2023-05-25 10:57:21
Definition: what is a gastric bypass?
The bypass is a type of bariatric surgery, like the sleeve or the gastrectomy, intended to treat severe obesity.
Dr Saad Joumaa digestive and bariatric surgeon: There are three types of techniques used in bariatric surgery: the restrictive technique which consists in reducing the volume of the stomach, the malabsorptive technique which aims to prevent the absorption of part calories ingested, and the mixed technique that combines the two. The bypass is a mixed technique, namely both restrictive and malabsorptive.
It’s a stomach bypass, which consists of reducing the stomach to a small pouch, removing the upper part of the small intestine in which much of the energy nutrient absorption takes place, and connecting the gastric pouch to the second part of the intestine hail. The upper part of the small intestine then joins the lower part to form a bile loop allowing the digestive secretions to join the food and digestion to begin. Most of the stomach, the duodenum and the initial part of the small intestine thereby are court-circuités.
This is a heavy surgical intervention, which requires a significant preoperative phase and postoperative follow-up, and which is not devoid of risks or side effects. “Although we generally observe good results, doing a bypass is not a decision to be taken lightly insists Dr. Joumaa.
Age, BMI: who is the bypass for and what contraindications?
This surgery has strict eligibility criteria.
- The patient must be at least 18 years old and at most 65 years old, except in exceptional cases and after a multidisciplinary consultation meeting (RCP). It is no matter what happens prohibited for children under 13 years old.
- Sonbody mass index (BMI) must be over 40or between 35 and 40 but associated with one or more obesity-related comorbidities (high blood pressure, type 2 diabetes, joint problems, etc.).
- Absence of contraindications other specialists: drug addiction, active cancer, serious psychiatric disorders, severe eating disorders, etc.
Mini bypass (Omega) or Y: the different techniques
The bypass as it is performed historically and according to the description above, is called Y-bypass. two sutures : one between the stomach and the small intestine and another in the middle of the intestine” describes the specialist.
Another one technique plus simple was therefore set up at the end of the 1990s, called mini bypass or Omega bypass, which consists of a single anastomosis to make an omega-shaped gastric pouch. “This second, less complex technique has several drawbacks, since it promotes bile reflux and above all causes a lot of food malabsorption, with a significant risk of malnutrition summarizes Dr. Joumaa. For these reasons, the HAS (Haute Autorité de Santé) has recommended that it not be covered by social security since September 2019 and this intervention is therefore almost no longer practiced in France. However, it remains authorized in many other countries around the world and in Europe.
Is a bypass reversible?
If the Y-bypass is a theoretically reversible operation since no part of the digestive anatomy is removed, the technique is quite complicated in practice.
Dr. Joumaa: The reversal of the bypass is a delicate operation, which must necessarily be carried out in Centers Specialized in Obesity (CSO) and which has a significant rate of complications.
The omega bypass is more easily reversible.
The bypass reversion is reimbursement by social security when medically indicatedin case of intolerance, chronic diarrhea, or other significant side effects.
What is the length of hospitalization?
Y-bypass surgery requires on average two to three hours of operating time in the theater. “But in practice it is quite variable depending on the patient, and it can range from an hour and a half to 5 to 6 hours for the most difficult cases”, indicates the specialist.
The hospitalization usually lasts 48 to 72 hours, thanks to the early rehabilitation program in the CSOs.
The convalescence then requires a work stoppage of 3 to 4 weeks on average. After a month, gentle sports activities can be resumed and it will be necessary to wait three months before starting more intense sports.
After surgery: what are the consequences of a bypass?
Bypass is an operation with important suites for which it is important to be prepared. It therefore requires a preoperative medical course with a dietician and a psychologist.
After the procedure, the patient comes out with simple analgesics for pain, anticoagulantsof the food supplements (including calcium, iron, folate, vitamin B12 and vitamin D), antacids to limit gastric reflux, bile thinners to prevent bile reflux and protein supplementation to limit muscle wasting.
