How are Laparoscopic Procedures Helpful in Gastric Bypass Surgery?

What is laparoscopic gastric bypass surgery?

Bariatric surgeries collectively include gastric bypass surgery and other weight-loss surgeries that are usually done when other methods including exercise and diet are not successful or the individual has serious issues because of being overweight.

Gastric bypass surgery, also known as Roux-en-Y gastric bypass (RYGB), is a common type of weight-loss surgery. Typically recommended for people suffering from severe obesity, bariatric laparoscopic surgery is a minimally invasive technique that modifies the digestive system, i.e., the small intestine and stomach. This helps to help to restrict the calories consumed and absorbed by the body, thus helping in weight loss.

There are many benefits of laparoscopic surgery as compared to traditional open surgery including:

• Smaller incisions

  Laparoscopic surgery, also known as keyhole surgery, is performed by making very small incisions of around ½-inch or less instead of large 6-12-inch incisions that are required for conventional open surgeries. This means reduced blood loss, lesser discomfort and pain, lower risk of postoperative complications and quicker recovery for the patient.

• Reduced scarring

  A significant benefit of laparoscopic surgery is minimised scarring. The procedure uses advanced technology that determines precise incision sites that ensure minimal invasion, which results in smaller scars in patients after the surgery and quicker healing.

• Reduced blood loss

  The use of advanced technology and small incisions in laparoscopic procedures helps to reduce the risk of excessive bleeding during surgery. This not only improves the safety of the patient but also reduces the probability of requiring blood transfusions.

• Enhanced visualisation

  Laparoscopic surgery uses advanced imaging technology and high-resolution cameras that enables the surgeon to get clear and enlarged views of the surgical area. This superior visual clarity helps to achieve more effective and safer surgical outcomes.

• Reduced infection risk

  Laparoscopic surgery reduces the risk of infections significantly as compared to traditional surgical procedures. The smaller incisions reduce the risk of exposure of internal organs to external contaminants, which is especially beneficial for obese patients. The smaller scars resulting from laparoscopic surgery help to reduce the patient’s susceptibility to post-operative infections and increase their safety.

• Quicker recovery and return to normal activities

  Compared to traditional surgical procedures, which need a longer recovery time of around 4-8 weeks, laparoscopic surgery enables the patient to recover in just 2-3 weeks. This allows them to resume their normal activities more quickly.

 Advantages of laparoscopic gastric bypass surgery

• Bariatric surgeries

  Typically, bariatric surgeries are referred to as malabsorptive or restrictive procedures. In the malabsorptive approach, the structure of the digestive tract is modified, which in turn, changes the calories absorbed. The restrictive approach, on the other hand, restricts the amount eaten by reducing the size of the stomach.

• Gastric bypass surgery

  Laparoscopic gastric bypass surgery is a restrictive-malabsorptive procedure that causes the stomach to restrict the amount of food in the stomach, which limits the nutrients and calories absorbed by the body. This causes the person to feel full faster, eat less and as a result, lose weight.

 Factors determining suitability for laparoscopic gastric bypass surgery

There are specific guidelines stipulated by the National Institute of Health to determine the suitability of patients for laparoscopic gastric bypass surgery. The key factors include:

• Excess body weight

  The patients for laparoscopic gastric bypass surgery must exceed their ideal body weight by around 100 pounds (45.5 kgs) or their body weight should be 100% more than the ideal body weight.

• Absence of endocrine or metabolic issues

  The patients must not have any underlying endocrine or metabolic problems that contribute to hormonal imbalances or improper breakdown of food resulting in Class III or morbid obesity.

• Measurable complications

  The patients should have complications that can be objectively measured such as high blood pressure, heart disease, lung disease, diabetes, arthritis and sleep apnoea.

• Understand the complications and risks

  The patient must understand the importance, potential complications and risks of the laparoscopic gastric bypass surgery that will enable them to take an informed decision regarding the procedure.

• Prior medical weight reduction attempts

  The patient should have tried to reduce their weight using conventional medical treatments and interventions without significant success.

• Long-term follow-up

  Gastric bypass surgery requires long-term commitment and the patients opting for this must be willing to undergo long-term monitoring, follow-up and observation by a medical professional along with making certain necessary changes in their lifestyle.

 Patient suitability

Not all severely overweight or obese individuals are suitable candidates for gastric bypass surgery. Qualification for weight-loss surgery requires meeting specific medical guidelines and undergoing an extensive screening process. Additionally, individuals must be willing to make permanent lifestyle modifications to support a healthier future.

For gastric bypass surgery, the following aspects must be considered:

1. Individual patient factors

   1. Medical History: The medical history of the patient is crucial in evaluating their eligibility for gastric bypass surgery. Conditions such as comorbidities, hypertension, cirrhosis, metabolic disorders, psychiatric disorders, chronic smoking, substance or steroid use, current eating behaviours, eating disorders and weight gain/loss history are to be carefully assessed.

