Presentation

The Gastric Bypass. consists of creating a small gastric pouch into which food arrives:

• This pouch has a reduced capacity of 30-50ml which only allows small meals (restrictive)
• ↓ calorie intake
• Less digestion of food by the new stomach.

This pouch is connected directly to the jejunum (« 1 » latero-lateral gastro-jejunal anastomosis):

• The food passes into the intestine, short-circuiting a large part of the stomach,  the duodenum and the  jejunum:
• Segment of the small intestine exceeded (malabsorption) – ↓ calories and nutrients:
• Intestinal hormones:
  1. Early satiety
  2. Appetite suppression
  3. Reversing the principal mechanism of type 2 diabetes

We make a second anastomosis at a distance of 150cm (anastomosis 2=  latero-lateral jejuno-jejunal  anastomosis) to allow the passage of  Bilio-Pancreatic Secretion:

• The section of biliopancreatic loop to the left of the G-J anastomosis allows the terminalisation/conversion of the Omega Loop Gastric Bypass into a Roux-en-Y Gastric Bypass.
• The systematic closing of mesenteric breaches helps reduce the risk of internal hernia which as a general rule, appear during the first 2 years following an LRYGBP, after substantial weight-loss and  reduction of the mesentery.

The Bypass helps to reduce calorie intake and also  the absorption of nutritive substances. It is surgery with a mixed effect: restriction and malabsorption.

Why choose the Bypass: 7 points

The gastric bypass as the surgical intervention of reference (gold standard) in terms of morbid obesity.

1. The gastric bypass is the most efficient bariatric/weight-loss surgery in terms of weight-loss results.
2. After the ablation of the gastric band (the fistula rate of the bypass is less than that of sleeve gastrectomy).
3. After the failure of sleeve gastrectomy (the fistula rate of the bypass is less than that of sleeve gastrectomy).
4. After sleeve gastrectomy with a very obese person -BMI >50 Kg/m2 (two-stage surgery).
5. With an obese patient who suffers from  GORD (bypass = best treatment for reflux) relative to a sleeve gastrectomy.
6. With an obese patient who is also diabetic (a bypass is the best treatment for obese people who are also diabetic)
7. With obese patients with anarchic eating habits, including regular sweet snacks and the notion of consuming large quantities of soft drinks (« dumping syndrome »).

Weight-loss explained by 4 mechanisms:

1. Small size of the gastric pouch (30-50 cc).
2. The importance of Malabsorption varies relative to the length of the jejunum excluded.
3. Reduction in the rate of ghrelin hormone and modifications to the rates of intestinal hormones  (increase in  GLP-1, PYY, and oxyntomodulin, reduction of GIP) – with
   1. Early satiety
   2. Appetite suppression
   3. The principal mechanism of type 2 diabetes being reversed.
4. Dumping syndrome associated with the ingestion of sweet foods (malaise, diarrhoea, sweating)

The gastric bypass is the most efficient bariatric/weight-loss surgery in terms of weight-loss results.

Advantages

• Substantial weight-loss.
• Rapid improvement in quality of life.
• Food comfort is better with a gastroplasty (vomiting is rare)

Results assessed in the long term:

• Weight loss after 5-10 years.
• 60-70% (% excess weight lost).
• Diabetes remission.
• Control of other disorders linked to obesity.

Inconveniences of having a Bypass:

• Surgery which is technically more difficult = the time taken for the surgery remains short if undertaken by an  « expert surgeon ».
• Risk of vitamin deficiency  = digestion of  « fat-soluble » vitamins is reduced (vitamins A, D, E K), vitamin B12 and certain other nutriments and trace elements.
• The results in terms of weight-loss, regression of comorbidities, managing any eventual complications by remote intervention and patient satisfaction, depend on the commitment of the patient to abide by a quality follow-up protocol.

Results

The percentage of loss of excess weight obtained with the Roux-en-Y gastric bypass (RYGB) – in the medium term – is significant (%EWL = 90 %) and remains stable after five years with a low rate of secondary effects (10-15%).

• With your small stomach pouch  (volume around 50cc), you will eat smaller quantities at each meal.
• Eating too much or too quickly may provoke vomiting or intense pain.
• The quantity of food you can eat will increase progressively, but will always remain small.
• The weight loss in the long term after a gastric bypass will depend on how committed you are. You must maintain the changes in your eating habits and take physical exercise.
• The improvements observed in terms of  type 2 diabetes, high blood pressure, and hypercholesterolemia (high cholesterol) may considerably reduce your risk of having a heart attack or a stroke.

Long term results of having an LRYGB gastric bypass:

The final result in the long term depends on you maintaining a healthy lifestyle, in terms of eating habits (we recommend food with low sugar content and vegetarian food) and taking physical exercise.

Possible complications

The difficulty with this surgical procedure (LRYGB) is in making a small gastric pouch and the realisation of making two intestinal sutures (anastomoses)  by coelioscopy.

The mortality rate is form 0 to 1%

We systematically make a scan, with oral opacification, based on a protocol published in 2017.

Immediate post-operative complications with a LRYGBP gastric bypass:

• Fistulas (suture breakage): 1 to 3%
• Haemorrhage: 1%.

Late complications with a LRYGBP bypass:

• Anastomotic ulcer (sometimes with perforation and pneumoperitoneum): 4%.
• SStenosis of the  gastrojejunal anastomosis: 2%.
• Internal hernia (intestinal occlusion): 2.5 %.
• Bladder stones (requiring a cholecystectomy)

Metabolic complications with a LRYGBP gastric bypass:

• Nutritional deficiencies (avoid deficiency of vitamin B12)
• Hypoglycaemia after a meal (dumping syndrome).