The most common obesity procedure performed worldwide and considered by many to be the gold standard for which all operations are compared is gastric bypass. Laparoscopic gastric bypass combines both restriction to the amount of food that can be eaten by creating a new small stomach pouch and also reduces the amount of food or calories that are absorbed by bypassing some of the small bowel. Like sleeve gastrectomy laparoscopic gastric bypass also reduces Ghrelin levels and hence helps to control appetite as people lose weight.
Compared to gastric banding patients lose weight much more quickly which is an advantage when patients need to lose weight quickly for example prior to orthopedic joint replacement surgery. Probably the biggest group to benefit from laparoscopic gastric bypass are diabetic patients. Bypassing the first part of the bowel changes gut hormones directly involved in glucose control. Around 80% of non-insulin diabetic patients will leave hospital following their surgery without any diabetic medication. For many, laparoscopic gastric bypass is an instant cure for diabetes.Australia was through the traditional open technique. Whilst the open technique is at the end of the day the same very effective operation as performed through laparoscopic techniques many patients have been put off because of the fear of a bigger open procedure with a longer recovery and have opted instead for the laparoscopic gastric band.
When performed laparoscopically gastric bypass is one of the most technically challenging operations and demands skills that most general surgeons do not possess. Not surprisingly when performed by inexperienced surgeons the complication rates from laparoscopic gastric bypass are higher than those for laparoscopic gastric banding and hence perhaps wisely the reluctance for many surgeons to attempt such surgery laparoscopically.
Another recent advance is 2-stage surgery for those patients who are at most risk of developing post-operative complications from any obesity procedure. These patients often have multiple life threatening diseases associated with obesity and also tend to be those who are classified as being super obese.
High risk patient may initially have a sleeve gastrectomy performed to allow them to lose weight and hence reduce the risks a second stage gastric bypass. This approach has been proven in clinical trials to reduce complication rates whilst ultimately allowing a laparoscopic gastric bypass to be performed which many patients especially the super obese require to get effective weight loss.
Patients who have previously had a laparoscopic gastric band and had to have it removed or have not had sufficient weight loss maybe suitable for conversion to laparoscopic gastric bypass. This again maybe done as a staged procedure especially if the band is being removed at the same time.
Does involve alteration of gastro-intestinal tract and joining of bowel with small risk of leakage
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