   2. Body Mass Index (BMI): The patient should have a BMI of: 

      • 37 without comorbidity.

      • 30 with comorbidity.

2. Surgeon's expertise

   Bariatric laparoscopic surgery is a complex procedure and when considering a surgeon for the procedure, it is extremely important to evaluate their expertise in terms of:

   1. Training In Laparoscopic Techniques: Surgeons who are skilled in laparoscopic procedures can facilitate faster recovery, minimise postoperative complications, reduce pain and minimise scarring.

   2. Experience In Gastric Bypass Surgery: Surgeons with specific experience in gastric bypass surgery demonstrate their proficiency and knowledge in this specialised technique, instilling confidence and promoting positive surgical outcomes.

 How is laparoscopic gastric bypass surgery performed?

Laparoscopic gastric bypass surgery procedure

• Laparoscopic gastric bypass surgery utilises 3-5 small ½-inch incisions in the abdomen.

• A laparoscope or slender scope, with a tiny video camera, and surgical tools are inserted through the incisions.

• The laparoscope provides a visual projection of the organs on a computer screen for the surgeon.

• The surgery involves reducing the stomach into a small pouch using surgical staples.

• The new stomach pouch is then connected to the lower portion of the small intestine in a "Y" shape.

• This configuration allows food to bypass most of the stomach and the initial portion of the small intestine.

• By doing so, the surgery restricts the amount of food the stomach can hold and limits the absorption of calories and nutrients in the food.

Risks of laparoscopic gastric bypass surgery

Some common risks of gastric bypass surgery, which are similar to other surgical procedures, include excessive bleeding, infection and reactions to anaesthesia. Additionally, there are specific complications related to gastric bypass surgery, including:

• Small bowel obstruction caused by the narrowing or obstruction of the small intestine due to scar tissue

• Hernias

• Anastomotic leaks or leaks in the connection point cause an infection in the abdominal cavity.

 Expected results after laparoscopic gastric bypass surgery

Typically, 1-2 years after laparoscopic gastric bypass surgery, significant weight loss of around 70% of the excess weight is observed. In the long term, some individuals may regain a portion of the lost weight, but the average weight loss remains at 50% of the excess weight. This weight tends to stabilise for approximately 20 years. The procedure also yields significant improvements in many weight-related health conditions.

Gastric bypass surgery side effects

There may be some long-term side effects of laparoscopic gastric bypass surgery including:

• Dumping syndrome: Symptoms include abdominal cramping, nausea, diarrhoea and hypoglycaemia (low blood sugar).

• Bile reflux: When the pyloric valve or opening between the stomach and small intestine malfunctions, causing bile reflux that can lead to stomach ulcers and gastritis.

• Malnutrition: This may cause nutritional deficiencies.

• Gallstones

• Ulcers in the stomach or duodenum.

• Weight regain.

 Conclusion

Laparoscopy, the gold standard for gastric bypass surgery, has revolutionised the field. This minimally invasive technique offers numerous benefits, including reduced bleeding, post-operative discomfort, surgical trauma and scarring. It also enables shorter hospital stays, faster recovery and improved healing. These advantages have made laparoscopic techniques the preferred choice for bariatric surgeries, leading to better outcomes for both surgeons and patients.

Frequently Asked Questions

1. What happens to the unused portion of the stomach after gastric bypass surgery?

Over time, the unused part of the stomach gradually reduces in size as it is not stretched by food and drink. However, it continues to produce enzymes and acids essential for digestion.

2. How soon after weight-loss surgery can we eat?

After weight-loss surgery, a progression from clear liquids to thicker liquids is followed. Around 2 weeks later, pureed or blended foods can be consumed, while regular foods can typically be reintroduced approximately 3 months after the surgery.

3. What is the recovery time for gastric bypass?

After gastric bypass surgery, the patient can leave the hospital in about 1 to 3 days and resume regular activities in about 2 to 3 weeks.

4. What kinds of conditions can bariatric surgeries treat?

Not only does bariatric surgery help to lose weight, but it can also help in reducing the risk of serious diseases including heart disease, sleep apnoea, stroke, non-alcoholic steatohepatitis or non-alcoholic fatty liver disease and type-2 diabetes.

5. When is laparoscopic surgery not recommended?

Laparoscopic surgery is not recommended if the individual:

• Suffers from chronic tuberculosis

• Has adhesions or scar tissue from other surgeries

• Has cancerous growth on the abdominal wall

• Has low platelet count (thrombocytopenia)

• Takes blood thinning medications

• Is pregnant