| Bariatric Surgery.info Research Into Gastric Bypass to Treat Obesity |
Open vs. laparoscopic gastric bypass,
weight reduction benefits |
Research Into Gastric BypassDevelopment of Gastric Bypass SurgeryThe gastric bypass procedure was published as a treatment for morbid obesity as early as 1967. The introduction of laparoscopy surgery led to the development of many new procedures, although the principle of the gastric bypass remained the same. The concept of the gastric bypass is that the gastric pouch and the malabsorption effect of a Roux-en-Y anastomosis with an 80 to 120-cm length of the limb will cause a feeling of fullness. Laparoscope-Assisted OperationsBetween 1993 and 1999, Wittgrove and Clark performed over 500 laparoscopic bypass procedures. The stomach is transected with a linear stapler (3.5-mm staples, 45 mm long) to form a proximal gastric pouch. The Roux-en-Y limb is brought to the upper abdomen either behind the colon and stomach, with an incision at the base of the mesentery of the transverse colon, or is placed in an ante-colic position. The end-to-side anastomosis of the remaining part of the stomach is made either with a circular stapler under percutaneous endoscopic control, or with an anastomosis technique that uses a linear stapler, side-to-side, as described by Lönroth et al.. The small-bowel anastomosis is also made with a linear stapler. Weight Loss Benefits of Gastric BypassThe average weight loss resulting from a gastric bypass is 60–70% of the excess weight after 5 years and 55–60% after 10 years; 90% of patients can expect to achieve this result. A comparative study at our hospital showed that higher weight loss and a better quality of life were obtained than with a vertical banded gastroplasty or the adjustable gastric band. Complications of Stomach BypassThe complications specific to this operation are anastomotic leakage 0.5 to 9%; marginal ulcer 4.5–16%; long-term micro-nutrient deficiencies in B12, folate and iron of up to 73%; weight regain in the long-term follow-up studies; and a mortality rate of 0.1–2.5% . Higa et al. reported a total complication rate of 14.8% in a series of 1,500 consecutive patients. Laparoscopic Surgical TechniqueThe laparoscopic gastric bypass is a viable alternative to traditional open techniques. It is as safe and effective and can be performed with equal or greater efficiency. Vitamin (A, D, E and B12 and folic acid) and mineral (calcium) supplements are obligatory. Biliopancreatic
Bypass
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