Gastric bypass surgery refers to a surgical procedure in which the stomach is divided into a small upper sac and a much larger "rest" sac and then the small intestine is rearranged to connect the two. Surgeons have developed several different ways to reconnect the gut, thus leading to several different gastric bypass procedures (GBP). Each GBP leads to a marked reduction in the functional volume of the stomach, accompanied by physiological and physical responses that change to food.
This surgery is prescribed to treat morbid obesity (defined as a body mass index greater than 40), type 2 diabetes, hypertension, sleep apnea, and other comorbid conditions. bariatric surgery is a term that encompasses all surgical treatments for morbid obesity, not just gastric bypasses, which form only one such class of surgery. Loss of weight produced, usually dramatic, greatly reduces comorbidity. Long-term mortality rates of gastric-bypass patients have been shown to decrease by 40%. As with all operations, complications can occur. A study from 2005 to 2006 revealed that 15% of patients had complications from gastric bypass, and 0.5% of patients died within six months after surgery due to complications.
Video Gastric bypass surgery
Usage
Gastric bypass is indicated for the treatment of morbid obesity surgery, a diagnosis made when the patient is severely obese, unable to achieve sustained and sustained weight loss with dietary efforts, and suffers from life-threatening comorbid conditions or serious life-quality impairment.
Prior to 1991, physicians interpreted serious obesity weighing at least 100 pounds (45 kg) more than "ideal weight", a weight determined by an actuary in which a person is expected to live the longest, as determined by the life insurance industry. This criterion fails for short stature.
In 1991, the National Institutes of Health (NIH) sponsored a consensus panel whose recommendations have set the current standard for consideration of surgical treatment, body mass index (BMI). BMI is defined as weight (in kilograms), divided by the square of height (in meters). The result is expressed as a figure in kilograms per square meter. In healthy adults, BMIs range from 18.5 to 24.9, with BMIs over 30 considered obese, and a BMI of less than 18.5 is considered weight. (BMI itself is not a reliable index of obesity: serious bodybuilders or athletes have a BMI in the range of obesity while having relatively few body fat.)
The National Institutes of Health (NIH) Consensus Panel recommends the following criteria for consideration of bariatric surgery, including gastric shortcut procedures:
- people who have a BMI of 40 or higher
- persons with a BMI of 35 or higher with one or more associated comorbid conditions
The Consensus panel also emphasizes the need for multidisciplinary treatment of bariatric surgical patients by doctors and therapists to manage associated comorbidities and nutrients, physical activity, behavior, and psychological needs. Surgical procedures are best considered as a tool that enables patients to change their lifestyle and eating habits, and to achieve effective and permanent obesity management and eating behaviors.
Since 1991, major developments in the field of bariatric surgery, particularly laparoscopy, have outdated some of the conclusions of the NIH panel. In 2004, the American Society for Bariatric Surgery (ASBS) sponsored a consensus conference that updated the evidence and conclusions from the NIH panel. The conference, comprised of doctors and scientists from surgical and non-surgical disciplines, reached several conclusions, including:
- bariatric surgery is the most effective treatment for morbid obesity
- The gastric bypass is one of four types of surgery for morbid obesity
- Laparoscopic surgery is as effective and safe as open surgery
- patients should undergo a comprehensive preoperative evaluation and have multi-disciplinary support for optimal results
Maps Gastric bypass surgery
Surgical technique
Gastric bypass, in various forms, accounts for most of the bariatric surgical procedures performed. An estimated 200,000 such operations were performed in the United States in 2008. The increasing number of these operations is now performed with limited access techniques, called "laparoscopy" .
Laparoscopic surgery is performed using several small incisions, or ports : one to insert a surgical telescope connected to a video camera, and another to allow access to special operating instruments. The surgeon sees the operation on the video screen. Laparoscopy is also called limited access surgery, reflecting the limitations on handling and feeling tissue as well as the limited and two dimensional resolution of the video image. With experience, an expert laparoscopic surgeon can perform most procedures as quickly as with open incisions - with the option of using incisions if necessary.
