Gastric bypass surgery

Roux-en-Y gastric bypass results in the greatest, most sustained weight loss of the restrictive gastric bariatric surgery procedures.

Surgical procedure where the stomach is divided into a large residual section and smaller pouch that is attached to the small intestine and a variable distance from the first part of the small intestine, largely bypassing the stomach and part of the duodenum.

Associated with the hospitalization of 2-4 days, and recovery period of 2 to 4 weeks.

Contraindicated in patients with who are poor surgical candidate, who have psychiatric disease, cannot tolerate general anesthesia, in pregnant patients, drug or alcohol addiction, untreated esophagitis, or unwilling to participate in long-term care.

Large male patients are at greater risk for severe life-threatening complications than smaller and or female patients.

Patients older than 55 years have a threefold higher mortality from surgery than younger patients.

Complication rate 5.8%.

Risk of life-threatening adverse complications increase for a 200 pound woman from 4% to 7.5% for a 600 pound patient.

Risk of life-threatening adverse complications increase for a 200 pound male from 7% to 13% for a 600 pound patient.

Incidence of pulmonary embolism with prophylaxis ranges from 0.36-3.0%.

Laparoscopic gastric bypass associated with a decrease in wound related complications, iatrogenic splenectomy rate, and mortality compared to open gastric bypass surgery.

Potential complications include gastrointestinal obstruction, hemorrhage, G.I. bleeding, and anastomotic leaks, infection, and the usual postoperative complications in patients with high morbidity.

Laparoscopic gastric bypass associated with higher frequency of bowel obstruction, gastrointestinal hemorrhage and stomal stenosis compared to open gastric bypass surgery.

Laparoscopic gastric banding procedure in adolescents compared to a medical supervised weight loss at 2 years showed greater weight loss for the surgical procedure (O’Brien PE).

Laparoscopic gastric banding procedure in adolescents is associated with a significant complication rate, which offsets the benefits of greater weight loss compared to medical management.

Laparoscopic gastric banding procedure in adolescents compared to a medical supervised weight loss demonstrated that medical management resulted in substantial improvements in hypertension, hyperlipidemia, and insulin resistance, although not as beneficial as the surgical group (O’Brien PE).

In a prospective cohort study comparing severely obese patients undergoing gastric bypass surgery compared with 2 severely obese control groups, one group seeking surgery, and the other in a random sample of severely obese adults: a six-year follow-up rate of the 93% in the Roux-en-Y gastric bypass group demonstrated a mean weight loss of 28% of initial bodyweight compared with weight gain of 0.2% and 0% in the two control groups, respectively (Adams AD et al).

In the above study diabetic remission rates were 62% in the RYGB group and 8% and 6% in each of the control groups.

Incident cases of diabetes at six years wAS 2% in the RYGB group compared with 17% and 15% in that two control groups, respectively.

Gastric banding compared with lifestyle interventions resulted in greater percentage achieving a loss of 50% of excess weight among adolescents (O’Brien PE).

Results in long-term weight loss, improved lifestyle and amelioration of risk factors, except for hypercholesterolemia, that are elevated at treatment.

Adolescents and adults who have gastric bypass surgery are able to maintain weight loss five years post-op.

For adolescents, the procedure more often reversed the course of diabetes and hypertension.

Rouxt-en-Y gastric bypass among severely obese is associated with higher rates of diabetes remission and lower risk of cardiovascular and other outcomes over 6 years compared with non surgical control patients.(Adams TD et al).

Following the procedure diabetes is cured in as many as 80% of patients and it occurs before significant weight loss, suggesting that by bypassing the foregut, grehlin (a hormone appetite suppressant) is suppressed and large volume of chyme is presented to the hindgut, with the latter causing an excess release of GLP 1.

Gastric bypass results in increased GLP-1, PYY3-36 and decreases Ghrelin.

Cases of postgastric bypass hypoglycemia reported associated a result of excess formation of new beta cells from the pancreatic duct stem cells (neisidioblastosis).

Potential chronic complications including weight gain, marginal ulcers, esophageal dilation, dumping syndrome, anastomotic stenoses, gallstones, hypocalcemia, secondary hyperparathyroidism, iron deficiency, protein malnutrition, anemia, metabolic acidosis bacterial overgrowth, kidney stones neuropathy,osteoporosis,and depression.

Patients are subject to micronutrient deficiencies after gastric bypass, as there is a need for lifelong micronutrient supplementation and monitoring for adverse effects including anemia, neurologic effects, and osteoporosis.

The metabolic benefits of gastric bypass surgery and diet are similar and are apparently due to weight loss itself, with no ads clinically important effects independent of weight loss (Yoshino M)..

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