Gastric bypass

With the gastric bypass in obese people, a part of the stomach and small intestine are bypassed and switched off. Read more!

Gastric bypass

Of the gastric bypass (Gastric bypass) refers to a surgical procedure in which a large part of the stomach and the small intestine are bypassed in obese people and thus eliminated. It remains only a small gastric remnant, the patients feel therefore already after very small amounts of food a feeling of satiety. The result is a fast and significant weight loss. Find out everything about the operation, its benefits and risks here!

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. E66

Product Overview

gastric bypass

  • What is a gastric bypass?

  • Preparation for gastric bypass

  • Course of gastric bypass surgery

  • For whom a gastric bypass is suitable

  • For whom a gastric bypass is not suitable

  • Efficacy of gastric bypass surgery

  • Benefits of gastric bypass over other procedures

  • side effects

  • Gastric bypass: risks and complications

  • Gastric bypass: diet after surgery

  • Gastric bypass: cost

What is a gastric bypass?

The gastric bypass (more precisely, Roux-en-Y gastric bypass) is a very commonly used method of obesity surgery with the aim of weight loss. The name derives from the name of the Swiss surgeon "Roux", who developed the basic technique of the procedure. The "Y" stands for the form in which the intestinal sections are joined together, namely Y-shaped.

The success of gastric bypass is based on two principles:

  • a stomach reduction to reduce the amounts of food (restriction)
  • the elimination of the important upper small intestine portion (duodenum), whereby the digestive juices important for the food splitting mix later with the chyme (worse nutrient absorption = malabsorption)

The weight loss after a gastric bypass is very effective and reliable, but it is provided with some lifelong restrictions: patients with a Reoux-en-Y bypass tolerate only very small meals, because the remaining after surgery residual stomach ("stomach pouch") only has a very small volume. In addition, the poorer nutrient utilization requires that patients take certain dietary supplements and vitamins (especially vitamin B12, trace elements and protein supplements) for life, in order to avoid any deficiency symptoms. As some of the nutrients remain undigested, fermentation processes in the large intestine can increasingly arise. The operation can hardly be reversed after successful weight loss.

Preparation for gastric bypass

Before surgery, pathological changes in the stomach must be ruled out. For example, the stomach is examined for diseases such as gastritis or gastric ulcer and a possible germ colonization with the bacterium "Helicobacter pylori", which can cause stomach ulcers. In addition to a gastroscopy and the examination of gastric juice, an ultrasound of the upper abdomen is also used, with which gallstones can be detected. These should be removed as part of the gastric bypass surgery, as they can lead to inflammation of the gallbladder and bile duct.

Course of gastric bypass surgery

Depending on the patient, gastric bypass surgery lasts about 90 to 150 minutes and is performed under general anesthesia. The procedure usually requires hospitalization of about one day prior to surgery (surgical and anesthetic preparation) plus five to seven days thereafter. After gastric bypass surgery, you will not be able to work for about three weeks.

The gastric bypass is today almost exclusively performed as a so-called minimally invasive surgery. This technique, also known as the "keyhole method", does not require a large abdominal incision. Instead, the instruments and a small camera are inserted into the abdomen via several skin incisions about two centimeters in size. Overall, minimally invasive surgery has a lower surgical risk than open surgery, making it particularly suitable for obese patients, who are more vulnerable to complications during and after surgery anyway.

The gastric bypass surgery consists of several stages:

  1. After initiating general anesthesia, the surgeon inserts the instruments and a camera with a light source into the abdomen through several skin incisions. Thereafter, a gas (usually CO2) is introduced into the abdominal cavity, so that the abdominal wall lifts slightly from the organs and thus the surgeon has more space in the abdominal cavity and a better view of the organs.
  2. Only the stomach is first separated just below the esophagus by a so-called stapler ("stapler"). The stapler cuts and staples at the same time, so that the cut edges are immediately closed. At the end of the esophagus, only a small residual stomach remains (the so-called gastric pouch or stomach pocket).It has a volume of less than 50 milliliters. The rest of the stomach remains in the body, but is closed at the top and so to speak "shut down".
  3. Next is a section through the small intestine in the area of ​​the so-called jejunum ("jejunum"). The lower cut end is now pulled up and sewn to the stomach pouch. Therefore, the compound is also called gastrojejunal anastomosis.
  4. Now further below, the remaining, cut end of the jejunum with the third small intestine section ("ileum") is sewn, so that the shape of a "Y" is formed (Y anastomosis). Here only the digestive juices from the duodenum (bile and pancreatic secretions) mix with the chyme.

For whom a gastric bypass is suitable

The gastric bypass is suitable for people with a body mass index (BMI) over 40 kg / mΒ² (obesity grade III or obesity permagna). In any case, the precondition for gastric bypass surgery is that all non-surgical measures have not shown sufficient success even after six to twelve months. These measures include, for example, professional nutritional counseling, exercise training and behavioral therapy (Multimodal Concept for Obesity, MMK). For the gastric bypass surgery should be at least 18 and no more than 65 years old, the operation in individual cases, even in younger or older people is possible.

