Gastric Bypass
Gastric bypass is probably the ‘gold standard’ surgical treatment for morbid obesity in most patients, it brings about a loss of more than 60% of excess weight and it offers a very good quality of life. Diabetes resolves in more than 80% of patients and high blood pressure in more than 70%, so it is particularly applicable to patients where obesity is complicated by these conditions.
Although it can demand considerable skill and experience to perform it safely, its popularity as an operation has greatly increased due to the benefits of the laparoscopic technique.
Exactly how gastric bypass delivers loss of weight and suppression of hunger is unclear.
- The primary mechanism is probably mechanical restriction achieved by creation of a small thumb-sized pouch from the upper stomach, with the result that food cannot get into the majority of the stomach. Although diminished efficiency of absorption was assumed to be a secondary mechanism, most patients display no clinical evidence of malabsorption and its actions are probably related to hormonal changed involving the gut.
Standard Indications for Laparoscopic Gastric Bypass:
• Body Mass Index greater than 40
• Body Mass Index between 35 and 40 associated with significant comorbidity such as hypertension, diabetes, arthritis or sleep apnoea.
Gastric bypass is an operation that has been shown to save lives and to transform the quality of life for most patients. However, to make it as safe as possible, it should be carried out by experienced and specialist surgeons in a hospital with full back up facilities and a range of appropriate instrumentation.