The Roux-en-Y gastric laparoscopy hull , first performed in 1993, is considered to be one of the most difficult procedures to be performed by restricted access techniques, but the use of this method has greatly popularized surgery due to its associated benefits such as shortened hospital stay, reduced discomfort, shorter recovery time, less scarring, and minimal risk of incisional hernia.
Important features
The gastric bypass procedure consists of:
- Make small bags (15-30 mL/1-2 tbsp) from the upper abdomen, accompanied by abdominal residual bypass (about 400 mL and variable). This limits the volume of edible food. The stomach can only be partitioned (like a wall between two rooms in a house or two office booths next to each other with a partition wall between them - and usually by using surgical staples), or it may actually be split into two separate/also with staples). The total division (separate/separate parts) is usually recommended to reduce the likelihood that the two abdominal sections will recover together ("fistulize") and negate the operation.
- Re-construction of the gastrointestinal tract to allow the drainage of both stomach segments. The special technique used for this reconstruction produces several operating variants, differing in the length of the small intestine used, the rate of absorption of the affected food, and the likelihood of adverse nutritional effects. Typically, the small intestine segment (called alimentary limb ) is brought to the proximal portion of the stomach.
Variations
Gastric Bypass, Roux en-Y ( RYGB, proximal)
This variant is the most commonly used gastric bypass technique, and is by far the most commonly used bariatric procedure in the United States. The small intestine is divided approximately 45 cm (18 inches) below the lower abdominal outlet and rearranged into a Y-configuration, allowing food flow from the upper abdominal sac via "Roux limb". In the proximal version, the junction Y is formed near the upper (proximal) end of the small intestine. Roux Limb is built using 80-150 cm (31-59Ã, Â °) of the small intestine, preserving the rest (and the majority) of absorbing nutrients. Patients will experience a very rapid onset of stomach flavor, followed by increased satiety (or "indifference" to food) shortly after the start of the meal.
Gastric Bypass, Roux en-Y ( RYGB, distal)
The small intestine usually is 6-10 m (20-33 ft) long. When the Y connection is moved further into the gastrointestinal tract, the amount available to absorb the nutrients is completely reduced, exchanged for greater operating effectiveness. Y joints form closer to the lower end (distal) of the small intestine, usually 100-150 cm (39-59Ã, in) from the lower end, causing reduced absorption (malabsorption) of food: especially fat and starch. , but also various minerals and vitamins that are fat soluble. Unabsorbed fats and starch enter the large intestine, where bacterial action can act on them to produce irritants and foul-smelling gases. This greater effect on nutrition is traded for a relatively modest increase in body weight.
"Mini shortcut" (MGB)
The mini-hull shortcut procedure was first developed by Robert Rutledge of the US in 1997, as a modified standard procedure of Billroth II. The mini short hull creates a long narrow belly channel along its right border (lower curvature). A loop of small intestine is raised and connected to this tube about 180 cm from the beginning of the intestine
Numerous studies have shown that loop reconstruction (Billroth II gastrojejunostomy) works safer when placed low in the abdomen, but can be disastrous when placed adjacent to the esophagus. Today thousands of "loops" are used for surgical procedures to treat gastric problems such as ulcers, stomach cancer, and stomach injuries. Mini-hub shorts use low-loop reconstruction sets and thus have a rare chance of bile reflux.
MGB has been proposed as an alternative to the Roux en-Y procedure because of its simplicity in construction, and is becoming increasingly popular because of the risk of low complications and sustained weight loss. It is estimated that 15.4% of weight loss operations in Asia are now done through MGB techniques.
Endoscopic duodenal-jejunal bypass
This technique has been studied clinically since the mid-2000s. This involves the implantation of the duodenal-jejunal bypass liner between the early duodenum (the first portion of the small intestine from the abdomen) and the mid-jejunum (secondary stage of the small intestine). This prevents the partially digested food from entering the first and early part of the secondary stage of the small intestine, mimicking the effects of the biliopancreatic part of the operation of the Roux en-Y hull shortness (RYGB). Although some serious side effects such as gastrointestinal bleeding, abdominal pain, and device migration - all resolved with device removal - early clinical trials have yielded promising results in treatment ability to promote weight loss and glucose homeostasis results.
