Laparoscopic Gastric Bypass_

The gastric bypass is the gold standard by which all other obesity surgeries are measured.  It has been present in various forms for over 30 years.  It converts the stomach from a 2 litre sac to a 30cc pouch by dividing the upper part of the stomach.  To enhance weight loss a loop of small bowel is connected to the pouch and again to a more distal loop of small bowel so that ingested food is bypassed beyond the digestive enzymes (that are released in the duodenum) leading to a degree of malabsorption.  The remainder stomach is left in situ.  An average weight loss of 65-70% excess body weight loss can be expected.

Advantages

• Rapid weight loss as hunger and satiety control is instantaneous.  Most people approach goal weight by 9 months with maximal weight loss at 18 months.
• Has been proven to be effective in the long-term with good data out beyond 15 years
• Interferes with an undefined insulin-glucose feedback system so that most diabetic patients discard their insulin immediately

Disadvantages

• Has a number of staple lines securing small bowel and stomach and leaks may occur.
• Is an aggressive technique and recovery is more prolonged with most patients requiring 2 weeks off work to recover.
• Has a number of long-term complications not seen in the other obesity surgeries such as dumping syndrome, stomal ulceration, internal herniation etc.
• Lifelong mineral and vitamin supplementation is essential