Gastric Bypass Surgery Procedures, Risks, and Complications

In the first part of this series, we discussed the fundamentals of gastric bypass surgery, the types of bariatric surgeries, and their positive and negative impacts on patients. We learned that most types of bariatric surgeries are primarily performed on people who are morbidly obese, but study results suggest that they can also be a potential major treatment for Diabetes.

The reason behind this is the discovery of the GLUT-1 molecule in the small intestine of an adult after a gastric bypass procedure. Why this is an interesting find for surgeons is because this molecule is only find in a fetus’ small intestine.

Researchers continue to unravel promising Diabetes cures; most of the current findings are not yet established. Hopefully, doctors and scientists can find the answer to this 20-year old plague or we will prove the World Health Organization (WHO) right in claiming Diabetes cases will rise twice more than 78 million in the next two decades.

Roux-en-Y Gastric Bypass

By BruceBlaus (Own work) [CC-BY-3.0], via Wikimedia Commons

Roux-en-Y Gastric Bypass carries favorable weight loss results and wonderful benefits, which appealed to the masses, despite the difficulty of the procedure. It is the most widely performed bariatric surgery in the US today, in fact. The surgery can be done in two ways — open surgery and laparoscopic.

Open surgery is done by creating an 8-10 inch incision on the abdomen while laparoscopic is done with the use of a laparoscope, a small tube with a tiny camera at the edge inserted through your stomach. Laparoscopic operation was hard especially back in 1993 when it was first performed due to the limited access technique.

Procedures

• The surgeon creates a small pouch as small as the size of an egg in your stomach by stapling a section of it off the main stomach. The purpose is to reduce the amount of food intake.
• This pouch would then be attached to the upper section of the small intestine. The purpose is to minimize the amount of calories and fat your system would absorb.

It doubles your chances for weight loss because you will eat less and your body will absorb less calories and fats.

Advantages

• Recovery period is shorter
• Hospital time is also shorter
• Scarring is very minimal (for laparoscopic method)
• Less discomfort
• Less risk of incisional hernia or incomplete healing of surgical wounds

Disadvantages

• Procedure is risky and can be fatal at times
• Possible internal bleeding and wound infection
• Possible blood clots
• Higher risk of respiratory issues
• Incision leaks to the system

Complications

• Malnutrition
• Calcium and/or iron deficiency
• Fatal vitamin and mineral deficiencies
• Dumping accompanied by nausea, tachycardia, diarrhea after meals, fainting, and flushing
• Internal bleeding

The risks and complications depend on your medical condition. After the procedure, it is paramount to consult your doctor frequently and report any abnormalities or unusual feeling for immediate medical attention.

Laparoscopic Adjustable Gastric Banding (LAGB)

Xopusmagnumx at en.wikipedia [CC-BY-SA-3.0 or GFDL], from Wikimedia Commons

The LAGD procedure may only take 30 mins to one hour depending on your surgeon’s experience. The procedure is recommended for people with a BMI of 40 or more, have tried several weight loss techniques but did not work, and patients who are neither alcohol nor drug dependent. Before the procedure, doctors may also order psychological briefing to determine mental stability.

Procedures

• The surgeon inject general anesthesia, then creates a small incision (about 1-5 small cuts) on your abdomen where the laparoscope is inserted.
• Next, the surgeon places an inflatable band around the upper section of the stomach creating a small pouch which would serve as the food reservoir
• Afterward, a small hole will also be created under the skin of your stomach which would serve as a port connected to the band. The purpose of this is to make adjusting the size of the inflatable band easier.
• After the procedure, the incision on the abdomen is stitched

Advantages

• The procedure can be reversed
• The size of the band can be adjusted depending on your needs (remember the port? If a patient wants the stomach pouch smaller to intensify weight loss, a fluid will be injected through the port making the inflatable band bigger and the stomach pouch smaller.

Disadvantages

• Possible allergic reaction due to anesthesia
• Possible respiratory problems
• Possible gastric band erosion or leak
• Gastric band slip
• Infection in the port
• Requiring minor surgeries to fix various gastric band problems such as turning upside down, accidental puncture during needle access, etc.
• Scarring and bowel blockage

Complications

• The American Society for Metabolic and Bariatric Surgery says food intolerance is common after gastric bypass.
• Anemia due to inability to thoroughly digest red meat, which is a major source of iron
• Vitamin and mineral deficiencies
• Fatal blood clots and other infections

Vertical Sleeve Gastrectomy (VSG)

This is the latest gastric banding procedure that aims to decrease the size of the stomach to 20% and shape the remaining 80% of it into a sleeve so it can only accommodate about ¼ cup of food. It then expands in the process to hold about a cupful. Most of the patients undergoing this procedure have a BMI of 40 or more. It is also recommended to those with a BMI of 35 or over or who have weight-related medical condition.

from Wikimedia Commons

Procedures

• The surgeon injects general anesthesia before the procedure, and then creates 2 to 5 incision on the abdomen.
• The laparoscope and surgical instruments are inserted into these incisions.
• The surgeon will remove a huge portion of the stomach by cutting through it vertically leaving a sleeve or banana-like shape.
• The surgeon will staple the stomach and close the incisions

Advantages

• Patients tend to lose up to 60% of weight because the stomach feels full with very little amount of food or liquid
• Lowers the risk of stroke, high blood pressure, elevated blood sugar levels

Disadvantages

• The procedure is irreversible
• Depending on the patient’s preference, this may require a second procedure know as biliopancreatic diversion.

Complications

• An increased risk of developing gallstones, which is why surgeons often recommend removing the gallbladder (cholecystectomy) before or during surgery.
• Blood clots
• Wound infection (especially if it’s an open surgery)
• Internal abdominal scarring
• Regurgitation due to eating excess food or swallowing food that’s not chewed well
• Allergic reaction to anesthesia
• Breathing problems or pneumonia
• Heartburn
• Gastritis
• Ulcers

Before, during, and after these procedures are the most critical phases. Surgeons hand out important rules that must be strictly followed to minimize the risks. Just the same, tests and assessments are performed to determine whether the patients are qualified and ready physically mentally, and emotionally.

If you have gone through any of these already, reporting any abnormalities is as important as taking your vitamins daily. Your surgeon needs to know the status of your health immediately. Skin irritations, swelling, sudden flu, or intense pain are warning signs that you need to see your doctor at once.