Physiology
Bowl reduces abdominal size by more than 90%. Normal stomach can stretch, sometimes up to more than 1000 mL, while the stomach pouch may be 15 mL. The gastric bypass sac is usually formed from the abdomen that is least susceptible to stretching. That, and its small original size, prevent significant long-term changes in bag volume. What changes, over time, is a measure of the relationship between the stomach and the intestine and the ability of the small intestine to withstand a larger volume of food. Over time, the functional capacity of the pockets increases; at that time, weight loss has occurred, and capacity building should work to enable lower weight maintenance.
When the patient only swallows a small amount of food, the first response is to stretch the abdominal wall, stimulating the nerves that tell the brain that the stomach is full. Patients feel the sensation of satiety, as if they had just eaten a great meal - but only with a thimble-filled meal. Most people do not stop eating just in response to a feeling of fullness, but patients quickly learn that the next bite should be eaten very slowly and cautiously, to avoid increased discomfort or vomiting.
Food first flushes in the stomach before entering the small intestine. When the small intestinal lumen is in contact with the nutrients, a number of hormones are released, including cholecystokinin from the duodenum and PYY and GLP-1 from the ileum. These hormones inhibit further food intake and thus have been dubbed "the satiety factor". Ghrelin is a hormone released in the stomach that stimulates hunger and food intake. Changes in circulating hormone levels after gastric bypass have been hypothesized to result in a reduction in dietary intake and body weight in obese patients. However, these findings are still controversial, and the exact mechanism by which gastric bypass surgery reduces food intake and body weight has not been explained.
For example, it is still widely felt that the stomach shortcut works by mechanical means, ie, food restriction and/or malabsorption. Recent clinical and animal studies, however, have indicated that the old conclusions about the Roux en-Y (RYGB) hull shortcut mechanism may be incorrect. More and more evidence suggests that major changes in weight and metabolism resulting from RYGB can not be explained by simple mechanical restriction or malabsorption. One study in rats found that RYGB induced a 19% increase in total and a 31% increase in energy expenditure at rest, an effect not shown in vertical arm gastrectomy rats. In addition, mice fed a couple lost only 47% more weight than their RYGB counterparts. Changes in dietary intake after RYGB only partially account for weight loss caused by RYGB, and there is no evidence of significant malabsorption of calories that contribute to weight loss. Thus, it appears that RYGB affects weight loss by altering the physiology of weight management and feeding behavior rather than with simple mechanical restriction or malabsorption.
To get the most benefit from this physiology, it is important that the patient only eats at mealtimes, 5 to 6 small portions daily, and not graze between meals. Concentration to obtain 80-100 g of protein daily is required. Food after surgery is 1/4-1/2 cup, slowly get 1 cup per year. This requires a change in eating behavior and long-standing habitual changes to find food. In almost every case where weight gain occurs late after surgery, the capacity to eat has not been greatly increased. Some consider the cause of weight gain to be a patient error, eg. eating between meals with high calorie snacks, although this has been disputed. Others believe it is an unpredictable failure or restriction of surgery for a particular patient (eg reactive hypoglycemia).
Complications
Each major surgery involves potential complications - side effects that increase risk, hospitalization, and death. Some common complications occur in all abdominal operations, while some complications occur in bariatric surgery.
Mortality and complication rate
The overall rate of complications for 30 days after surgery ranged from 7% for laparoscopic procedures up to 14.5% for surgery through open incision. One study of death revealed a 0% mortality rate of 401 laparoscopic cases, and 0.6% of 955 open procedures (6 deaths). Similar mortality rates - a 30-day mortality of 0.11% (364 deaths), and a 90-day mortality of 0.3% - were recorded in the US Center Excellence program, the result being from 33,117 operations in 106 centers.
Death and complications are influenced by pre-existing risk factors such as obesity rates, heart disease, obstructive sleep apnea, diabetes mellitus, and previous lung embolism history. It is also influenced by the experience of surgical surgeons: the learning curve for laparoscopic bariatric surgery is estimated to be about 100 cases. Monitoring and experience is important when choosing a surgeon, such as how a surgeon becomes experienced in dealing with problems is to deal with and solve them.
