Dr. Mohit Jain
MS(Mumbai), FMAS, FIAGESSenior Laparoscopic Surgeon, General Surgeon & Bariatric (Obesity) Surgeon.
SURGEON ( LAPAROSCOPIC)
Gastric Bypass Surgery
The intervention of the gastric bypass surgery in Delhi involves reducing the volume of the stomach and modifying the food circuit.
Food does not pass through the stomach and the upper part of the digestive tract, it goes directly into the middle part of the small intestine.
There are 2 types of bypass:
The classic Bypass
The mini Bypass
The mini bypass is a recent evolution of the bypass, its theoretical advantages are:
An easier technical realization, so a shorter intervention, ½ h to 1 hour.
Total reversibility, relatively simple to achieve technically by laparoscopy.
The main disadvantages of the mini bypass seem to be:
Gastroesophageal reflux (this problem should be resolved by using a longer gastric tube).
The weight loss at 1 year seems the same as with the bypass, as the weight loss at 5 years. The results at 10 years are not known.
Very important: the mini bypass has “mini” only its name: its mode of action and its consequences on the body are the same as with the bypass, monitoring and taking vitamins, in the long run, are essential.
The bypass acts by several mechanisms that combine:
A restriction (such as gastroplasty)
Malabsorption: foods are less digested
Dumping Syndrome: (The ingestion of highly sugary foods in large quantities causes a feeling of general malaise and an acceleration of the pulse, these foods must, therefore, be taken in small quantities)
A decrease in the rate of ghrêline, which is the hormone of hunger, which leads to a lack of interest in food (attention: this mechanism of action is not effective on any compulsions).
Advantages & Disadvantages
The bypass is a complex procedure, with a hospital stay of 2 to 4 days on average.
The bypass must lead to a very important weight loss of
the order of 5 kgs per month, during the first 6 months, then a weight loss of 2 to 4 kgs per month.
It is indicated for Body Mass Indexes greater than 45.
According to scientific data, the bypass makes – on average – 70% of excess weight lost in 1 year.
Undernutrition and vitamin deficiencies are not uncommon
Oral supplementation with vitamins and trace elements is essential.
The modification of the alimentary circuit is responsible for the reduction of the digestion of the so-called “fat-soluble” vitamins (vitamins A, D, EK), vitamin B12 and certain nutrients and oligo-elements. These different products must be brought in addition to the diet, in the form of capsules.
The class bypass is difficult to reverse, the mini bypass is relatively easily reversible.
Food comfort is better than gastroplasty
Vomiting is rare.
Dietary habits should be changed
3 meals and possibly 2 snacks.
Sugary snacking is not well tolerated, especially with the conventional bypass
because of ”dumping syndrome”, which is considered a benefit by the operated patients.
Regular monitoring by a multidisciplinary team is mandatory.
3 Blood tests are necessary the first year, then 1 to 2 blood tests a year, to look for vitamin deficiency, anemia, undernutrition.
THE DAY BEFORE
You are hospitalized around 17 hours if your hospitalization is planned in the morning.
You can eat normally.
You will be fasting from midnight.
If your intervention is scheduled in the afternoon, you can return in the morning, a light breakfast is possible before 8 am.
The procedure requires complete general anesthesia, it is performed by laparoscopy, it lasts 2 to 3 hours.
After the procedure, you will spend a few hours in the recovery room before being taken back to your room.
You will not have a probe in your nose. A small tube (called Redon) is put in place at the end of the procedure, it comes out through a small hole in the abdomen. Redon is used to aspirating secretions and will be removed on D2 or D3.
Pain medications will be administered by the vein.
The evening of the intervention: fasting.
THE DAY AFTER THE INTERVENTION (J1)
You will be able to drink a glass of water after the assessment of the laparoscopic surgeon in Delhi.
Pain medications will be administered by the vein.
A physiotherapist will help you to sit down and make a passive mobilization.
You can leave the facility late in the morning, usually D1 or D2 after the procedure.
Your surgeon will give you:
An order of the different medications needed after the procedure.
A prescription for scar care and anticoagulant injections.
A work stoppage of 2 or 3 weeks, depending on your general condition and the arduousness of your professional activity.
A detailed program for the gradual recovery of your diet.
The first month
The first month will allow you to get used to your new digestive circuit.
Eat very slowly, because you must not fill the small stomach, which is healing.
After the first month
EAT-IN CALM AT REGULAR HOURS
Split your food intake into three meals (and possibly one or two snacks)
Vary your diet
Eat only small pieces
Chew for a long time, swallow several times
Take the time to enjoy your meal. Remember that digestion begins in your mouth
Drink as little as possible during your meals
When you feel full, stop eating
Watch your teeth
A teaspoon more can make you vomit. You have only a mini stomach, do not forget it.
IF YOU VOMIT
Either you have eaten too much
Either you have eaten too fast
Either you have eaten too many chunks
Either you have not chew enough
Either you swallowed too fast
Beware of Dumping Syndrome: ingestion of an unusual amount of sugary products can lead to general discomfort.
Avoid sugary drinks and, in principle, soft drinks.
Drink outside meals often, in small amounts, even without thirst.
Resume regular physical activity, recreation, and endurance.
The simplest regular physical activity is walking: walk at a good pace but at your own pace, ideally 3 times 30 to 40 minutes a week.
A physiotherapist can help you. After the first month, you can resume the sport without any problem.
Observe adequate hours of sleep.
FOLLOW YOUR DOCTOR REGULARLY
In addition to your daily intake of vitamins and trace elements, your doctor will encourage you to optimize your diet in the direction of a better intake of iron and calcium (possibly after a dosage of these elements).
Attention also to possible protein malnutrition. If you do not bring enough protein to your diet, you will lose weight on your muscle mass, while it would be better to lose weight on your fat or water of your body. At worst, you can suffer protein malnutrition, with decreased immune defenses and fatigue, anemia, increased susceptibility to infections. Good luck