Gastric Bypass
Gastric bypass, also known as Malabsorptive Surgery, is a type of weight loss surgery for morbidly obese people, where the traditional treatments of diet, exercise and diet pills have failed to provide a solution.
There are different types of gastric bypass surgery, but they all involve bypassing part of the small intestine, so that less nutrients can be absorbed from the food you eat. Often the stomach is also stapled to create a small pouch that acts as a new stomach. This new stomach is then attached directly to the remainder of the small intestine. Thus less food can be eaten as the size of the stomach has been dramatically reduced, and less food can be absorbed as part of the small intestine has also been removed. Thus there is a risk of nutritional deficiency after this operation.
This surgery can either be performed with an open method (involving an incision about one foot long) or by using a laparascope (keyhole surgery). A laparascope is a tubular medical instrument that has a camera attached to one end. About five little incicisions are made in your abdomen and chest, into which the surgical instruments and camera are inserted. These incisions are closed using two or three stitches each. Recovery is usually quicker when the operation is performed using a laparascope, although it is not suitable for everyone.
This surgery is performed under general anaesthetic and lasts in the region of four hours.
What happens after surgery?
You may have some tubes attached to you - one coming out of your nose which leads down to your stomach. This is so air and fluid can be drained out of your stomach. You may have a tube running directly from your abdomen to a bag to drain fluid. Sometimes, your skin can become irritated around this tube. You may also be catheterised.
For the first 24 hours after surgery you will be on a clear liquids only, after which time your surgeon may allow you a liquid diet. You will be encourage to start walking around to lessen the risk of blood clots, and will probably wear compression pumps around your legs whilst you are in bed to encourage a healthy blood circulation.
The surgeon will probably want to X-ray you to check that the bypass is functioning correctly. On average, you will stay in hospital between 3 and 5 days.
You will be placed on a liquid diet for a few weeks to allow the operation to heal properly.
You will never be able to ear "normally" again. Your stomach will be smaller than an egg and if you eat too much or too quickly you will be likely to vomit. You may notice some side effects from the rapid weight loss, including mood changes, hair loss, dry skin and a general feeling of malaise. However, you can expect to lose about half of your excess weight within two years and lessen your risk of succumbing to obesity related illnesses.
What are the risks?
Risks of the surgery itself include:
- The risks of having a general anaesthetic, which can be greater in obese people. These include chest infections and DVT which in the worst case scenario can lead to death from a pulmonary embolism (blood clot in the lung). These risks are increased in smokers.
- Infection of the operation site.
- Other organs may be damaged during the surgery.
- The staples in the stomach may leak. This is a serious problem that in many cases can be treated with antiobiotics but sometimes necessitates emergency surgery to repair the leak.
- You may suffer a hernia at the site of the incision - this is more common if you have the open surgery.
- You may bleed excessively.
- Internal organs may be inadvertently damaged; eg the liver or spleen.
- The opening between the stomach and small intestine can become restricted, which may require additional surgery to correct.
- You may not lose as much weight as you hoped to, especially if you "cheat" by pureeing chocolate bars and the like.
- If you lose a lot of weight quickly, you may develop gall stones which can require additional surgery.
- You may be at risk of deficiency of certain nutrients, such as iron and vitamins B12, C and D.
- You may suffer from "dumping syndrome", where the contents of the stomach pass too quickly through the small intestine causing light headedness, vomiting or diarrhoea.
You will need to discuss all these points with your surgeon, as the risks are more important in some people than others.
Can I get a gastric bypass on the NHS?
Gastric bypass is recommended for people with a BMI in excess of 40, or over 35, if their weight is posing an extreme health risk.
- You are aged over 18 years (and perhaps less than 60 years).
- You have tried to lose weight by conventional methods but have been unsuccessful
- You don't have any preexisting physiological or psychological contraindications (eg heart problems or body dysmorphia).
- Your weight problem has not been caused by a problem with your metabolism.
- You understand what it means to have a gastric bypass and are sufficiently motivated to cope with the changes in lifestyle.
In order to qualify for the surgery on the NHS, you will need the support of your GP. In addition, you can contact your Primary Care Trust (PCT) and ask them where patients who fulfil the criteria for gastric bypass surgery are being treated. If it is at a hospital outside of your area, your GP may need permission to refer you out of area.
If you decide to have gastric bypass performed in the private sector, the cost is normally in the region of £10,000.