Gastric Bypass2022-11-02T22:41:59+10:30

Gastric Bypass

Laparoscopic gastric bypass is largely a restrictive procedure but there is also a degree of malabsorption which does help with overall weight loss. It involves creating a small pouch from the upper stomach and then connecting this to the small bowel. By creating a new small stomach pouch the amount of food eaten is reduced. Like sleeve gastrectomy laparoscopic gastric bypass also alters some of the hormones involved in appetite control and hence helps to control appetite as people lose weight. Currently we perform two different types of gastric bypass procedures the single anastomosis gastric bypass and the roux en Y gastric bypass which is often preferred for patients who suffer from severe heartburn or reflux symptoms.

Gastric Bypass is often preferred in patients who have had previous gastric surgery such as older Bariatric procedures eg the lapband, but also in patients who have had surgery such as Fundoplication  for control of heartburn and reflux. Another group to benefit from laparoscopic gastric bypass are diabetic patients. Bypassing the first part of the bowel changes gut hormones directly involved in glucose control. Around 80% of non-insulin diabetic patients will leave hospital following their surgery without any diabetic medication.

Advantages

• Effective and reliable weight loss

• Average of 65 to 70% excess weight loss out to 10 years

• Performed laparoscopically

• Fast recovery and short hospital stay

• No foreign body

Whilst laparoscopic gastric bypass in the USA has commonly been performed since the early 1990s, most gastric bypass procedures performed in Australia until the mid 2000s were through the traditional open technique. Whilst the open technique is at the end of the day the same very effective operation as performed through laparoscopic techniques many patients were put off because of the fear of a bigger open procedure with a longer recovery and opted instead for the laparoscopic gastric band.

When performed laparoscopically gastric bypass is one of the most technically challenging operations and demands skills that most general surgeons do not possess. Not surprisingly when performed by inexperienced surgeons the complication rates from laparoscopic gastric bypass are higher than those for laparoscopic gastric banding and hence perhaps wisely the reluctance for many surgeons to attempt such surgery laparoscopically.

During his training Mr France was fortunate enough to be involved in over 100 open gastric bypass operations with Mr Phillip Game, an Adelaide surgeon who has performed over 400 gastric bypass procedures. Seeing Mr Game’s excellent results and its obvious place in obesity surgery Mr France traveled to the USA where he spent 12 months in a laparoscopic fellowship. During this time he was trained by experienced surgeons in the art of laparoscopic gastric bypass and in doing so became one of the first surgeons in Australia to be formally trained in laparoscopic gastric bypass.

Another recent advance is 2-stage surgery for those patients who are at most risk of developing post-operative complications from any obesity procedure. These patients often have multiple life threatening diseases associated with obesity and also tend to be those who are classified as being super obese.

For high-risk patients Mr France prefers to initially perform a sleeve gastrectomy as a first step to allow patients to lose weight and hence reduce the risks a second stage gastric bypass. This approach has been proven in clinical trials to reduce complication rates whilst ultimately allowing a laparoscopic gastric bypass to be performed which many patients especially the super obese require to get effective weight loss.

Patients who have previously had a laparoscopic gastric band and had to have it removed or have not had sufficient weight loss maybe suitable for conversion to laparoscopic gastric bypass. This again maybe done as a staged procedure especially if the band is being removed at the same time.

Generally most patients will be asked to go on a pre-operative diet.

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