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Research Into Gastric Bypass to Treat Obesity

Open vs. laparoscopic gastric bypass, weight reduction benefits
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Research Into Gastric Bypass

Development of Gastric Bypass Surgery

The 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 Operations

Between 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 Bypass

The 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 Bypass

The 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 Technique

The 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
Vertical Banded Gastroplasty

Source:
Wittgrove AC, Clark GW, Schubert KR (1996) Laparoscopic gastric bypass, Roux-en-Y: technique and results in 75 patients with 3–30 months follow-up. Obes Surg 6:500–504
Cleator IGM, Litwin D, Phang PT, Brosseuk DT, Rae AJ (1994) Laparoscopic ileogastrostomy for morbid obesity. Obes Surg 4:358–360
Sugerman HJ, Brewer WH, Shiffman ML, et al. (1995) A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg 169:91–96
Wittgrove AC, Clark GW (2000) Laparoscopic gastric bypass: a five year prospective study of 500 patients followed from 3 to 60 months. Obes Surg 10:233–239
Lönroth H, Dalenbäck J, Haglind E, Lundell L (1996) Laparoscopic gastric bypass. Surg Endosc 10:636–638
Pories WJ, MacDonald KG Jr, Morgan EJ, Sinha MK, Dohm GL, Swanson MS, et al. (1992) Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr 55 [2 Suppl]:582–585
Sugerman HJ, Kellum JM, Engle KM, Wolfe L, Starkey JV, Birkenhauer R, et al. (1992) Gastric bypass for treating severe obesity. Am J Clin Nutr 55 [2 Suppl]:560–566
Hell E, Miller K, Moorehead MK, Samuels N (2000) Evaluation of health status and quality of life after bariatric surgery: comparison of standard Roux-en-Y gastric bypass, vertical banded gastroplasty and laparoscopic adjustable gastric banding. Obes Surg 10:214–219
MacLean LD, Rhode B, Forse RA, Nohr C (1995) Surgery for obesity—an update of a randomized trial. Obes Surg:8:145–153
Higa KD, Ho T, Boone KB (2001) Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendoscopy Advanced Surgical Techniques A 11:377–382
International Federation For The Surgery of Obesity

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Laparoscopic or open bariatric surgery, such as gastric banding or bypass is not an easy solution to morbid obesity and weight loss. It is a serious surgical procedure, involving health risks. To produce lasting weight loss it requires a long-term patient commitment to eating a healthy diet and following a regular program of physical exercise. Life-long use of nutritional supplements may also be necessary. So, before deciding, discuss your options fully with your doctor. © 2003-2017 Bariatric-Surgery.Info - Terms - Contact - Information - Resources