Journal of Obesity & Weight Loss Therapy
Open Access

Gastric bypass surgery; Health; Weight loss; Type 2 diabetes

Introduction

Understanding gastric bypass surgery

Gastric bypass surgery also known as Roux-en-Y gastric bypass (RYGB) it’s a surgical procedure designed to assist individuals with significant weight loss by altering their digestive system [1]. The procedure involves creating a small stomach pouch and rerouting the small intestine, thus bypassing a portion of the stomach and the upper part of the small intestine. This leads to reduced food intake and a decrease in the absorption of nutrients resulting in weight loss.

Advantages of gastric bypass surgery

Significant and sustained weight loss: Gastric bypass surgery has consistently shown remarkable results in terms of weight loss. Patients often experience a substantial reduction in excess body weight, with studies reporting an average of 60-80% weight loss within the first year following the procedure [2]. This weight loss can lead to improved overall health and a decreased risk of obesity-related conditions such as diabetes, heart disease and sleep apnea.

Resolution of obesity-related comorbidities: One of the most significant advantages of gastric bypass surgery is the potential for resolution or improvement of obesity-related health conditions. Type 2 diabetes, high blood pressure, high cholesterol levels, and obstructive sleep apnea are among the conditions that often show significant improvement or complete resolution after the surgery [3-5].

Enhanced quality of life: Beyond physical health benefits, gastric bypass surgery can have a positive impact on an individual's psychological well-being. Weight loss often leads to increased self-esteem, improved body image, and greater mobility, allowing individuals to engage in activities they may have previously avoided due to weight-related limitations.

Literature Review

Risks and considerations

While gastric bypass surgery can be life-changing, it is essential to recognize that it is a major surgical procedure and carries certain risks. Some potential risks and complications associated with the surgery include

Infection: As with any surgical procedure, there is a risk of infection at the incision sites or within the abdomen.

Nutritional deficiencies: Due to the altered digestion process, patients may be at risk of nutrient deficiencies, particularly in vitamins and minerals. Regular monitoring and appropriate supplementation are crucial to prevent deficiencies and ensure optimal health.

Dumping syndrome: Dumping syndrome occurs when food moves too quickly from the stomach into the small intestine, resulting in symptoms such as nausea, vomiting, diarrhea, and dizziness. It can be managed through dietary modifications and medication.

It is important for individuals considering gastric bypass surgery to have a comprehensive understanding of the risks and benefits involved. Thorough consultation with a qualified healthcare professional specializing in bariatric surgery is crucial to make an informed decision and determine if the procedure is suitable for an individual's specific circumstances [6].

Post-surgery lifestyle changes

Gastric bypass surgery is not a magic solution; it requires a lifelong commitment to significant lifestyle changes to ensure long-term success. Patients must adopt a healthy, balanced diet, portion control, and regular exercise to maintain weight loss and prevent complications. Support from healthcare professionals, dietitians, and support groups can play a crucial role in helping individuals navigate these changes successfully.

Gastric bypass surgery offers hope for individuals struggling with obesity, providing a powerful tool for achieving significant and sustained weight loss. Alongside the potential benefits, it is vital to consider the risks and commit to the necessary lifestyle changes. Ultimately, the decision to undergo gastric bypass surgery should be made in consultation with a qualified healthcare professional, ensuring personalized care and support throughout the transformative journey towards improved health and well-being [7].

Gastric bypass surgery is a well-established and effective weight loss procedure that has been performed for several decades. It is typically recommended for individuals with a body mass index (BMI) of 40 or higher, or those with a BMI of 35 or higher with obesity-related health conditions. The surgery is usually considered after other weight loss methods, such as diet and exercise have been unsuccessful [8-11].

Procedure

The gastric bypass surgery involves several steps

Creation of a small stomach pouch: The surgeon divides the top portion of the stomach, creating a small pouch that can hold only a limited amount of food (approximately 1 ounce) [12,13].

Diverting the small intestine: The surgeon then cuts the small intestine and attaches the lower part of it directly to the stomach pouch. This bypasses a section of the small intestine, reducing the absorption of calories and nutrients.

Types of gastric bypass surgery

Roux-en-Y gastric bypass (RYGB): This is the most commonly performed gastric bypass procedure. It involves creating a small stomach pouch and rerouting a segment of the small intestine to form a Y-shaped connection.