Complications of abdominal surgery
Infection
Intrition or abdominal infection (peritonitis, abscess) may occur due to release of bacteria from the intestine during surgery. Nosocomial infections, such as pneumonia, bladder or renal infections, and sepsis (blood-borne infections) are also possible. Effective short-term antibiotic use, diligent respiratory therapy, and an activity boost within hours of surgery can reduce the risk of infection.
Venous thromboembolism
Any injury, such as a surgical operation, causes the body to increase blood clotting. Simultaneously, activity can be reduced. There is the possibility of increased formation of clots in blood vessels in the limbs, or sometimes pelvis, especially in unhealthy obese patients. A lump that breaks free and floats to the lungs is called a pulmonary embolism, a very dangerous event. Blood thinners are usually given before surgery to reduce the likelihood of these types of complications.
Bleeding
Many blood vessels must be cut to divide the stomach and move the intestines. All of this later can start bleeding, either to the abdomen (intra-abdominal hemorrhage), or to the intestine itself (gastrointestinal bleeding). Transfusions may be necessary, and repeat surgery is sometimes necessary. The use of blood thinners to prevent venous thromboembolism can actually increase the risk of slight bleeding.
Hernia
Hernia is an abnormal opening, either in the stomach or through the muscles of the abdominal wall. Internal hernia can occur due to bowel surgery and rearrangement, and is the cause of bowel obstruction. Antegastric antennae The honex operation of Roux-en-Y has been estimated to produce an internal hernia in 0.2% of cases, mainly through Petersen defects. Incisional hernia occurs when the surgical incision does not heal well; the abdominal muscles are separated and allow for protrusion of the membrane such as a sac, which may contain the contents of the stomach or other entrails, and which can be painful and unsightly. The risk of abdominal wall hernia greatly decreases in laparoscopic surgery.
Bowel obstruction
Abdominal surgery always produces some scarring of the intestine, called adhesion. Hernia, either internal or through the abdominal wall, can also occur. When the intestines become trapped by adhesion or hernia, the intestines will become flexed and obstructed, sometimes years after the original procedure. Surgery is usually needed to correct this problem.
Gastric shortcut complication
Anastomotic leak
Anastomosis is a surgical connection between the stomach and the intestine, or between two parts of the intestine. The surgeon tries to create a watertight connection by connecting the two organs with staples or stitches, one of which makes a hole in the intestinal wall. The surgeon will depend on the body's natural healing ability and ability to make seals, such as a sealed tire, to succeed with surgery. If the seal fails to form for any reason, the fluid from the digestive tract can leak into the sterile abdominal cavity and cause infection and abscess formation. Leakage of anastomosis can occur in about 2% of the Roux-en-Y hull shorts and less than 1% in mini-gastric bypass. Leaks usually occur in intestinal-gut connections (gastro-jejunostomy).
Striktur anastomotika
Like curing anastomosis, it forms scar tissue, which naturally tends to shrink ("contract") over time, making the opening smaller. This is called "stricture". Usually, the passage of food through anastomosis will keep it open, but if the inflammation and healing process goes beyond the stretching process, scar tissue can make the opening so small that even the liquid can no longer pass through it. The solution is a procedure called gastroendoscopy, and stretch the connection by inflating the balloon inside. Sometimes this manipulation may have to be done more than once to achieve lasting correction.
Ulceration in anastomosis occurs in 1-16% of patients. Possible causes of ulcers are:
- The blood supply is limited to anastomosis (compared to the blood supply available for the original stomach)
- Tension of anastomosis
- Gastric acid
- Bacteria Helicobacter pylori
- Smoking
- Use of non-steroidal anti-inflammatory drugs
This condition can be treated by:
- Proton pump inhibitors, e.g. esomeprazole
- Agent cytoprotectant and acid buffering, e.g. sucralfate
- Temporary restrictions on solid food consumption
Dumping syndrome
Usually, the pyloric valve at the lower end of the stomach regulates the release of food into the intestines. When the stomach shortage patients eat sweet foods, the sugar passes quickly to the intestine, where it induces a physiological reaction called dumping syndrome. The body will overwhelm the intestine with the contents of the stomach in an attempt to melt the sugar. The affected person may feel their heart beating fast and strong, sweating cold, feeling the butterflies in the stomach, and possibly experiencing anxiety attacks. People usually have to lie down, and can be very uncomfortable for 30-45 minutes. Diarrhea can then follow.
