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The principle behind the gastric by-pass is to lower the capacity of the stomach thereby reducing absorption of food in the digestive tract. This operation leads to significant weight loss that patients qualify as more comfortable ,with a higher operating risk; the operation is irreversible and the patient has to take vitamins for the rest of his/her life thereafter..
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The gastric by-pass is proposed by our staff when the gastric ring has failed to produce weight loss. As a first intention, it is proposed for people aged, on average, over fifty who are suffering from diabetes, against which complaint the gastric by-pass is very effective.
The success rate is around 70% and patients' satisfaction rate greater than 90%. The higher operating risk explains why this operation is proposed only for these indications.
Preoperative examination :
- An oesophago-gastrofiberscopy is performed. This examination involves observing the inside of the stomach for ulcers or hiatus hernias. It is generally performed under general anaesthetic as it is not usually well tolerated by the patient.
- Abdominal ultrasound: a painless examination to establish whether the liver is free from excess fat and whether there are gallstones in the gallbladder.
- A blood sample
- In certain cases, after assessment by the anaesthetist, a consultation with a heart specialist may be requested.
All these examinations may be performed the day before the operation..
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The patient goes into hospital the day before the operation.
Surgical preparation:
- Antiseptic shower.
- Anti-thrombosis stockings are provided.
- An anticoagulant injection is given to prevent the risk of phlebitis on the morning of the operation..
- The abdomen wall is prepared with an antiseptic solution
- Pre-medication
The operation
This is performed the day after the patient enters hospital.
The operation lasts on average one and a half hours.
It is performed under general anaesthetic using keyhole surgery, i.e. with 5 small openings.
After the operation, the patient remains in the recovery room for about 2 hours.
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The patient gets up a few hours after the operation.
He/she must not eat for from 24 hours to 3 days, depending on how the operation went.
Pain is generally minimal after the operation and can be perfectly well controlled using simple pain-killers.
Depending on the patient's condition, an X-ray known as an oeso-gastro-duodenal transit examination is performed. A liquid must be drunk during this examination which may cause a brief bout of diarrhoea. The purpose of the examination is to check that there is no problem with the by-pass. After this examination, the patient can begin to eat again.
The nutritionist visits the patient to give him/her final information before he/she leaves.
Once this examination has been performed, the patient can leave the clinic.
On leaving, the patient is prescribed the following :
- A few days of pain-killers and medicine to protect the stomach.
- Vitamins.
- Anticoagulants only if the patient has a history of thrombosis or is at very high risk.
- 3 weeks off work.
- A consultation one month after the operation, then every three months.
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Complications relating to the gastric by-pass |
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Operating complications
These are the same as with any form of surgery. Phlebitis, pulmonary embolism, haemorrhage and infection may occur. During the operation, it may in exceptional circumstances be necessary to open the abdomen to control haemorraghing, for example.
Of complications specific to fitting the gastric ring, the following may be encountered :
- Leakage around the digestive sutures.
- Digestive occlusion
- Haemorraghing around the sutures
These complications, although rare, almost always require a second operation, usually carried out using laparascopy.
The theoretical risk of death is from 2 to 5 per thousand, as against 1 per thousand for the gastric ring.
Complications arising after the operation:
In contrast to the gastric rung, complications are rare after the operation.
- Nutritional deficiencies are prevented by taking vitamins, iron and calcium..
- Ulcer on the anastomosis is treated by anti-ulcerative medication
- Intestinal occlusion: related to an adhesion or internal hernia, diagnosed by scanner and requiring a further operation by laparoscopy
The isolated part of the stomach cannot easily be explored, apart from by scanner. This type of complication remains of only anecdotal interest when one considers the thousands of operations of this type that are performed and the frequency of complications specific to obesity.
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Follow-up after this type of operation is highly recommended. This is a moral undertaking between the patient and the medical team. The patient is of course free to change surgical teams for his follow-up.
The recommendations are:
Consult a nutritionist if possible every three months and at least every 6 months. The purpose of this consultation is to detect any nutritional deficiency. With time, this consultation can be made on a yearly basis.
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The results of the gastric by-pass are excellent and better than those obtained with the gastric ring. The operation does, however, have much greater operating risks, which explains why we propose it only in certain selected cases.
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