Metabolic gastric bypass refers to the use of gastric bypass surgery to treat type II diabetes and other metabolic diseases and disorders.
Also known as a Roux-en-Y gastric bypass, the metabolic gastric bypass is a combination malabsorptive/restrictive surgery that bypasses the stomach through creation of a small pouch. Like other gastric surgeries, this reduces the actual food intake of the patient, preventing calorie absorption in the small intestine. This procedure is considered the “gold standard” of weight loss surgery due to its proven, decades long track record.
Unlike gastric sleeve, which has shown a record of slightly slower weight loss (24 months for sleeve versus 12-18 months for bypass), metabolic gastric bypass can induce “dumping syndrome,” an uncomfortable array of gastrointestinal symptoms that occurs when too much food passes through the large intestine. Some patients actually prefer this since it creates a negative reinforcement which helps them to sustain weight loss and moderate eating habits.
Unlike the lap band, metabolic gastric bypass surgery is permanent and requires more time under general anesthesia, and a more prolonged recovery time.
Who is a candidate?
Candidates tend to have a BMI over 40, or a BMI between 35 and 40 with accompanying diseases such as diabetes, sleep apnea, cardiomyopathy (heart damage) or severe joint degeneration and pain. They should have a long record of failed previous non-surgical weight loss interventions (diet, exercise) before considering gastric bypass.
Candidates who may be especially susceptible to gastrointestinal reflux disease (GERD) and who desire having dumping syndrome as a negative reinforcement in order to facilitate weight loss are better candidates for metabolic gastric bypass. The rates of GERD are lower for metabolic gastric bypass compared to gastric sleeve.
Who is not a candidate?
Patients who have current drug and alcohol abuse, a history of binge eating, untreated major depression or psychosis, severe cardiac disease, or disorders that interfere with healing such as blood clot disorders are not good candidates for the metabolic gastric bypass. Metabolic gastric bypass should not be considered a first-line option for weight loss and should be considered only after exhausting non-surgical weight loss options.
You may be asked to change your diet, lose or maintain a stable weight, or alter your dietary habits (i.e. eating smaller meals throughout the day) before surgery. This increases the chance of successful, sustained weight loss after the surgery. Like other surgeries, metabolic gastric bypass may require you to undergo certain general surgery procedures such as preoperative blood testing, medications, and cessation of smoking or use of pain relievers and anti-inflammatory drugs.
Recovery is a slow and gradual healing and readjustment process as you adjust to eating smaller portions of food. Pain in the first 2-3 days after surgery in the upper left part of the abdomen is common, but can be managed with pain relievers, and should be minimal to nonexistent by 2-3 weeks from the surgery. Although light walking is suggested soon after surgery, strenuous exercise should be avoided for the first few weeks.
Patients should stick to an all-liquid diet for the first week, before gradually easing into soft foods and eventually, back to a normal diet. However, portion sizes should be heavily restricted and patients should eat slowly in order to accurately gauge their satiety and fullness. Lifestyle changes implemented before the surgery should be maintained long-term.
The most common complications from mini gastric bypass surgery are nausea and vomiting, malnutrition (as the surgery results in malabsorption of nutrients to reduce calorie consumption), gallstones, and internal hernia. Nausea and vomiting are not true complications, but do occur in 50% of patients.
Major complications—occurring in less than 3% of procedures—include bowel obstruction, staple line leak, internal hemorrhage, and pulmonary embolism. As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. A proper assessment of every patient, along with complete lab work, will help to prevent postoperative complications. Gastric bypass has a higher risk profile than gastric sleeve or lap band surgery, due to prolonged procedure time and greater level of invasiveness.
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