Gastric Bypass: Advantages & Disadvantages*

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Growing problem of obesity

Obesity is a common health condition rapidly increasing around the world. It is a complex issue that also encompasses biological, physical, psychological and social aspects. In general terms, obesity is the condition in which the weight of a person reaches a certain level when it starts to seriously affect health, causing chronic and ultimately life-threatening disorders. Excess weight is a well-known risk factor for the development of coronary heart disease, respiratory failure, diabetes mellitus, dyslipidemia, hypertension, joint degeneration and cancer. The risk of death among women with a body-mass index of 32 or greater is twice as higher than among women who are not overweight.

Who should consider gastric bypass?

When conventional approaches of dietary restrictions and exercise programmes do not help to achieve substantial long-term weight loss, gastric surgeries are recommended. When even the most modern pharmacological methods are unable to produce the desired results, surgery can help attain what is otherwise unattainable. Among the weight loss surgeries so far gastric bypass is showing the best results. It is the most successful way to help patients with severe obesity because of its safety, low morbidity and very low mortality, as well as the ability to reach remission of serious medical conditions related to obesity.

Gastric bypass surgery is usually performed laparoscopically. Laparoscopic gastric bypass surgery is a technically challenging operation. During the surgery, the proximal stomach is separated from the distal stomach to form a small, restrictive gastric pouch. Gastric bypass alters the way in which the human body digests food. This type of surgery works by restriction and malabsorbtion. Patients after gastric bypass surgery experience early satiety and, consequently, eat smaller meals, therefore, their weight starts decreasing.

Advantages of gastric bypass surgery

  • Laparoscopic gastric bypass surgery is a purely restrictive intervention. It is also minimally aggressive and reversible. It is the most commonly performed weight reduction operation. Gastric bypass is generally regarded as the gold standard operation and is reported to achieve greater weight loss with greater reliability. The long term results show average 60 % to 70 % of excess body weight loss. Weight is likely to fall for up to 10 years.
  • As body weight goes down, many health issues associated with morbid obesity improve or even get resolved. For instance, sleep apnea, gastro-esophageal reflux disease, heartburn, urinary stress incontinence, and the functioning of the respiratory tract. Studies showed that gastric bypass reduces the risk of heart attack.
  • Patients with diabetes mellitus require less medication and manage it a lot better. Dyslipidemia, particularly hypertriglyceridemia and elevated cholesterol/HDL cholesterol are also resolved much more reliably and impressively than with any medication. Also it has been found that about 60% or more patients are able to go off medications for high blood pressure problems after gastric bypass surgery.
  • Gastric bypass surgery is also a relatively safe procedure even for older patients and patients with known cardiovascular disease. The laparoscopic gastric bypass surgery shows good results in short postoperative pain, short length of hospital stay, quick return to work and other activities of daily living, and a rare rate and severity of wound infections.
  • Patients who undergo bariatric surgery successfully achieve substantial weight loss, improve quality of life and report about good health in general. The combination of these changes has a tremendous impact on life expectancy of the severely obese patients.

Disadvantages of gastric bypass surgery

  • Despite the significant benefits of gastric bypass surgery, certain systemic and surgical complications are associated with this type of surgery. Most bariatric patients have significant co morbidity, increasing their risk of postoperative cardiopulmonary complications which can cause difficulties during the surgery.
  • Apart from technical complications, cardiopulmonary and wound-related complications are the most common and most severe and can lead to cardiovascular accidents, myocardial infarction, pulmonary embolism, respiratory failure and others.
  • About 10 percent of all patients have postoperative complications such as bleeding from the gastrointestinal tract, strictures, obstructions, ulcers, gallstones, urinary tract infection and other issues like nutritional deficiencies in getting enough folic acid, thiamine, calcium, zinc, vitamin B12, vitamin D, vitamin A and iron. It may lead to anemia, encephalopathy and other disorders.
  • Patients with addictive behaviour, such as alcohol abuse and active cigarette smoking fall into the group of increased risk for complications. They often fail to stick to their diet and medical instructions, therefore the risk of poor weight loss and complications is exceptionally high.
  • Patients who had a dependence on food before the surgery, may suffer from addiction transfer, potentially trading a food addiction to alcohol or drugs abuse problem. All these issues may lead to weight regain and ground for reoperation.

Solution to obesity

Obese patients represent a unique part of population with important anatomical and physiological problems that can influence the surgery outcome. However, it is still possible to achieve optimal health after gastric bypass. Gastric bypass surgery decreases the risk of all-cause mortality and cardiovascular mortality in obese patients. Bariatric surgery is followed by substantial and durable weight loss and is associated with favourable metabolic effects far beyond those achieved by lifestyle modifications and pharmacological treatments. As a result, gastric bypass may improve or even resolve diabetes mellitus, hypertension, sleep apnea and dyslipidemia.

All patients should be carefully screened before the surgery and all postoperative patients need a constant monitoring by doctor to check for other potential problems.