A gastric bypass is especially recommended for people whose overweight stems mainly from a high consumption of high-calorie food (sweets, fats) and sweet drinks. Because these are now split worse and therefore can be utilized by the body only to a small extent and stored as body fat.

If metabolic diseases (such as diabetes mellitus, high blood pressure or a sleep apnea syndrome) are already present due to the excess weight, a gastric bypass may already be useful from a BMI of 35 kg / mΒ².

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    Stomach reduction - what's in it?

    Gastric surgery is the last resort for many overweight people to lose weight significantly and permanently. Which methods are available? Do you really get slim with it? And what are the risks? Find out here about tubular stomachs, gastric band balloons and bypasses.

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    Gastric balloon - no room for food

    A comparatively gentle method of reducing gastric volume is the gastric balloon. It is introduced in the empty state through the esophagus and then filled with water via a catheter. The patient is then fed much faster. The balloon, however, must be removed after six months so that it takes no damage. In some cases, it will burst prematurely. The weight loss that can be achieved is 10 to 20 kilos.

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    Gastric band - organ in the corset

    More complicated than the balloon is the gastric band. It is placed from outside around the upper part of the stomach. This reduces the capacity of the stomach and slows down the transport of food. The gastric band can remain in the body, but it can also be removed again. It takes off more than with a gastric balloon - but at most about 50 percent of the excess weight. Normally, most will not be so.

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    Not suitable for everyone

    For people with problematic gastric anatomy, but also eating disorders such as binge eating or bulimia, the method is not suitable. In addition to the risks of surgery, gastric banding may also cause other complications, such as bulging of the forestomach or esophagus, slipping of the cuff, or inflammation in the abdomen.

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    Tubular stomach - capped organ

    Tubular stomach surgery removes 90 percent of the stomach. Therefore, only a little fits in and the patient quickly feels full. So you take off quickly and more than with a gastric band. Realistic is a reduction of 60 to 70 percent of overweight. Also, complications of obesity such as type 2 diabetes, high blood pressure or lipid metabolism disorders, usually improve quickly or even disappear completely.

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    There is no turning back

    This procedure is irreversible. This usually means you can never eat normal portions again. Those who do not pay close attention to their diet are threatened with nutritional deficiencies. In some cases, the stomach may unintentionally widen again. And of course, the usual surgical risks such as bleeding and infection can occur.

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    Gastric bypass - diversion for the porridge

    An even more serious - but also more effective - procedure is the gastric bypass. The small intestine is sewn to a tiny residual stomach below the esophagus. The food bypasses the stomach and duodenum. The digestive juices enter the small intestine late, and the passage, where nutrients can enter the body, shortens. This means fewer calories are absorbed and utilized.

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    Biliopancreatic division

    Very similar works the Biliopankreatic division.It is the most elaborate and at the same time most effective operation in obesity surgery. The stomach is drastically reduced. Because bile and pancreas are supplied very late, no food can be taken in most of the small intestine.

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    Swallow pills for life

    Also gastric bypass and biliopancreatic division are irreversible - and he is a drastic physical intervention. Since fewer vitamins and trace elements are absorbed, the patient must swallow and partially inject them. In addition, flatulence, diarrhea and fatty stools threaten with inappropriate meals and even circular waste with sudden evacuation (dumping syndrome).

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    Lighter, healthier, happier

    A stomach reduction can significantly improve life. Many obese manage to lose weight significantly and permanently. This greatly benefits the quality of life: they are fitter, more self-confident and have fewer prejudices to contend with. Above all, however, health benefits. The risk of cardiovascular disease and cancer is falling. High blood pressure or type 2 diabetes can even disappear again.

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    Side effects included

    However, stomach surgery is no triviality. The bigger the procedure, the more effective it is - but the more serious are the possible complications and sometimes lifelong "side effects". And some of the patients continue to gain weight despite the operation: Even a small stomach can be outsmarted with high-calorie liquid or mushy foods.

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    Eat earlier, drink today?

    Because the emotional problems, which are often involved in the fact that people increase strongly, can not be solved operationally. If feasting goes away as a soul support, another problematic behavior can quickly come up. Alcohol abuse, for example, after a stomach reduction is not uncommon. The psychological pre- and aftercare is therefore important.

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    Side effects included

    If you do not fall into this category, you have to bear the costs yourself. And they are considerable. What many do not think: In addition costs can come, which arise because of complications. Also for those the cash register is - as after all OPs, which are classified as cosmetic operations - not responsible. In extreme cases, they can amount to a multiple of what the intervention cost.

For whom a gastric bypass is not suitable

Various physical and mental illnesses speak against an obesity operation such as gastric bypass. Especially after previous operations or malformations of the stomach, gastric ulcer and addictions as well as untreated eating disorders such as binge eating or bulimia, gastric bypass should not be used. Even pregnant women have to do without a gastric bypass.

