Laparoscopic Gastric Bypass (R-YGB)
Laparoscopic Gastric Bypass Surgery (R-YGB)
Laparoscopic Gastric Bypass (R-YGB) is the most common type of combined bariatric surgery. Gastric bypass surgery is noted for its successful outcomes in obesity treatment. This procedure not only reduces the stomach’s size but also shortens the path through the small intestine, thus reducing nutrient absorption.
The beginning part of the stomach is separated from the rest, leaving a pouch of about 30-50 ml. Additionally, some of the small intestine is bypassed and connected to the newly formed small stomach. This enables patients to feel full with much smaller portions. At the same time, the absorption of a significant portion of high-calorie foods is prevented.
Laparoscopic Gastric Bypass Surgery (R-YGB) provides effective and permanent weight loss. Patients achieve a sense of complete fullness with much smaller portions due to the reduced stomach pouch, similar to restrictive surgeries.
Gastric bypass surgery can be repeated if necessary.
In Which Conditions Is Gastric Bypass Surgery (R-YGB) Performed?
Gastric Bypass (R-YGB) is primarily a surgical procedure to treat severe obesity. It can also be applied in cases of multiple obesity-related diseases. One of the most significant conditions is type 2 diabetes. In the surgical treatment of uncontrolled type 2 diabetes, positive results can be obtained through gastric bypass surgery.
How Is Gastric Bypass Surgery (R-YGB) Performed?
Before gastric bypass surgery, patients planning the operation undergo a thorough evaluation. In addition to physical examinations, each patient is evaluated in detail by endocrinologists and psychiatrists before the surgery.
Procedure:
- Surgical Method: Gastric bypass is performed laparoscopically, and robotic surgery has also become a preferred method in recent years.
- Incisions: The surgery is performed through 4-6 incisions, each 1 cm in diameter.
- Stomach Reduction: In gastric bypass surgery, the stomach is reduced similarly to sleeve gastrectomy, with about 95% of it bypassed.
- Intestinal Bypass: A portion of the stomach, separated surgically, is connected mid-small intestine, bypassing the duodenum. The other part continues its function without being removed from the body, preventing food from passing through the duodenum.
Post-Surgery:
- Patients must stay in the hospital for 4-6 days. Upon discharge, dietary guidelines are provided for follow-up with a nutritionist. In the first year, close follow-up is conducted by an endocrinologist, psychiatrist, and nutritionist, in addition to the bariatric surgeon.
Frequently Asked Questions about Gastric Bypass Surgery
What Are the Types of Gastric Bypass?
- Roux en Y Gastric Bypass: This involves dividing the stomach into two sections, creating a small stomach pouch (about 25-30 ml), and connecting it directly to the small intestine. This setup bypasses most of the stomach and part of the small intestine.
- Mini Gastric Bypass: In this technique, the stomach is shaped into a tube, and a segment of the small intestine is connected to the new stomach pouch, approximately 200 cm down. This type is simpler and involves only one connection, but weight loss mechanisms are the same for both bypass types.
What Are the Risks of Gastric Bypass Surgery?
- Potential risks include bleeding, infection, postoperative ileus (intestinal blockage), hernia, and general anesthesia complications. The most serious risk is leakage at the connection between the stomach and small intestine, possibly requiring a second surgery.
- Obesity increases additional surgical risks, such as blood clots and heart problems. About 10-15% of patients experience some complications, though severe complications are rare and manageable.
Who Is Suitable for Gastric Bypass Surgery?
Candidates for bariatric surgery are evaluated based on body mass index (BMI). Patients with a BMI of 40 and above, or a BMI of 35-40 with obesity-related conditions like type 2 diabetes, high blood pressure, or sleep apnea, may be suitable for this surgery.
Hospital Stay Duration Post-Surgery:
Patients usually stay in the hospital for 3-4 days, although pre-surgery evaluations or post-surgery recovery periods may extend this duration.
Restrictions Post-Surgery:
Patients should avoid heavy lifting for six weeks following surgery.
Driving and Physical Activity Post-Surgery:
Driving should be avoided for two weeks post-surgery. Walking, stair climbing, and showering are permissible.
When Can Patients Return to Work?
Patients with sedentary jobs can return to work after 2-3 weeks. Those engaged in physically intense activities should wait 6-8 weeks post-surgery.
When Does Weight Loss Begin?
Weight loss begins gradually, faster in the initial months, and it may take 1.5-2 years to achieve maximum weight loss, typically 70-80% of excess weight.
Dietary Considerations After Gastric Bypass Surgery
- Meal Frequency: At least three well-balanced meals a day are essential.
- Meal Composition: Meals should primarily include protein, fruits, vegetables, and whole-grain products.
- Hydration: Consuming at least 1.5-2 liters of fluids daily is crucial to prevent dehydration.
- Food Types: Avoid simple sugars. Opt for soft and easily digestible foods.
- Chewing: Chew food thoroughly to avoid blockage at the stomach outlet.
- Protein Intake: Adequate protein consumption is essential for health.
- Avoid Simultaneous Liquid and Solid Consumption: Drinking liquids with meals may lead to early fullness or stomach expansion, causing discomfort.
Commonly Asked Questions on Food and Dietary Restrictions
- Week 1 Post-Surgery: Bone broth, diluted apple juice, and vegetable juices.
- Weeks 2-5 Post-Surgery: Gradual transition to soft and mashed foods, focusing on protein and calcium-rich options.
- Foods to Avoid Post-Surgery: Fresh bread, rice pilaf, dense meats, and fibrous fruits and vegetables (e.g., celery, raw fruits, broccoli, citrus).
Constipation After Gastric Bypass Surgery:
Due to a reduced food intake, bowel habits may change. Fiber-rich foods and sufficient fluid intake are recommended to prevent constipation.
Dumping Syndrome After Surgery:
Excessive consumption of simple carbohydrates can cause “dumping syndrome,” leading to rapid emptying of the stomach. Limiting sugary foods can help prevent this condition and ensure balanced nutrition.