Lack of nutrition
Common nutritional deficiencies occur after gastric bypass surgery, and are often not recognized. They include:
- Hyperparathyroidism secondary to inadequate absorption of calcium may occur in GBP patients. Calcium is mainly absorbed in the duodenum, which is bypassed by surgery. Most patients can achieve adequate calcium absorption by supplementation with vitamin D and calcium citrate (carbonate is not absorbed - it requires acid stomach, which is bypassed).
- Iron is often very short, especially in women who are menstruating, and should be added. Again, it is usually absorbed in the duodenum. Ferrous sulfate may cause GI distress in normal doses; alternatives include iron fumarate, or chelated form of iron. Occasionally, a female patient experiences severe anemia, even with supplements, and should be treated with parenteral iron. Signs of iron deficiency include: brittle nails, inflamed tongue, constipation, depression, headache, fatigue, and oral lesions.
- Signs and symptoms of zinc deficiency can also occur such as: acne, eczema, white spots on the nails, hair loss, depression, amnesia, and lethargy.
- Thiamine deficiency (also known as vitamin B 1 ) carries the risk of permanent neurological damage (ie Wernicke's encephalopathy or polyneuropathy). Signs of thiamin deficiency include heart failure, memory loss, numbness in the hands, constipation, and loss of appetite.
- Vitamin B 12 requires intrinsic factor from the gastric mucosa to be absorbed. In patients with small gastric pockets, they can not be absorbed, even if given orally, and deficiency can cause pernicious anemia and neuropathy. Vitamin B deficiency 12 is quite common after gastric bypass surgery with a reported rate of 30% in some clinical trials. Sublingual B 12 (cyanocobalamin) appears to be quite absorbed. In cases where sublingual B 12 does not provide sufficient quantities, injections may be required.
- Lack of protein nutrition is a real risk. Some patients experience difficult vomiting after surgery, until their gastrointestinal tract adjusts to changes, and can not eat an adequate amount even with 6 times a day. Many patients require protein supplementation during the early phase of rapid weight loss to prevent excessive muscle mass loss. Hair loss is also a risk of protein malnutrition.
- Vitamin A deficiency generally occurs as a result of a deficiency of fat-soluble vitamins. These often come after intestinal bypass procedures such as jejunoileal bypass (no longer done) or biliopancreatic/duodenal switching procedures. In this procedure, fat absorption is greatly impaired. There is also the possibility of vitamin A deficiency with the use of orlistat weight loss drugs (marketed as Xenical and Alli).
- Folate deficiency is also common in patients with gastric bypass surgery.
Nutritional effects
After surgery, the patient feels full after swallowing only a small amount of food, immediately followed by a sense of satiety and loss of appetite. The total food intake is greatly reduced. Due to the diminished size of the newly created abdominal sac, and reduced food intake, adequate nutritional demand that patients follow the surgeon's instructions for food consumption, including the amount of food to be taken daily, adequate protein intake, and the use of vitamins and mineral supplements. Calcium supplements, iron supplements, protein supplements, multi-vitamins (sometimes prenatal vitamins are the best), and vitamin B supplements <12 (cyanocobalamin) are all very important for postoperative bypass patients.
The amount of food intake and food absorption rate will decrease rapidly after gastric bypass surgery, and the number of acid-producing cells that line the abdomen increases. Doctors often prescribe acid-lowering drugs to fight high levels of acidity. Many patients then experience a condition known as achlorhydria, where there is not enough acid in the stomach. As a result of low acidity levels, patients may develop an overgrowth of bacteria. A study conducted on 43 postoperative patients revealed that almost all patients were positive for a hydrogen breath test, which indicated an overgrowth of bacteria in the small intestine. Excessive bacterial growth causes intestinal ecology to change and cause nausea and vomiting. Recurring nausea and vomiting ultimately alter food absorbance rates, contributing to nutritional deficiencies and nutrients common to postoperative gastric bypass patients.
