Laparoscopic Gastric Bypass Surgery in Delhi, India

Gastric bypass is a surgical procedure for those who intend to lose weight and have failed to do so by natural methods. This procedure changes how the stomach and intestines function and handle the food eaten. As the name suggests, food is bypassed by parts of the stomach and small intestine that absorb food. Consequently, the body does not receive all the calories consumed through food, only part of them.

This surgery is both a metabolic and a weight loss procedure. The procedure causes the division of the stomach and small intestine, connecting the new segments and forming a "Y" shape.

When is a Laparoscopic Gastric Bypass Needed?

Gastric bypass is a type of bariatric surgery which is recommended for obese individuals and those who find it difficult to lose weight through non-invasive methods. It is often carried out in people with severe obesity. It relieves chronic medical conditions such as diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, and chronic acid reflux, such as GERD.

Who are the Best Candidates for Laparoscopic Gastric Bypass?

Gastric bypass surgery is ideal for people who have the following issues:

• Have Class III obesity, which is determined with the help of BMI that indicates at least 40 kg/m2.
• Or have a BMI of at least 35 kg/m2 with at least one obesity-related condition.
• Or have obesity-related type 2 diabetes. This is indicated because obesity directly affects blood glucose regulation. To manage uncontrolled diabetes, which is not possible or working with non-invasive methods, gastric bypass surgery may be recommended. This is especially true when the BMI is 30 or higher.

In addition to the above, the prospective candidate must meet the following criteria:

• Ready to commit to making major lifestyle modifications. This is because surgery will help lose weight, but it needs to be maintained. If eating habits are not changed, the desired outcome of surgery is difficult to achieve.
• Should be mentally and physically fit for the surgery. Standard full-body tests are often carried out to assess the patient's physical health and evaluate if they are fit for surgery.
• People who have tried and failed at other weight loss means may opt for gastric bypass surgery.

Who Should Not Consider Laparoscopic Gastric Bypass?

People with the following conditions are not the ideal candidates for gastric bypass surgery:

• There is a history of severe heart failure, coronary artery disease, and end-stage lung disease.
• Those people who are undergoing cancer treatment
• People with portal hypertension
• People with dependency on alcohol, drugs or smoking
• People with an impaired intellectual capacity
• Pregnant women

How do you Prepare for Keyhole Surgery?

Before gastric bypass surgery, surgeons advise undergoing specific tests, quitting certain habits and consulting with doctors of other specialities to ensure complete mental and physical fitness. Some of these include:

• A complete physical examination.
• Blood tests, gallbladder ultrasound, and other such tests ensure fitness.
• Consultations with other doctors help address other medical ailments such as diabetes, heart or lung disorders, hypertension, etc.
• Nutritional counselling is extremely important for people undergoing bariatric surgery to understand what needs to be followed before and after the surgery.
• Address concerns regarding the surgery, its outcomes, and the recovery period.
• Speaking to a counsellor before the surgery can help prepare better emotionally for the surgery. This is because the surgery involves making major lifestyle modifications post-operatively.
• It is advisable to quit smoking several weeks before surgery to ensure its success. Also, smoking has long-term side effects on overall health and weight.
• It is imperative to inform doctors about the ongoing medicines, vitamins, herbal supplements, and other medications since they may interfere with the surgery.

Laparoscopic Gastric Bypass Surgery Procedure

The procedure can be performed using either a laparoscope or a robotic platform, which involves making several minor incisions in the abdomen and using a camera and specialised instruments to perform the surgery.

The general steps of a gastric bypass procedure are as follows:

1. Preparation: Before the surgery, the patient is put under general anaesthesia and is prepared for the operation.
2. Creating the stomach pouch: The surgeon uses staples to make a small pouch at the top of the stomach. This pouch is designed to hold a small amount of food.
3. Rerouting the small intestine: The surgeon then divides the small intestine and attaches the lower end of it directly to the stomach pouch, creating a "Roux-en-Y" limb. The upper end of the divided small intestine is reattached further down the small intestine, creating a "biliopancreatic limb." This rerouting of the intestine causes the food to bypass most of the stomach and the upper section of the small intestine, which reduces the amount of food absorbed and results in weight loss.
4. Closing the incisions: Once the rerouting of the small intestine is complete, the surgeon closes the incisions, and the patient is taken to a recovery room.
5. Recovery: After the surgery, the patient is closely monitored for complications and may stay in the hospital for a few days. The patient will have to be on a strict diet and exercise regimen as they recover from the surgery.

Possible Complications of Laparoscopic Gastric Bypass Surgery

Surgeries that modify the digestive system can entirely change the way food is digested, leading to some digestive complications, which may include:

• Dumping syndrome: This syndrome includes symptoms that occur when the stomach quickly dumps food in the small intestine. The symptoms are nausea, vomiting, diarrhoea, abdominal cramping, and hypoglycemia. These symptoms fade with time. Doctors thus provide dietary guidelines to strictly adhere to while recovering from dumping syndrome.
• Malabsorption and malnutrition: Gastric bypass surgery induces malabsorption in the small intestine. It lowers the absorption of calories and might cause nutritional deficiencies if not careful. Often, nutritional supplements are prescribed to avoid this.
• Gallstones: Rapid weight loss causes the liver to process a huge chunk of cholesterol, sending bile with excess cholesterol to the gallbladder. This leads to the formation of cholesterol gallstones.
• Ulcers: People who have undergone gastric bypass surgery carry an increased risk of developing gastric ulcers. Hence, smoking or taking NSAIDs should be avoided.
• Weight regain: If the protocols discussed before the surgery are not adhered to, it is common to regain the lost weight. Under such circumstances, a revision surgical procedure may be needed.

Risks of Laparoscopic Gastric Bypass Surgery

The common risks of the procedure are:

• Reactions to anaesthesia
• Hernias
• Small bowel obstruction
• Wound infection: On occasion, surgical incisions may become infected during the recovery process. Indications of a wound infection include discomfort in or near the wound, inflamed, hot to the touch, red skin, and pus discharge from the wound.
• Anastomotic leaks: This could potentially result in a severe infection inside the abdomen. Symptoms that may indicate a leak include an elevated body temperature, a rapid heartbeat, abdominal pain, chills, shivering, and rapid breathing.
• Blood clots: After surgery, patients receive measures to minimise the risk of developing blood clots, including wearing specialised stockings on their legs or taking medication to thin their blood. However, despite these measures, there is still a possibility of experiencing blood clots. The most common locations for blood clots to form are in the lower leg, also known as deep vein thrombosis, or in the lungs, called pulmonary embolism.

Care after Laparoscopic Gastric Bypass Surgery

Most people stay 1-2 days in the hospital after the surgery. At the hospital, the following instructions must be followed:

• On the day of surgery, after moving from the recovery room, the patient is made to walk as much as possible.
• The doctors start with liquid intake 4 hours after the surgery.
• Special stockings are worn to prevent blood clots in the legs.

At home

Diet is taken as advised by the dietician, along with some medications for pain.

Outlook

Losing weight after the surgery helps manage other medical conditions, such as diabetes, GERD, asthma, and others, better. If you can relate to any of the above, schedule an appointment with us today!

Review

Reviewed by Dr Atul NC Peters, Senior Director - Bariatric, Minimal Access & General Surgery, Laparoscopic / Minimal Access Surgery, Bariatric Surgery / Metabolic, General Surgery, Department of General Surgery and Robotics on 1st May 2024.