Gastric bypass: OP as the last chance, if all weight loss attempts fail
For some, the last resort is to get rid of morbid obesity: gastric bypass. But how does the surgery work and what are the risks?
Eating smaller amounts and at the same time being able to absorb fewer nutrients from the diet - this should enable gastric bypass surgery and thus help obese people to decrease. It is offered in the circle of Prof. Michael Korenkov, chief physician of general and visceral surgery at the Klinikum Werra-Meißner. The operation takes around three and a half hours, which is carried out with the so-called minimally invasive method. For this, small holes are cut into the abdominal wall. Through this, both instruments and cameras are pushed into the abdominal cavity so that the surgeon can operate by means of a probe and monitor. While Korenkov performs the procedure, senior physician Harald Günnel ensures that a light in a probe enough light falls into the operation area.
First, the abdominal cavity of the patient is filled with carbon dioxide. "It has the advantage that it is not a flammable gas and is well degraded by the body," explains surgical nurse David Dittrich. The gas lifts the abdominal wall. For the surgeon it has the advantage that they have more space and the organs are more accessible. The gas is released by the body during the following days.
With an electric cautery, a kind of medical curling iron, Korenkov cuts the fat off the stomach. This is then separated into a smaller and a larger part and closed with titanium clips. The separated larger part is thus shut down and remains in the body.
In the small remaining stomach Korenkov cuts a hole with the cautery. Then he measures the part of the duodenum - a part of the small intestine - which is to be shut down. As a rule, this is one and a half meters. In the intestine is also a hole cut with the cautery. The holes in the stomach and intestine are stacked and sealed with titanium clips.
Thereafter, the disused piece of intestine, which hangs on the also disused, larger piece of stomach, also connected to the intestine again. That's the hardest part of surgery, says Dittrich, because the gut is constantly moving. Therefore, Korenkov puts a suture on the contiguous bowel parts, so they do not slip away. And: "The deeper you go in the gut, the more fat is there," explains Korenkov.
Sits the seam, two intestinal loops have emerged. The digestive juices - that is, bile and pancreatic juice - run through a loop, and the other porridge comes out of the stomach. Both come together only when the intestinal loops meet. Only from there - and thus reduced - the body can absorb calories from the food pulp.
When all organs are connected, a blue liquid is injected into the new digestive tract. This will allow surgeons to see if everything is tightly sealed or if fluid is leaking at one point. It is also checked by monitor whether everything is connected correctly and, for example, the intestinal loops are correct. When everything is in place and the instruments are pulled out of the holes in the abdominal cavity, Korenkov and Günnel place drainage in some of the holes so that fluids can drain off.
The procedure took around three and a half hours and many patients hope for a decrease. However, the operation is only the beginning, say Korenkov and Günnel after the operation. According to this, it is the behavior of the patient, who by the way - a consequence of the lower nutrient intake - has to take vitamins for the rest of his life in order not to get any shortage.
Gastric bypass improves kidney function in Type 2 diabetics
Gastric bypass has positive effects on kidney function in patients with insulin-dependent diabetes mellitus type 2, which cannot be sufficiently controlled with drugs. Adrian T. Billeter and his co-authors speak of these findings in the current issue of the Deutsches Ärzteblatt medical journal. In a prospective cohort study, 20 patients with a Body Mass Index of 25-35 kg/m2 have undergone a standardized gastric bypass surgery (Roux-en-Y-gastric bypass). Before the operation and 12 and 24 months after the surgery, their blood and urine were sampled to evaluate the kidney function.
Kidney diseases or renal dysfunction (nephropathy) are the most common and most dangerous complications in patients with diabetes mellitus type 2 (DMT2). The prevalence is 20-40% of DMT2 patients. Many of those affected by diabetic nephropathy develop terminal renal insufficiency requiring dialysis. Strict blood sugar control alone does not improve nephropathy.
The gastric bypass reduced the glycolized hemoglobin (HbA1c) and the need for insulin in slightly obese patience with type 2 diabetes. After the operation the renal function improved. For example, serum creatinine levels dropped significantly and remained at a constantly low level for 24 months. For the authors, the gastric bypass represents a new treatment option, which could be effective even if the organ is already damaged. However, their study results still need to be confirmed by randomized controlled studies.
Gastric bypass is highly effective for at least 10 years
Approximately 23% of men and 24% of women in Germany have a BMI of ≥ 30 kg/m2 and are considered obese. Obesity is classified as morbid if the BMI ≥ 40 kg/m2 without comorbidity and BMI ≥ 35 kg/m2 with comorbidity. If other treatment methods do not bring satisfactory results, bariatric surgery may be an option. The possible procedures are Roux-Y-gastric bypass (RYGB), sleeve gastrectomy and adjustable gastric banding.
The various methods of bariatric surgery are significantly more effective in reducing body weight than non-surgical ones. In the first year, patients with Roux-Y gastric bypass lose more weight than patients with sleeve gastrectomy or gastric banding. The difference remains almost the same for over 4 years, although individual groups even show weight increase. The Roux-Y gastric bypass is highly effective even 10 years after the surgery.
"Impressively, the study demonstrates the long-term effectiveness of bariatric surgery for over 10 years in a large number of bypass patients compared to unoperated patients with similar comorbidity," comments Prof. Dr. med. Thomas P. Huettl and Dr. med. Otto Dietl, chief physicians at the Obesity Center Munich. "However, the patients with the bypass surgery are inhomogeneous compared to sleeve gastrectomy and gastric banding groups. Even so the superiority of gastric bypass surgery and sleeve gastrectomy compared to the gastric banding is now proven.“
However, data from prospective randomized studies differed from the results of the current study. In the first two years there was no difference in weight loss and remission of comorbidities between the patients with bypass and sleeve gastrectomy. "Both procedures, Roux-Y-gastric bypass and sleeve gastrectomy, must now be regarded as standard procedures," say Huettl and Dietl. The therapy choice is made individually, taking into account the BMI, comorbidities, medication and addictive drugs history, such as nicotine consumption, and patient wishes.
Long-lasting weight loss thanks to gastric bypass surgery
A long-term study shows the persistent effect of a Roux-en-Y gastric bypass. The study was performed by surgeons on obese patients. Ten years later most patients who had undergone surgery were able to maintain the achieved weight loss. Compared to other bariatric surgeries, patients after an Roux-en-Y gastric bypass achieved the greatest success.
573 people with a long history of obesity who had received a Roux-en-Y gastric bypass surgery were monitored for over ten years and compared with an unoperated control group. The group consisted of 1,274 highly obese people with a Body Mass Index of about 47 who did not receive any formal therapy against obesity. Almost every third person from the study group had Diabetes Type 2.
Ten years later, RYGB patients have lost 21% more weight. Only 19 out of 564 experienced the Jojo effect and almost returned to their initial weight after these ten years. The successful results after a Roux-en-Y gastric bypass surgery outweighed: ten years almost later 40% of the patients who had undergone the surgery were able to achieve a weight loss of 30%. In the control group, only 4% achieved this target. The authors explain that even without a therapy they could lose a few extra pounds due to age-related effects. One also cannot rule out that some individuals may have participated in a movement programme.