Gastric Bypass
Gastric
bypass is probably the ‘gold standard’ surgical treatment for morbid
obesity in most patients, it brings about a loss of more than 60% of
excess weight and it offers a very good quality of life. Diabetes
resolves in more than 80% of patients and high blood pressure in more
than 70%, so it is particularly applicable to patients where obesity is
complicated by these conditions. Although it can demand considerable
skill and experience to perform it safely, its popularity as an
operation has greatly increased due to the benefits of the laparoscopic
technique.
Exactly how gastric bypass delivers loss of weight and suppression of
hunger is unclear. - The primary mechanism is probably mechanical
restriction achieved by creation of a small thumb-sized pouch from the
upper stomach, with the result that food cannot get into the majority
of the stomach. Although diminished efficiency of absorption was
assumed to be a secondary mechanism, most patients display no clinical
evidence of malabsorption and its actions are probably related to
hormonal changed involving the gut.
Standard Indications for Laparoscopic Gastric Bypass: • Body Mass Index
greater than 40 • Body Mass Index between 35 and 40 associated with
significant comorbidity such as hypertension, diabetes, arthritis or
sleep apnoea.
Gastric bypass is an operation that has been shown to save lives and to
transform the quality of life for most patients. However, to make it as
safe as possible, it should be carried out by experienced and
specialist surgeons in a hospital with full back up facilities and a
range of appropriate instrumentation.