Gastric Bypass – Bariatric Surgery
Gastric bypass is one type of weight-loss surgery that may be recommended for people who are morbidly obese. This procedure changes the whole digestion process by surgically reshaping your stomach. As a result, food bypasses the small intestine and goes directly to an area farther down in your gastrointestinal system. You will feel full much faster after eating, and your body absorbs less calories. There are several types of gastric bypass surgeries, all of which limit food absorption, and some of which also reduce stomach size.
At The Bariatric and Metabolic Surgery Unit at Sheba Medical Center in Israel, we have experienced, highly qualified specialists that perform all four types of gastric bypass. Gastrointestinal surgeons, dietitians, and other physicians collaborate to design each patient’s personalized treatment plan, which includes support and guidance before, during, and after the gastric bypass procedure.
How does gastric bypass work?
To perform gastric bypass surgery, your surgeon will create a small gastric pouch out of the top part of your stomach and connect it to a loop made from your small intestine. The other end of the small intestine loop will then be reconnected to a lower point of the small intestine. Both junctures are called an anastomosis. As a result of this restructuring, you will have a smaller stomach, and food will totally bypass most of the stomach before entering the intestines.
The procedure is done laparoscopically under general anesthesia and typically takes an hour and a half to three hours. You will need to remain hospitalized for two to four days, and you should be able to return to normal functioning quickly, about a week later.
During the first one to two weeks after gastric bypass, your diet will consist only of liquids (e.g., smooth soup, yogurt). Slowly, you will be able to add soft foods, and usually patients are able to progress to regular food about six weeks later.
The initial weight loss may be rapid, and because of the malabsorption process, you will need to take vitamin and mineral supplements to ensure that your body gets all the necessary nutrients of a healthy diet. Generally, you will need to continue taking these supplements for the rest of your life.
There are four different types of gastric bypass procedures:
- Gastric bypass, Roux en-Y (RYGB, proximal) – this is the most commonly performed technique. A small stomach pocket is formed, and the small intestine is divided and arranged into a “Roux en-Y” loop near its upper (proximal) end. Food flows from the gastric pouch through this Y-shaped loop, which consists of only a small portion of the intestine. You will feel full faster due to having a smaller stomach, and less food is absorbed because it bypasses the upper small intestine.
- Gastric bypass, Roux en-Y (RYGB, distal) – this procedure creates a small gastric pouch and forms the “Roux en-Y” loop lower down the small intestine (closer to the distal end), so the portion of the intestine that can fully absorb nutrients is very small. Generally, the effects on nutritional absorption are greater.
- Mini-gastric bypass (MGB) – this surgery reshapes the stomach into a long narrow tube, which is connected to a loop of the small intestine, placed low on the intestine. Due to the simplicity of the procedure and the low complication rate, this method is growing in popularity.
- Endoscopic duodenal-jejunal bypass sleeve (DJBL) – also called an EndoBarrier, this relatively new procedure implants a bypass liner between the primary portion of the small intestine and the secondary portion of the small intestine. As a result, partially digested food cannot enter the secondary stage of the small intestine, and you will feel full quickly after eating.
What conditions can be treated with gastric bypass?
Gastric bypass can be used effectively to treat patients who suffer from obesity-related problems and have not been able to lose weight through diet, exercise, and medicine.
Along with promoting weight loss, gastric bypass can help treat:
- High blood pressure and the associated risk of stroke and heart attack
- High cholesterol
- High blood sugar and type 2 diabetes
- Sleep apnea
- Bone and joint issues
What are the possible complications and risks?
Gastric bypass is a complex surgery and involves a number of possible complications and risks. The rate of complications is 10% – 12%, with a 3% rate of serious complications. Possible problems include:
- Peritonitis, which is an inflammation of the peritoneum (smooth membrane that lines the abdominal cavity), caused by a stomach leak from the pouch
- Stomal stenosis, which is a narrowing of the opening between the stomach and intestine; this can lead to vomiting
- Internal hernia, a dangerous condition in which the small intestine can be trapped and blocked
- Dumping syndrome, in which the solid parts of a meal get “dumped” directly into the small intestine; can cause nausea, rapid heartbeat, fainting, abdominal cramping, and diarrhea
- Malnutrition, low levels of vitamins and minerals (if you don’t take daily supplements)
Who is a candidate for gastric bypass?
At Sheba, we may advise gastric bypass as a life-changing treatment for morbidly obese people who have not achieved long-term success with other weight-loss efforts. The general criteria for this surgery include:
- Body mass index (BMI) greater than 40
- Body mass index (BMI) greater than 35 and suffering from an obesity related health condition, such as hypertension, sleep apnea, type 2 diabetes, and certain types of heart disease
- Readiness to make long-term lifestyle changes to diet and exercise
Why choose Sheba for gastric bypass in Israel?
Our Bariatric and Metabolic Surgery Unit features a skilled team of five world-class bariatric surgeons who have the cumulative experience gained from performing thousands of surgeries. All procedures are performed in dedicated operating rooms that are equipped with the latest, cutting-edge technologies.
Sheba’s team is committed to developing a strong and lasting relationship with each patient. We will meet with you prior to the surgery to answer your questions and prepare you for the procedure. During and following the surgery, you will benefit from the support and assistance of our doctors, psychologists, and dietitians. To help you reach your weight loss goals, we provide a variety of holistic services, such as counselors who will teach you how to implement lifelong behavioral pattern changes and endocrinologists to assist with personalized therapies for diabetes and other issues.
Your exceptional and efficient healthcare experience at Sheba matters to us. To that end, we will assign you a personal medical coordinator from the International Medical Tourism Division who will provide assistance throughout every stage of your treatment.
Meet Our Team
Sheba Medical Center
Prof. David Goitein
Prof. David Goitein, MD
Director, Bariatric and Metabolic Surgery Unit
Prof. Goitein is a leading specialist who has performed hundreds of advanced laparoscopic surgeries. He is an active participant in many professional scientific societies worldwide, and he has published dozens of articles in notable medical journals. Prof. Goitein received his medical degree from the Hadassah Medical School, Hebrew University, Jerusalem.
Sheba Medical Center
David Hazzan, MD
David Hazzan, MD
Director of the Invasive Microbial and Robotic Surgery Unit
Dr. Hazzan specializes in general surgery, laparoscopic and robotic surgery, and obesity treatment. He founded the Invasive Microbial Surgery Unit at Carmel Hospital in Haifa, and then managed it for four years. Dr. Hazzan is a leading surgeon in Israel performing abdominal wall hernia surgery with the help of the da Vinci robot. He has performed hundreds of gastrointestinal surgeries using a minimally invasive approach. Dr. Hazzan received his medical degree from the Jose Maria Vargas School of Medicine, Central University of Venezuela.
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