The size of the stomach being considerably reduced, the patient will never be able to eat as before in terms of quantity and will therefore have to eat more small meals. “The patient should do at least 5 to 6 small meals a day by eating very slowly, and the resumption of food after surgery must be done very gradually” insists Dr. Joumaa.
THE first two days, the diet should be exclusively liquid and smooth. Then, during 3 to 4 weeks approximately, the patient must eat soft, mixing his food. It is only after this period that solid foods can be reintroduced, while taking care to split meals and eat very slowly to facilitate digestion.
During the first month following the operation, the patients are seen regularly by the medical team to check that everything is fine and to take control blood samples. “Obesity is a chronic pathology, the patient must be followed for life” reminds the specialist.
Il will have to take food and vitamin supplements for life, to avoid deficiencies with potentially very serious consequences. “After several months without vitamin supplementation, the patient may develop severe neurological disorders that can range from until coma », warns the surgeon.
Among the post-operative consequences, the patient may feel the first three months of great fatigue, linked to rapid and significant weight loss.
What foods are prohibited after a bypass?
One of the frequent complications of the bypass is the dumping syndrome, also called flushing syndrome or rapid gastric emptying, which occurs when food, especially sugars, moves too quickly from the stomach to the small intestine. This syndrome is characterized by the occurrence of several very unpleasant symptoms: abdominal pain, nausea, diarrhea, bloating, hot flushes, headaches, etc.
“You must therefore try to reduce the consumption of fast sugars in your diet as much as possible to avoid this phenomenon” insists Dr. Joumaa. Sugary drinks – and even more when they are carbonated – are in particular to be eliminated.
Alcoholic beverages must also be very strongly limited, even ideally eliminated, because its effects on blood alcohol levels are increased tenfold after a bypass. Alcohol passes through the blood fasterthe blood alcohol peak is therefore greater and fasterwith increased risk of dangerous driving.
To avoid significant muscle wasting linked to rapid weight loss, it is essential to eat enough protein and exercise regularly.
What is the difference between the sleeve and the bypass?
The sleeve is also part of bariatric surgery operations, but it is only restrictive typeand not malabsorptive like the bypass.
The sleeve consists only of cutting 3/4 of the stomach in order to limit the gastric volume, so it is a simpler and faster operation. “Unlike the bypass, the sleeve is an irreversible operation” specifies the surgeon.
Weight loss and result: how many kg lost in the 1st month after a bypass?
Weight loss after a bypass is quite variable depending on the patient and the number of pounds they have to lose. “Weight loss in the first month is generallyat least 5 kg, but can be up to 20 kg in some patients whose excess weight is particularly important” sums up Dr. Joumaa, who reminds us in passing that very rapid weight loss is not necessarily a good sign.
Eventually, and according to observational studies carried out over decades, the bypass allows the patient to lose between 55 and 65% of their excess weight at 5 years after the operation, knowing that the majority of weight loss occurs after 2 years. The excess weight corresponding to the difference between the starting weight and the ideal weight, the objective to be achieved for the patient. For example, a 150 kg person who wishes to weigh 80, is 70 kg overweight. If he manages to reach 100 kg and maintain it after 5 years of bypass, he will be at 65% loss of excess weight.
“These figures correspond to a global average, but in practice some patients manage to lose 100% of their excess weight or even more, to reach their ideal weight or even exceed it” specifies the surgeon.
It is considered that the bypass is a “failure” when it did not allow a loss of excess weight greater than 50%.
What is the price of a bypass operation?
According to the CCAM codification of social security, the intervention itself costs 850 euros. Added to this price is the price of hospitalization which is on average 1600 euros for a single room, but which can double if the patient presents risks (sleep apnea for example) and must be hospitalized in continuous care.
In total, the price of a bypass can therefore range from 4 to 8 thousand euroswith a Variable support depending on the mutual insurance companies.
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