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Gastric bypass

Gastric bypass treatment in Hebbal, Bangalore

Gastric bypass treatment in Hebbal, Bangalore is a technique where the stomach is surgically divided into two pouches, the upper pouch is small, and the lower remnant is much larger. Then rearranging, the small intestine connects it to both pouches. Surgeons develop various ways to reconnect the intestine, which has given rise to different gastric bypass procedures (GBP).

GBP is advised as a treatment for cases of morbid obesity.  Morbid obesity is a body mass index higher than 40.  This surgery is also performed for treating sleep apnea, hypertension, type 2 diabetes, and various comorbidity conditions. Bariatric surgery includes all surgical treatments for morbid obesity, including gastric bypasses, which is just a single class of this type of operation. The weight loss that follows is generally quite significant and significantly decreases comorbidities.

Techniques of surgery

Laparoscopic surgery is done by making various small-sized incisions (ports).  One port serves the purpose of inserting a surgical telescope that is attached to a video camera.  Other ports are used to enable access to specialised instruments used for operating. The surgeon sees the operation on a video screen. Laparoscopy surgery is also referred to as limited access surgery due to the limitation of feeling and handling of the tissues, as well as two-dimensionality and limited video resolution. An experienced and skilled laparoscopic surgeon can do surgeries as expeditiously as with an open incision, with the option to make an incision if needed. 

The Roux-en-Y laparoscopic gastric bypass is among the most challenging surgeries with limited access.  Yet, this method has made the operation very popular because of the benefits that are associated with as, such as decreased hospital stay, lesser discomfort, shortened time for recovery, reduced scarring, and shallow risk for incisional hernia. 

Gastric bypass procedure

  • The upper stomach is used to form a little (15–30 ml/1-2 tbsp) thumb-sized pouch, while the remaining stomach (400–500 ml or variable) is skipped. Using surgical staples, the belly can be either simply divided into two different pieces or wholly divided into two separate parts. The entire division makes it less likely that the two portions of the stomach will mend back together and defeat the procedure's objective.

  • GI tract reconstruction is performed for drainage from both pouches of the stomach. The technique used for the reconstruction creates various variants of the operation based on the differing lengths of the small intestine used, the extent to which the absorption of food gets affected, and the possibility of unfavourable nutritional effects. Generally, a small part of the small bowel is attached to the stomach’s proximal remains.

Variations

Gastric bypass, Roux-en-Y (RYGB, proximal)

It is the most standard technique for a gastric bypass that is performed most commonly.  The small intestine is divided approximately 18 in / 45 cm below the outlet of the lower stomach. It is then re-arranged in Y-configuration, allowing food outflow from the small pouch of the upper stomach through a Roux limb. When it is proximal, Y-intersection will be created close to the small intestine’s proximal/upper end.  Construction of the Roux limb is done using 31–59 in / 80–150 cm of the small intestine, the rest (majority) being preserved from absorbing nutrients. The patient very quickly feels that the stomach is full, accompanied by a feeling of satiation/indifference towards food for a short period post the beginning of a meal.

Gastric bypass, Roux-en-Y (RYGB, distal)

The length of the small intestine will generally be between 20 to 33 ft / 6 to 10 m long. When the Y-connection gets moved lower in the gastrointestinal tract, small intestine amount available for complete absorption of nutrients becomes lesser and lesser to provide for better effectiveness of the surgery. The Y-connection gets created nearer the distal / lower end of the small intestine; generally, 39 to 59 in / 100 to 150 cm away from its lower end, decreasing food absorption and causing malabsorption: mainly of starches and fats and starches, and even of several minerals and fat-soluble vitamins. Starches and unabsorbed fats move to the large intestine, where bacterial actions could act on them and create malodorous gases and irritants.

Mini-gastric bypass (MGB)

In a mini gastric bypass long, narrow tube of the stomach is created along its lesser curvature / right border. About 180 cm from the intestine's beginning, a loop is carried up from the small gut and attached to this tube.

Currently, loops are employed in procedures for treating gastric problems like stomach cancer, ulcers, and stomach injury. In the mini-gastric bypass, low set loop reconstruction is used, leading to a low possibility of bile reflux.

MGB is considered an alternative for Roux-en-Y because it is simple to construct, has few complications, and sustains weight loss. 

Endoscopic duodenal-jejunal bypass

In this procedure, a duodenal-jejunal bypass liner is implanted between the start of the first portion of the small intestine from the stomach (duodenum) and the small intestine’s secondary stage (mid-jejunum). It disallows food that is partially digested from entering the initial and first part of the secondary stage of the small intestine, recreating the effects of the biliopancreatic portion of Roux-en-Y gastric bypass surgery. Contact at Manipal Hospitals to know more about the treatments with the help of best doctors in Bangalore. 

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