If you have tried diets, cures, tablets or medicines and they haven't helped you lose and maintain a healthy weight, option may be an operation to artificially reduce the amount your stomach can hold and decrease your appetite.

Laparoscopic Gastric Banding :: Gastric Bypass
Bilio Pancreatic Diversion BPD :: Sleeve Gastrectomy

LAPAROSCOPIC GASTRIC BYPASS

Laparoscopic gastric bypass is the favoured restrictive procedure in the USA. It is a complex procedure requiring formation of a small gastric pouch using stapling devices to divide the upper stomach and produce a 20cc pouch. The small intestine is divided about 30cm from the point where it commences at the duodenum and is joined by stapling techniques to the bowel 70-80cm below the point of division. The lower divided end is passed behind the colon and attached to the small gastric pouch via a small opening of about 1cm diameter, "the stoma". A loop of silicone tubing is wrapped around the small pouch about 1cm above the stoma. The purpose of this is to stop the stoma enlarging as this would allow food to pass more rapidly out of the stomach pouch and so the patient would tend to eat more and might gain weight. This could cause the surgery to fail.

One of the advantages of this procedure is that no adjustments, as with lap banding, are necessary.

The effects of the surgery are:

To reduce the amount of food the patient can eat. One slice of toast is enough to fill most patients. Because the stoma is narrow the food can only leave the stomach slowly, thus providing the patient with prolonged feelings of satiation.

The food enters the small bowel. This produces the inability to eat sweet sugary foods as these produce a condition known as ‘dumping’. This is an unpleasant condition with feelings of sweating, anxiety, fast pulse and nausea. This deters patients from eating these fattening foods and thus aids weight reduction. It may therefore be particularly suitable for patients who are addicted to sweets.

There is a variable length of small bowel bypassed producing a degree of malabsorption. This varies from 75cm to 150cm depending on how much malabsorption we wish to produce. The malabsorption is not as severe as with BPD but can help maintain weight loss.

The duodenum and upper small bowel is bypassed. This can produce nutrient malabsorption and deficiency. Iron and calcium deficiencies are common and protein deficiency can occur. Supplements must be taken to prevent the metabolic effects.

Complications of surgery:

Anaesthetic complications, such as myocardial infarction and pneumonia, pulmonary emboli and wound infections can occur as with any procedure on the morbidly obese. The procedure may have to be converted to an open procedure, in 5% of cases. The most serious problem that can occur is leakage from points where the intestine is joined together or to the stomach. This can lead to infection and peritonitis and is the main cause of post-operative death. The mortality rate for the procedure is approx 1%. Small bowel obstruction can occur in the immediate post-operative period or later due to adhesions. This is one of the main causes of re-operation. The incidence of re-operation is 5%.

Long-term metabolic side effects such as calcium deficiency with bone softening,
anaemia and hypo-proteinemia. Morbidity rates; that is, any adverse side effects
such as vomiting, reflux, diarrhoea and metabolic effects, are quoted as 10% approximately.

My preferred form of laparoscopic bypass:

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