Read more about the investigations

  • J1 investigation
  • J2 investigation

Efficacy of gastric bypass surgery

Gastric bypass is a very effective procedure, but only a few patients achieve normal weight (BMI ≀ 25 kg / mΒ²). Studies have shown that with a gastric bypass in the long term, a weight loss of about 60 to 70 percent of the overweight is possible, ie the weight that separates the person from the normal weight.

In addition to the purely cosmetic effect, the weight loss after the gastric bypass surgery has above all favorable effects on the metabolism. For example, the intervention in many cases greatly ameliorates and sometimes even heals existing diabetes mellitus (diabetes mellitus). In many cases, blood glucose levels drop even shortly after surgery, although the patient has not lost significant weight. The reasons are not yet clear. It is believed that the operation will initiate various hormonal changes (for example, the hormones ghrelin, glucagon, GIP, etc.), which have a beneficial effect on the metabolism.

Read more about the therapies

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Benefits of gastric bypass over other procedures

Because gastric bypass surgery combines two principles (restriction and malabsorption, see above), the procedure is extremely effective and is particularly effective when patients are overweight resulting from excessive intake of high calorie liquid or soft foods. For these so-called "sweet-eater" alone would be a reduction in the gastric volume, as it is achieved by the gastric band, the gastric balloon or the tube stomach, not enough.

side effects

The gastric bypass is associated with some side effects. How strong these are will vary individually and therefore can not be predicted with certainty. Among the important ones are:

Indigestion due to malabsorption: Flatulence, abdominal pain, nausea, feeling of fullness

Iron deficiency and anemia (anemia): Normally, most of the food-grade iron is taken up in the duodenum. Since the gas is bypassed the food at the duodenum, the iron absorption is difficult. The iron deficiency is prevented by an additional gift of iron.

Vitamin B12 deficiency (special form of anemia): Vitamin B12 is taken up on the last section of the small intestine (terminal ileum). But this is an adjuvant, the so-called intrinsic factor ("intrinsic factor") required, which is formed by the stomach. When gastric bypass, the food is, however, bypassed the stomach and thus formed less intrinsic factor. Vitamin B12 must therefore be regularly injected into the muscle as a syringe to the vein. There are also vitamin B-12 preparations available that are absorbed directly through the oral mucosa (sublingual application). Their effectiveness is still discussed.

Vitamin D deficiency: Why it can come in a gastric bypass to a vitamin D deficiency is not yet clear. Vitamin D can be easily supplemented with food (orally).

Dumping syndrome: Dumping syndrome (dulling syndrome) is a series of symptoms (dizziness, nausea, sweating, or palpitations) that can result from instantaneous (fall-like) depletion of food from the esophagus to the small intestine. Because the stomach pouch is missing the lower gastric sphincter (porter). The porridge attracts in the small intestine by osmotic forces water from the surrounding tissue and the blood vessels. This reduces the volume of fluid in the circulation, which can lead to a fall in blood pressure. A dumping syndrome occurs mainly after very sugary drinks or fatty foods.

Gastric ulcer in the stomach pouch: After gastric bypass surgery, the risk of gastric ulcer is increased in the gastric pouch. Help is provided by acid-reducing medications, so-called proton pump inhibitors (PPIs), which must be taken permanently if gastric ulcer develops after gastric bypass surgery.

Loss of muscle mass: A fast weight loss is often associated with a loss of muscle mass, because the organism tries to balance the relative lack of carbohydrates by breaking down body protein (especially from less stressed muscle cells). Regular exercise can stop this effect. For overweight people, above all, joint-sparing sports such as light weight training, cycling, swimming or aqua jogging are advisable.

Gastric bypass: risks and complications

Gastric bypass is a major abdominal surgery that greatly changes the normal anatomy of the gastrointestinal system. Basically, the surgical risk is low, but complications can not be ruled out, as with all surgical procedures. Non-specific operational risks include:

  • anesthesia complications
  • Organ and vascular injuries with bleeding
  • Infections of internal and external wounds
  • Leakage of artificial organ connections (anastomoses) with the risk of peritonitis (peritonitis)
  • wound healing
  • Disorders of normal gastrointestinal movements (intestinal atony)

Gastric bypass: diet after surgery

People with a gastric bypass must follow the following nutritional rules for life, to avoid digestive problems:

  • Chew food very well
  • eat small portions
  • Avoid very sugary foods and drinks
  • refrain from very long-fiber meat or vegetables
  • Take a dietary supplement (see above)

Medicines after gastric bypass

Some medications are absorbed by the body after a gastric bypass with altered dynamics or in a lesser amount. Many medications therefore require dose adjustments by the physician.

Gastric bypass: cost

The costs for a gastric bypass vary considerably depending on the clinic. They are between about 6,500 and 15,000 euros. The gastric bypass is currently not a regular benefit of the statutory health insurance. That means the cost of gastric bypass only be accepted on request and only under certain conditions. Inform yourself in detail about the necessary requirements before submitting the application!

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