Gastric ByPass Surgery
Gastric Bypass is the creation of a transition path from the stomach to the intestines in general surgery. It is a method applied in various diseases that block the exit of the stomach. In the sense used in obesity surgery, gastric bypass is a surgical method in which most of the stomach is disabled, and the food taken is digested using almost only half of the intestines.
Gastric Bypass Surgery In Which The Patient Is Applied To?
It can be applied to patients who are obese and cannot lose weight or have weight-related insulin resistance, complaints with excess weight. Until five years ago, it was the most common surgical method. But as the tube stomach became more popular, the frequency of its application decreased. It is now applied as a second operation (revision surgery) in patients who gain weight again after the tube stomach. Again, as revision surgery, it can be applied to all patients who have previously had tube stomach, gastric band, stomach folding, or vertical gastroplasty. Again, all of these procedures can be performed laparoscopically (closed).
What Tests Are Performed Before Gastric Bypass Surgery?
First, the following tests and examinations are applied to each patient before surgery
* Blood biochemistry tests
* Hormone tests
* Hepatitis tests
* Whole abdominal ultrasound
* Stomach endoscopy (with anesthesiologist)
* ECG (heart chart)
* Lung graph
* Lung breath test
* Exertion test and Echo (electrocardiography) if necessary)
After all these tests, the necessary examinations and examinations are carried out by anesthesia, internal medicine, cardiology, pulmonology, and Endocrine specialists. As a result of these examinations, it is first looked at whether there is another underlying disease that can cause the patient to gain weight. If there is no such disease, the patient is examined from the point of view of anesthesia, like every patient who will have surgery, to see if there is an obstacle to the operation. Relevant experts make recommendations on treatments that will be applied before surgery, if necessary. During and after this operation, the problems that may occur are minimized.
How Is Gastric Bypass Surgery Performed?
The entire procedure is performed by the laparoscopic (closed) surgery method. Laparoscopic surgery is performed by making a large number of small incisions. Ports placed through these incisions are used to reach the abdomen of hand tools. One of them is a surgical telescope connected to a video camera, and the other is for specialized surgical instruments to enter. The surgeon monitors the operation from a video monitor. With experience, an experienced laparoscopic surgeon can perform many procedures laparoscopically, just like in open surgery.
What Are The Different Applications Of Gastric Bypass Surgery?
Gastric bypass, Roux-en-Y (proximal)
This variant is the most commonly used gastric bypass technique and is the most commonly performed bariatric procedure in the United States. It is the operation that causes the least nutritional problems. A proximal gastric(at the entrance to the stomach) gastric pouch smaller than 30 ml is created at the entrance to the stomach. This new gastric bag has a volume smaller than about 1 cup of tea. By creating a gastric bag, the existing stomach is disabled and nutrients are provided here. It is taken from the part of the small intestine leading to the distal (large intestine) and cut about 50-75 cm and attached to the new gastric bag created. The end of the small intestine, which is left behind and through which bile and pancreatic fluid come, approaches 70-80 cm ahead and is joined back to the intestine.
Gastric Bypass, Roux-en-Y (distal)
The normal small intestine is between 600-1000 cm. The end of the intestine from the bile is joined with the intestine from food about 1 meter further. Combining saffron with food towards the end of the small intestine causes malabsorption (reduced absorption) of mainly fat and starches, but also various minerals and fat-soluble vitamins. Unabsorbed fats and starch pass into the colon. This can provide faster weight loss. But more serious problems with nutrition (such as severe vitamin deficiency) can be observed. In addition, bacterial activity here can cause the production of irritants and the formation of foul-smelling gases.
Loop Gastric Bypass (Mini Gastric Bypass)
Here, the bowel is joined directly with the stomach without dividing in half. Although it is simpler to create, this method causes bile and pancreatic enzymes to escape from the small intestine into the stomach and then into the esophagus, leading to severe inflammation (inflammation) and ulceration in the esophagus. Although its application is simpler, it is not a very preferred method.