Mini gastric bypass (MGB): This procedure is a variation of gastric bypass surgery that involves a longer and narrower gastric pouch and a loop of the small intestine.

Benefits of gastric bypass surgery

Long-term weight loss: Gastric bypass surgery is associated with significant and sustained weight loss. Most patients can expect to lose around 60-80% of their excess body weight within the first year after surgery.

Improvement or resolution of obesity-related health conditions: Gastric bypass surgery has been shown to improve or resolve many obesity-related conditions, including type 2 diabetes, high blood pressure, high cholesterol levels, obstructive sleep apnea and joint pain.

Enhanced quality of life: Beyond physical health improvements, patients often experience enhanced quality of life following gastric bypass surgery. They may have increased energy levels, improved mobility, reduced reliance on medication and a positive impact on mental well-being.

Precautions

Surgery risks and complications: Like any major surgery, gastric bypass surgery carries risks such as infection, bleeding, blood clots, and adverse reactions to anesthesia. These risks are generally low but should be discussed with the surgeon before the procedure.

Lifestyle changes: Post-surgery, individuals must commit to significant lifestyle changes. These include adopting a balanced diet, portion control, regular exercise, and lifelong vitamin and mineral supplementation. Behavioral counseling and support from healthcare professionals are often recommended to help patients adjust to these changes successfully.

Psychological factors: Candidates for gastric bypass surgery undergo psychological evaluation to ensure they are mentally prepared for the procedure and can cope with the emotional and psychological challenges associated with significant weight loss.

Follow-up care: Regular follow-up appointments with the healthcare team are crucial to monitor progress, address any complications, and provide ongoing support [14,15].

Conclusion

Gastric bypass surgery can be a life-changing intervention for individuals struggling with severe obesity. However, it is essential to approach it as part of a comprehensive weight management plan, involving a multidisciplinary team of healthcare professionals. With the right support and commitment to lifestyle changes, gastric bypass surgery can pave the way for long-term weight loss and improved health outcomes.

Acknowledgement

None

Conflict of Interest

None

1. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, et al. (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292: 1724-1737.

Indexed at, Google Scholar, Crossref

2. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, et al. (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351: 2683-2693.

Indexed at, Google Scholar, Crossref

3. Peterli R, Wölnerhanssen B, Peters T, Vetter D, Kröll D, et al. (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 319: 255-265.

Indexed at, Google Scholar, Crossref

4. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, et al. (2017) Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med 377: 1143-1155.

Indexed at, Google Scholar, Crossref

5. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, et al. (2017) Bariatric surgery versus intensive medical therapy for diabetes-5-year outcomes. N Engl J Med. 376: 641-651.

Indexed at, Google Scholar, Crossref

6. O'Brien PE, Hindle A, Brennan L, Skinner S, Burton P, et al. (2019) Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-center review of 20-year outcomes after adjustable gastric banding. Obes Surg 29: 3-14.

Indexed at, Google Scholar, Crossref

7. Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev 2014: CD003641.

Indexed at, Google Scholar, Crossref

8. Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J (2017) Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study.

Lancet Diabetes Endocrinol 5: 174-183.
Indexed at, Google Scholar, Crossref

9. Maggard-Gibbons M, Maglione M, Livhits M, Ewing B, Maher AR, et al. (2013) Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA 309: 2250-2261.

Indexed at, Google Scholar, Crossref

10. Courcoulas AP, Christian NJ, Belle SH, Berk PD, Flum D, et al. (2013) Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 310: 2416-2425.

Indexed at, Google Scholar, Crossref

11. Schauer PR, Kashyap SR, Wolski K (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366: 1567-1576.

Indexed at, Google Scholar, Crossref

12. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, et al. (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122: 248-256.e5.

Indexed at, Google Scholar, Crossref

13. Pories WJ, Swanson MS, MacDonald KG, et al. (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222: 339-352.

Indexed at, Google Scholar, Crossref

14. Aminian A, Brethauer SA, Andalib A, Punchai S, Mackey J, et al. (2016) Can sleeve gastrectomy "cure" diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes. Ann Surg 264: 674-681.

Indexed at, Google Scholar, Crossref

15. Nguyen NT, Nguyen B, Gebhart A, Hohmann S (2013) Changes in the makeup of bariatric surgery: a national increase in use of laparoscopic sleeve gastrectomy. J Am Coll Surg 216: 252-257.

Indexed at, Google Scholar, Crossref