Gastric bypass is indicated for people who have a Body Mass Index of or greater than 40kg per square meter. It is also indicated for cases where the BMI is equal to or greater than 35 kg per square meter, along with significant co morbidities. Another indication of the surgery is for cases where other weight reduction techniques have not succeeded. The surgery nevertheless is a major operation with its set of protocols. Therefore before carrying out the procedure a full examination and investigation procedure is carried out to render the patient fit for surgery.
The patient is made clear about the various aspects of the treatment, and the various benefits and complications that may arise. Other areas of consideration during this stage that will continue onwards include medical management of co morbidities, diet, exercise, nursing care, and psychological assistance in getting used to the change. (Society of American Gastrointestinal and Endoscopic Surgeons [SAGES], N. P. ) Surgeons carry out many variations of the procedure; taking into consideration the individual upon the operation is being conducted.
The pouches in each case may range from 16 to 60 cc, pouch variations may differ, and small bowel routing may also be of varying types. The essential technique of bypass includes a high gastric transaction, which creates a pouch with lesser curvature. The continuity is then established via Roux en Y entero-enterostomy. The proximal jujenum is repositioned so that its Roux limb becomes retrocolic and retrogastric, which is then anastomosed in the position with the proximal gastric pouch. The stoma that is formed due to this anastomosis is only 12 mm in diameter, requiring no artificial support.
The procedure is able to by pass the distal stomach, which after the surgery continues to perform at a lesser rate. However, this repositioning may be contributory to the formation of acid-peptic diseases, which is very rare. The operation is safe for billiary and pancreatic structures, and the normal function of the bowels remains. Due to this surgery, the patient gets early satiety, which reduces the need for frequent meals, and thereby helps the utilization of the fat stores of the body. (Gastric Bypass, N. P. )
Most of the procedures are based on the steps mentioned above. However, gastric bypass has different types and variations. The first is the Roux en Y entero enterostomy which has been mentioned above. The second type of surgery is the extensive gastric bypass surgery or the billiopancreatic diversion. This surgery is a more complicated procedure in which, the lower portion of the stomach is removed entirely. The remaining section of the stomach is then joined to the final segment of the small intestine, and helps in bypassing the jejunum and the duodenum entirely.
This procedure has however a high risk of nutritional deficiency among the patients and is therefore not widely used. (WebMD, N. P. ) In contrast to this is the mini gastric bypass surgery that is gaining attention due to its minimum invasiveness and better outcomes. The time duration is considerably shorter than the other procedures, which take about 2 hours. It is of minimum duration and does not cause extensive pain or symptoms. The procedure involves creation of a narrow tube which is attached to the small intestine.
The location of this tube is six feet from its starting point to bypass the most absorptive area of the small intestine. There is no need for surgical excision and any extensive cutting or damaging. The results of the procedure are comparable to the other two procedures and the outcomes are satisfactory. (DocShop. com, N. P. ) The costs of the procedure can be considered under two areas; the financial costs and the emotional costs. The average cost of a gastric bypass surgery is $25,000.
In most of the cases, where the patient is insured, the cost does not matter much as the insurance takes care of it. However, the patient must be able to provide sufficient proof if asked that he or she has tried all available methods of reducing weight and failed in achieving results. The role of the surgeon in insuring the patient for the surgery may be very important. The payment plans are usually finalized before the conduction of the surgery, to prevent any problems post operatively.
The patient must be clearly outlined of the various advantages and disadvantages of the procedure, so that the patient is able to make an informed decision about his or her treatment. Patient must be informed that he or she runs a higher than average risk of morbidity and mortality should he continue to remain on this weight. He or she must also be made aware of the potential complications of obesity. All these factors when brought to light can help patient really decide on what he wants to do. (Brooke, N. P. )
The physician must consider the pros and cons of the procedure, discuss them with the patient, and then decide on carrying out the operation. The pros of the operation include the immediate decrease in the blood pressure and blood cholesterol in such patients. This helps them in getting of antihypertensives or lipid drugs. The complications that are associated with obesity also start to decrease. The patients are immediately at a reduced risk of heart conditions. Patients with type II diabetes may no longer need medications to control their blood sugar levels.
Asthma attacks, respiratory insufficiency, sleep apnea syndrome and acid reflux disease is reduced considerably. (All About Life Changes, N. P. ) There is much debate about the quality of life that takes place after the bypass surgery takes place. Various studies have been carried out to quantifiably verify the improvements in the life quality. Surveys have shown that people who have undergone bariatric surgery have better quality of life than before, are in lesser need of medications to control their lipid, sugar levels or other co-morbid conditions.
(Hager, pp 776) Hypertension, which is one of the most common problems of obesity was seen to reduce after the surgery to levels that did not need medication treatments. Similarly, the use of psychiatric medication for patients who were depressed about their weight also decreased. The surveys overall have shown an improvement in the quality of lives of the patients, who were in the past victimized by their increased weights. (Hager, pp. 777) Alternatives to bariatric surgeries are essentially the same as those of weight loss techniques.
Behavior modification regarding eating habits is one of the basic techniques that should be carried out regardless of the patient undergoing bariatric surgery. Decreasing the amount of food consumption with substitution with fruits and vegetables is another method to help reduce weight. Drug therapies and alternative medicines are also options that can be given to the patient. However, al these methods are based on the individual motivation and on his or her persistence in this regard. The introduction of the lap band has been a boon in the treatment of surgical procedure cases.
This procedure creates a small pouch in the upper stomach through the help of an adjustable stroma. This procedure does not include stapling as is the case with other surgical procedures. This procedure creates a virtual stomach that decreases the functional capacity of the stomach. Mostly, the pouch formed is made of 15cc, but adjustments according to the patient can be made. Since this procedure can take place in the radiology department with no surgical excision required, it prevents cutting of the stomach, stapling of the stomach, it is currently the most ideal procedure for patients.
The advantage of the procedure is that it is reversible, that is once the weight loss has been achieved, the band can be removed. (Lap Band Procedure, N. P. ) The vertical banded gastroplasty is another procedure most popularly referred to as gastric stapling. the procedure uses soft bands and staples that decrease the size of the stomach. In this surgery however the band is placed on the lower stomach. This procedure is however, dependant on the patient’s will to reduce weight, and will only have marginal success should the patient not cooperate.