Laparoscopic Gastric Bypass

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Introduction

Obesity is the second leading cause of preventable death in the United States after smoking. More than 100 million Americans (65% of the adult population) are overweight. Annually, obesity-related diseases account for 400,000 of premature deaths. Factors may contribute to the condition are a combination of genetics, environmental issues, and behavioral attitude, Consumption of high-calorie foods, consumption of too much food, and a sedentary lifestyle all work together to create this condition. Obesity is associated with the development of diabetes mellitus, hypertension, dyslipidemia, arthritis, sleep apnea, cholelithiasis, cardiovascular disease and cancer. Severe obesity that threatens one’s health and can shorten lifespan is defined as morbid obesity.

Medically and surgically obesity can be treated. Medical treatment for obesity is difficult, because the amount of weight lost is small and patients tend to regain most of the weight. In patients, operations designed to result in significant and long-lasting weight loss that are severely obese are called bariatric surgery. The term bariatric surgery is derived from the Greek words baros (weight) and iatreia (medical treatment). Laparoscopic gastric bypass surgery, described here, is also one such surgery. A gastric pouch is created in this surgery.

Body mass index (BMI) describes relative weight for height and correlates considerably with an individual’s total body fat. BMI is based on height and weight and applies to adults of both sexes. Calculation of BMI: BMI equals weight in kg/height in m2 or weight in lb/height in square inches.

Gastric bypass is a operation used to treat the severe accumulation of excess weight as fatty tissue and the health problems (comorbidities) it causes. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations.

Indications

In 1991, the National Institutes of Health (NIH) provided a consensus statement for patient selection for bariatric surgery. If Patients met one of the following criteria they can be considered candidates for surgery:

• Body mass index (BMI) >40
• BMI of 35-40 plus one of the following obesity-associated co-morbidities:
  • Obesity-related cardio-myopathy
  • Severe diabetes mellitus
  • Osteoarthritis interfering with lifestyle
  • Pickwickian syndrome
  • Severe sleep apnea

  To be candidates for bariatric surgery, patients should have attempted, without success, to lose an appropriate amount of weight through supervised diet changes. Patients must also comply with postoperative diet and exercise.

  Procedure

  A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower "remnant" pouch and then re-arranges the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different GBP names. Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food.

  The gastric bypass procedure consists in Creation of a small, (15–30 mL/1–2 tbsp) thumb-sized pouch from the upper stomach, accompanied by bypass of the remaining stomach (about 400 mL and variable). This restricts the volume of food which can be eaten. This is a combination of restrictive as well as malabsorbtive effect on the body of the patient. The stomach may simply be partitioned by the use of surgical staples, or it may be totally divided into two parts. Total division is usually advocated, to reduce the possibility that the two parts of the stomach will heal back together ("fistulize"), negating the operation. Re-construction of the GI tract to enable drainage of both segments of the stomach. The technique of this reconstruction produces several variants of the operation, which differ in the lengths of small bowel used, the degree to which food absorption is affected, and the likelihood of adverse nutritional effects.

  Contraindications

  Contraindications for gastric bypass surgery include the following:

  • End-stage organ disease (e.g., hepatic, cardiac, pulmonary)
  • History of major psychiatric disorder
  •  History of substance abuse
  • Bariatric surgery is only a tool for weight loss. Patients who are not committed to making long-term lifestyle changes are not ideal candidates for this procedure.