How does the surgery work?
The gastric bypass surgery is performed under general anesthesia, which means that the patient is unconscious for about 90-150 minutes while being intubated and ventilated. The procedure itself is almost exclusively performed using the keyhole technique (minimally invasive surgery/laparoscopy), less frequently through a larger incision (open surgery). The surgical instruments and a camera are inserted into the abdomen through several small skin incisions after the abdomen has been filled or “inflated” with a gas (CO2) so that the abdominal wall rises and the surgeon has a better view of the organs.
After the stomach is located, it is separated with a row of staples just below the stomach entrance. A small residual stomach (stomach pouch) has thus been created below the end of the oesophagus, which usually has a capacity of less than 50ml. The remaining, closed stomach remains in place and is “shut down”, so to speak.
Next, the small intestine in the area of the jejunum (empty intestine) is cut through: The lower end of the incision is then “pulled up” and connected to the small remaining stomach (gastrojejunal anastomosis). The upper end of the cut through jejunum is now connected to the small intestine following the jejunum. All in all, the following functional picture emerges: The ingested food passes through the esophagus into the small residual stomach and from there, without contact with the duodenum, directly into the small intestine and later into the colon. All digestive secretions from the stomach and the duodenum (bile/pancreatic juice) are conducted directly into the small intestine where they are added to the food to be digested. Another name for the operation of a gastric bypass is Roux-en-Y gastric bypass.
Aftercare
Immediately after the operation, a slow, gentle diet and physical mobilization follows during the hospital stay. The advantages of the keyhole technique quickly become apparent, as the small incisions allow less pain and a faster “getting back on your feet”. The sutures or staples of the closed small skin incisions can usually be removed between the 10th and 14th day after surgery.Due to the reduced stomach volume, it is no longer possible to eat large meals, so that particular attention must be paid to eating several small, protein-rich portions throughout the day and to chewing the food well.
Very long-fiber meat or vegetables should be avoided, as well as foods and drinks with high sugar content. As vitamins and nutrients can no longer be absorbed so well due to the reduction in stomach size, a lifelong intake of food supplements is also necessary so that no deficiency symptoms occur. The effect of medications can also vary due to the altered gastrointestinal passage time: it may be necessary to adjust the dosage of the medication to be taken, which must be discussed individually with the treating doctor.