Nutrition protein
Protein is an important food substance, which is contained in foods such as vegetables, fruits, nuts, nuts, meat, fish, poultry, dairy products and eggs. With reduced ability to eat large amounts of food, gastric bypass patients should focus on their protein needs first, and every meal. In some cases, surgeons may recommend the use of liquid protein supplements. Powdered protein supplements added to smoothies or foods can be an important part of a post-op diet.
Calorie Nutrition
The deep weight loss that occurs after bariatric surgery is because it consumes less energy (calories) than the body needs to use every day. Fatty tissue must be burned to offset the deficit, and weight loss results. Finally, as the body becomes smaller, its energy needs decrease, while patients simultaneously find the possibility to eat more food. When the energy consumed equals the calories eaten, weight loss will stop. Proximal GBP usually results in a loss of 60-80% of excess weight , and very rarely leads to excessive weight loss. The risk of excessive weight loss is slightly greater with distal GBP. Vitamin
Vitamins are usually contained in foods and supplements. The amount of food eaten after GBP is greatly reduced, and the vitamin content decreases. Supplements should be made to meet the minimum daily requirement of all vitamins and minerals. Pre-natal vitamins are sometimes recommended by doctors, as they contain more vitamins than most multi-vitamins. The absorption of most vitamins is not seriously affected after proximal GBP, although vitamin B 12 may not be well absorbed in some people: sublingual preparations of B 12 provide adequate absorption. Several studies have shown that GBP patients who take probiotics after surgery are able to absorb and maintain a higher number of B 12 than patients who do not take probiotics after surgery. After distal GBP, vitamin A, D, and E are fat soluble may not be well absorbed, especially if the fat intake is large. Water dispersed vitamin forms can be indicated on the recommendation of a special doctor. For some patients, sublingual B 12 is insufficient, and patients may require an injection of B 12 .
Minerals
All versions of GBP cut the duodenum, which is the main site of iron and calcium absorption. Iron replacement is very important in menstruating women, and iron and calcium supplementation is preferred in all patients. Ferrous sulfate is not well tolerated. Alternative forms of iron (fumarate, gluconate, chelata) are less irritating and may be better absorbed. Calcium preparations carbonate should also be avoided; calcium as citrate or gluconate (with 1200 mg as calcium) has greater independent bioavailability than acid in the stomach, and is likely to be better absorbed. Chewable calcium supplements containing vitamin K are sometimes recommended by doctors as a good way to get calcium.
Alcohol metabolism
Postoperative stomach shortcut patients develop a lower tolerance for alcoholic beverages because their altered digestive tracts absorb alcohol at a faster rate than people who have not undergone surgery. It also requires longer postoperative patients to reach a hangover level after consuming alcohol. In a study conducted on 36 postoperative patients and a control group of 36 subjects (who did not undergo surgery), each subject drank 5 oz. a glass of red wine and alcohol in their breath is measured to evaluate the metabolism of alcohol. The gastric-bypass group had an average peak alcohol breath level of 0.08%, while the control group had an average peak alcoholic level of 0.05%. It took an average of 108 minutes for the gastric-bypass group to return to zero alcohol breath, while taking an average control group of 72 minutes.
Pica
There have been reported cases where the pica reappears after stomach shortcuts in patients with a history of preoperative disorders, which may be caused by iron deficiency. Pica is a compulsive tendency to consume substances other than ordinary foods. Some examples are people who eat paper, clay, plaster, ash, or ice. Low iron and hemoglobin levels are common in patients undergoing gastric bypass. One study reported on postoperative shortcut patients who consumed 8 to 10 32 oz. glass of ice a day. The patient's blood test showed iron levels of 2.3 mmol/L and hemoglobin levels of 5.83 mmol/L. Normal adult female iron blood levels were 30 to 126 Âμg/dL and normal hemoglobin levels were 12.1 to 15.1 g/dl. This deficiency in patient iron levels may have led to an increase in Pica activity. The patient is then given an iron supplement that carries hemoglobin and iron levels to normal levels. After one month, the patient's meal is reduced to two to three glasses of ice per day. After one year of taking iron supplements, the iron and hemoglobin levels remained within the normal range and the patient reported that he no longer wanted ice.
