Gastric Bypass - Best Surgical Option in Obesity with Co-Morbities - Health Education - DesiMD Healthcare - India

Gastric Bypass : Best Surgical Option in Obesity with Co-Morbities

Dr.Venugopal Pareek profile Authored by Dr.Venugopal Pareek on 3 Apr 2014 - 18:39.

Obesity is a major health hazard affecting almost a third of Indians. Considered till now a disease affecting developed countries, obesity is now evolving as a major health hazard affecting India.

Normally we gain weight when we consume more calories than used by our body for its normal functions (basal metabolic rate-BMR) and physical activity. The excess and unused calories are stored as fat. We become obese if we consistently consume excess calories over a long period of time.

If we try to lose weight by starving or dieting override, the set point by cutting calorie intake, our brain responds by lowering metabolism and slowing activity, we then gain back any weight you lost.

Health Hazards of Obesity

Severely obese persons are approximately 6 times as likely to develop heart disease as those who have normal weight. Heart disease is the leading cause of death today and obesity is one of the main causes of heart disease.

High blood pressure is much more common in obese persons and leads to development of heart disease.  Overweight persons are 40 times as likely to develop Type-2 adult-onset diabetes.

Seriously overweight persons face constant challenges emotionally: repeated failure with dieting, disapproval from family and friends and remarks from strangers.

Gastric Bypass Gold Standard Treatment

In the Roux-en-Y Gastric Bypass about 60 to 70 percent of the stomach is eliminated.  In this procedure, the stomach is separated into two sections. The upper part is made into a very small pouch, about the size of an egg about 70 ml. The small pouch is at the bottom of the oesophagus and is very resistant to stretching. The lower part of the stomach is not removed.  Nothing enters it but it still produces gastric juices which aids in digestion process by eventually joining the small intestines.

These two parts of the stomach are completely separated and are closed by a method of stapling and sewing to eliminate the chance of leaking. The small intestine is disconnected about 50- 75 cm distal to its origin and the distal disconnected end is connected to small stomach pouch with a half inch opening between the stomach and the intestine. Secretions from the remaining stomach assist in digestion as it is attached to small intestines several feet below the new stomach depending on the weight of patient. The entire procedure is done laparoscopically and requires 3-4 days hospital stay.

Post-Operative Care

The patient is advised about the physical adjustments he/she will have to make after the surgery. In the first six months after the surgery, eating too much or too fast may cause either vomiting or an intense pain under the breastbone.

Instead of eating regular-sized meals three times a day, the person will be required to eat four to six very small meals: about 2 ounces (60 ml) each. Most people, however, quickly learn how much they can eat at one meal. And over time, the quantity of food intake increases. 

Nutrient deficiencies following Gastric Bypass

Protein is always at the center of any weight-loss approach. Inadequate protein intake is a major concern following Roux-en-Y gastric bypass. Protein consumption must be of high quality, ie. including all the essential amino acids. Sources of high-quality protein include milk, cheese, whey, soy, eggs, fish, and meat.

Micronutrient Deficiencies

The most frequent problems are the combined iron and vitamin B12 deficiencies. These deficiencies may develop at any time following the surgery. Iron deficiency may arise as early as the first 6 months, and is usually followed by vitamin B12 deficiency. Iron, vitamin B12, and folic acid status are determined by measuring hemoglobin, red blood cell or corpuscular volume (MCV), folate levels and treated accordingly.

Benefits after Gastric Bypass
 

1. Type 2 Diabetes Mellitus

Fasting plasma glucose and glycosylated hemoglobin concentrations return to normal levels in over 80 percent of patients. A significant reduction in the use of oral anti-diabetic agents and insulin is seen in 80 percent of patients.

 2. Obstructive Sleep Apnoea

Laparoscopic Roux-en-Y gastric bypass very effectively controls sleep apnea. In long-term follow-up, 93 percent

of patients demonstrated significant improvement.

3. Hypertension

Resolved in 52 percent to 92 percent of patients after laparoscopic gastric bypass in large series.

4. Dyslipidemia and hypercholesterolemia

Bariatric surgery improves serum lipid profiles in 79 percent of patients and thereby decreases cardiovascular risk. The highest rates of change occur with gastric bypass procedures with improvement in hyperlipidemia in over 96% of patient

5. GERD

Three laparoscopic gastric bypass studies report resolution of GERD in 72 percent to 98 percent of patients.

6. Joint Pains

The resolution of weight-induced degenerative joint disease is reported in 41percent to 90 percent of patients
 

7. Thyroid disorders

Hypothyroidism improves in more than 40 percent of patients following gastric bypass surgery. Reduction of thyroxine requirements is most likely the result of the decrease in the body mass index (BMI).

Surgery for weight reduction is not a miracle procedure. Though you can generally expect to lose weight and keep it off, changes needed in diet and exercise habits and the subsequent health benefits of losing weight is all yours

 

*Disclaimer
*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.