We tend to use the term gastric bypass surgery somewhat loosely these days and include both true bypass operations such as the Roux-En-Y and popular and less radical forms of weight loss surgery such as gastric banding. While both have a role to play in curing the problem of obesity, bypass surgery takes full advantage of the body to affect weight loss and, in order to understand just how gastric bypass surgery works, it is necessary to have a basic understanding of the digestive system.
The process of digestion begins as soon as you start to eat when, as you chew your food in your mouth, saliva, which contains the digestive enzyme amylase, is mixed with your food and starts to break down carbohydrates. Although it may not seem an important part of the digestive system, the saliva glands produce about 40% of the amylase used in the digestive process and so chewing your food properly is an essential part of the process.
Food is then passed down the esophagus and into the stomach where muscular contractions mix the food as digestive juices and pepsin are added. In adults the stomach typically holds the equivalent of about 3 pints.
Once thoroughly mixed the food is passed out of the lower end of the stomach through the pylorus, a circular muscle which opens and closes rhythmically to control the flow of food from the stomach.
Having left the stomach food enters the duodenum, which is about 2 feet in length and it the first of three sections that together form the small intestine. Here two other organs of the body come into play - the liver and the pancreas.
The liver passes bile, which is an essential enzyme used in the digestion of fat, into the duodenum and also receives essential nutrients from the duodenum through a series of veins known as the portal veins. The liver itself is thus also responsible for processing food products.
The pancreas, which is principally known as the organ which is responsible for producing insulin, also produces a number of digestive enzymes, including lipase, which mixes with bile in the duodenum to further assist in breaking down fat.
Once food has been mixed with various digestive enzymes in the duodenum it then passes into the jejunum, which is about 6 to 8 feet in length, and then on into the ileum, which is about 10 to 12 feet long, where the digestive process continues and nutrients are extracted.
Once digestion is complete the remaining waste products are passed into the large bowel which plays an important role in absorbing water to prevent excess water loss. Waste products are then held in the large bowel until they are released from the body.
Gastric bypass surgery by bypassing part of the small bowl (the duodenum, jejunum and ileum) restricts the body from absorbing calories from the food that is eaten which, in turn, leads to weight loss. However, it also restricts the absorption of a variety of necessary vitamins and minerals and this explains the need for life-long supplements following surgery.
Gastric Bypass Surgery Patients
Obesity is a condition that has no single effective solution, considering that the problem may not lie on simple matters of changing lifestyle and health choices. With more and more people being diagnosed as clinically obese, it would seem that health concerns cannot be addressed by diet and exercise alone, which is why medical experts recommend gastric bypass surgery as a last resort to attempt to correct where diet and exercise have failed.
Not for everyone.
The first thing to remember is that not all obese individuals are candidates for gastric bypass surgery. Gastric bypass surgery is only advised for the morbidly obese, or those who are at least 50 kgs over their ideal weight. People with moderate weight problems are better off changing their diets and undergoing an exercise regimen rather than undergoing this drastic procedure.
Gastric bypass surgery is also not a magic procedure that will end all future weight gain. It will require that a patient maintain a lifetime of commitment to healthy eating and fitness. Most insurance policies also do not cover this procedure, which may cost upwards from $15,000.
What happens in a gastric bypass operation
Basically, a bariatric surgeon will perform two procedures: reduce stomach size with gastric staples or a gastric silastic ring and change the way food works in the body by bypassing a part of the small intestine so food does not remain there.
Gastric bypass surgery will require general anesthesia since the surgeon will be dividing the stomach into two parts, separating each with two rows of staples. An incision is made between the staples. The top section or pouch usually holds only about a tablespoon of food (the stomach can hold a quart). Eventually, this will expand to contain as much as one cup.
The logic of the operation is that once the stomach is decreased in size, the patient will feel full with less food intake. With the duodenum and jejunum bypassed, the number of calories absorbed by the body is also decreased since food goes directly from the stomach to the ileum which is the latter portion of the intestines.
The procedures that are used for these types of surgery include the roux-en-y, biliopancreatic diversion and fobi pouch bypass.
What to expect after undergoing gastric bypass surgery
Most complications arising from gastric bypass surgery may be corrected and improved upon. However, the patient should understand that his digestive process is not what it used to be. He will need to watch his diet, take supplements, medications, eat specially-prepared food and work with medical professionals who will closely monitor his condition. And this is what he will have to deal with for the rest of his life.
Some concerns after surgery
Vomiting
As the patient slowly adjusts to his new condition, he might make the mistake of eating more than his stomach can hold. Since gastric bypass surgery prevents food from passing out of the stomach, he might vomit the excess as a result. The patient will also need to chew his food very well since bigger particles might stretch his stomach pouch.
Dumping
Because the pyloric valve is bypassed, there is a tendency for food to leave the stomach too quickly and enter the digestive tract immediately. This action causes the body to release adrenalin which sets off some stressful symptoms like palpitations, nausea, diarrhea and sweating. Dumping is not necessarily a health risk but it is very uncomfortable for the patient. It is less likely to occur after a duodenal switch.
Vitamin deficiency
This operation will significantly lower the body's efficiency in absorbing vitamins and minerals, which is why it is very important for patients to take nutritional supplements.
Hernia
At least 10% of patients suffer from abdominal hernias after surgery, caused by straining and vomiting. To reduce the risk, laparoscopy-assisted surgery may be considered instead.
Health Problems
Post-operation, some patients may suffer from gastritis, infection and gallstones. If weight is lost too quickly, they may also experience unsightly loosening of skin. There is also a risk that they will regain weight after a few years.
The gastric bypass bottomline
Gastric bypass surgery is a major operation and the there are significant risks of complications. In fact, most gastric bypass operations are irreversible which is why potential patients are well advised to communicate with their doctors and understand completely what is involved and what they can realistically expect.
More than anything, potential patients must also try to consider the drastic change in their lifestyle that gastric bypass surgery will cause. It will not only change their body shape and weight, it will also require them to change their diet and eating habits. Immediately after surgery, patients will have to adhere to a strict regimen of proper nutrition and exercise. They might also want to consider joining support groups after they undergo gastric bypass.
Both Donald Saunders & Thomas Salathe are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
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