Results and health benefits of gastric bypass
Weight loss of 65-80% of overweight is typical of most reported gastric-by-stroke series. More medically significant effects include dramatic reductions in comorbid conditions:
- Hyperlipidaemia is corrected in more than 70% of patients.
- Essential hypertension is reduced in more than 70% of patients, and treatment requirements are usually reduced in the rest.
- Obstructive sleep apnea increases markedly with weight loss and bariatric surgery can be curative for sleep apnea. Snoring also reduces most patients.
- Type 2 diabetes is reversed up to 90% of patients usually leading to normal blood glucose levels without drugs, sometimes within days of surgery. Furthermore, type 2 diabetes is prevented by more than 30-fold in patients with pre-diabetes. All of these findings were first reported by Walter Pories and Jose F. Caro.
- Gastroesophageal reflux disease is relieved in almost all patients.
- Signs of venous thromboembolic disease such as leg swelling are usually reduced.
- Lower back pain and joint pain usually improve or improve in almost all patients.
A study in a large prospective study in 2010 obese patients showed a 29% mortality decrease up to 15 years after surgery (hazard ratio of 0.71 when adjusted for sex, age, and risk factors), compared with non-surgical group in 2037 patients.
At the same time, most patients can enjoy greater participation in family and social activities.
Stomach shortcut
The patient's pocket costs for the Roux-en-Y gastric-bypass surgery vary widely depending on the method of payment, region, surgical practice and hospital in which the procedure is performed.
Payment methods in the United States include private insurance (Individual & Family coverage, Small Group coverage through companies (Under 50 full-time employees) and Large Group coverage through companies (50 or more full time employees), public insurance (Medicare and Medicaid ) and self-payments, pocket costs for patients with private or public insurance that specifically register bariatric operations as a closed benefit including some special parameters of insurance policies such as deductible rates, coinage percentages, copay amounts and from pocket boundaries.
Uninsured patients have to pay for direct surgery (or through third party lenders), and the total of the pocket costs will depend on the surgical practice they choose and the hospital where the surgical practice performs the procedure. On average, the total cost of gastric bypass surgery is about $ 24,000 in the United States, although at a country-specific rate it ranges from an average of $ 15,000 (Arkansas) to an average of $ 57,000 (Alaska).
In Germany gastric bypass surgery, if not covered by health insurance and therefore paid in person, costs up to EUR15,000; in Switzerland CHF 20,000-25.000.
Living with stomach shortcuts
Gastric bypass surgery has an emotional and physiological impact on the individual. Many who have undergone surgery suffer from depression in subsequent months as a result of changes in the role food plays in their emotional well-being. Strict limitations on the diet can put great emotional stress on the patient. Energy levels in the postoperative period can be low, both due to restrictions on food intake and negative changes in emotional states. It may take up to three months for the emotional level to rebound.
Muscle weakness in the months following surgery is also common. This is due to a number of factors, including limiting protein intake, loss of muscle mass and decreased energy levels. Muscle weakness can lead to balance problems, difficulty climbing stairs or lifting heavy objects, and increasing fatigue following simple physical tasks. Many of these problems pass over time as food intake gradually increases. However, the first months after surgery can be very difficult, a problem that is not often mentioned by doctors who suggest surgery. The benefits and risks of this operation have been determined; However, his psychological effects are not well understood.
Even if physical activity increases, patients may still have long-term psychological effects due to excess skin and fat. Bypass surgery is often followed up by a body lift from the skin and liposuction from fat deposits. This extra surgery has its own innate risk but is even more dangerous when combined with the typical nutritional deficiencies that accompany the recovery of stomach gastric patients.
Accreditation of surgeon
Source of the article : Wikipedia
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