like any major surgical procedure, gastric operation carries potential risks. These can range from minor to serious and should be carefully considered when deciding whether to proceed. Gastric bypass surgery side effects may include:

1. Infection
2. Significant bleeding
3. Blood clots
4. Reactions to anaesthesia
5. Breathing issues
6. Leaks in the gastrointestinal system

Patients may also experience some long-term complications after gastric bypass. These include:

1. Dumping syndrome (food moves too fast through the small intestine, causing symptoms like vomiting, nausea, diarrhoea, etc.)
2. Bowel obstruction
3. Gallstones
4. Hernias
5. Malnutrition

Risks of Delaying Gastric Bypass Surgery

Delaying gastric bypass surgery can lead to several complications associated with the continued presence and progression of obesity. Here are some risks involved:

1. Worsening Health Conditions: Obesity-related diseases such as diabetes, hypertension, and sleep apnea may worsen over time without effective weight loss. This increases the risk of serious complications like heart disease or stroke.
2. Reduced Mobility: Increased body weight can exacerbate joint pain and mobility issues. It leads to a further decrease in physical activity and quality of life.
3. Psychological Impact: Continued struggles with obesity can also have negative effects on mental health, causing depression and anxiety.

Cost of Gastric Bypass Surgery

The expense of gastric bypass surgery can vary widely depending on several factors. Understanding these elements is vital for patients considering this procedure. Generally, the cost starts from ₹ 2,50,000 and reaches ₹ 4,50,000. The average price of the procedure is ₹ 3,20,000.

Note: The figures mentioned above are approximate. Individuals are advised to consult HexaHealth experts for up-to-date pricing information.

Factors that influence the cost of gastric bypass surgery in India include:

1. Surgeons Expertise: The medical experts experience can affect the cost. Highly qualified and well-known surgeons charge more for the services they provide.
2. Healthcare Facility: Private hospitals are costlier than public hospitals, but they often provide more personalised care and shorter wait times.
3. Geographic Location: Expenses can vary significantly based on the city where the surgery is performed. The procedure is expensive in urban centres and regions with a higher cost of living.
4. Pre and Post–Surgery Care: Preoperative evaluations, post-operative follow-ups, diet counselling, and other support services can add to the total cost.
5. Insurance: The extent of coverage provided can affect out-of-pocket expenses.

Takeaway

Gastric bypass surgery is an effective method for achieving significant weight loss. It also assists in the long-term management of diabetes, hypertension, and other metabolic disorders. This procedure, which alters the digestive tract, requires a commitment to a new lifestyle and diet to maintain the benefits.