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Laparoscopic Gastric Bypass

Gastric bypass cost:               5950 EUR (all-inclusive) Look what is included >>

Required BMI:                         Starting from 30kg/m2, depending on co-morbidities

Expected weight loss:             70-80% of excess body weight

Anaesthesia:                           General anaesthesia

Surgery time:                          1 – 1.5 hours

Hospital stay:                          2-3 nights

Sick leave:                                2 weeks

Operation reversible:                Yes

Need for supplements:             ++

Insufficient weight loss/regain: Trimming the pouch or bypassing more small bowel

Laparoscopic gastric bypass surgery is the most popular type of weight loss surgery in the world and the so called gold standard of weight loss surgeries. The reason for this is good and sustained loss of weight, very good control of accompanying diseases and low risk of surgical complications. The long term results of the surgery – weight loss, effect on accompanying diseases, low mortality rate – are well documented and reliable.

Laparoscpic gastric bypassThere are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 millilitres in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

How does gastric bypass surgery work?

First, the newly created small stomach pouch necessitates significantly smaller meals.  As a result, patients feel full after eating a small quantity of food,  and thus consume less calories.

Secondly, because there is less digestion of food by the smaller stomach pouch and bypassed part of the small bowel,  some extent less absorption of calories and nutrients will occur.

Additionally, rerouting of the food stream leads to changes in gut hormones that promote satiety and suppress hunger.

The main difference of gastric bypass surgery compared with sleeve gastrectomy is the shortening of the food’s path in the digestive system.

What are the long term effects of the surgery?

Long term effects of any gastric surgery are reliant on a patient making the necessary changes to lifestyle, particularly in relation to diet and exercise ?

Many studies have been carried out and published on the long term (over 5 years) effects of gastric bypass surgery. The loss of weight is expressed as an excess body weight loss percentage.

2 years after the surgery, the weight loss is 75-85% of excess body weight. 5 years after the surgery, the excess body weight loss is 52-72%, based on different studies.

Important! In  2015  research at  North Estonian Medical Centre was carried out studying patients who had undergone bypass surgery at least 5 years ago.  After the bypass surgery they had lost on average 68% of their excess body weight. This is comparable with the published international research.

The percent of excess body weight loss is higher in  patients of younger age and lower BMI.

Many diseases connected to being overweight like sleep apnea, type 2 diabetes, joint diseases, high blood pressure or polycystic ovary syndrome (PCOS) improve or disappear as a result of a bypass surgery.

Pros

  • 70%  excess body weight loss, lasting results;
  • Rise of life expectancy;
  • 95% of patients experience improvement in their life quality;
  • Type 2 diabetes goes into remission in 75-85% cases;
  • Sleep apnoea and snoring disappear in 90% cases;
  • Heartburn disappears in 100% cases;
  • Disappearance or major relief from back and joint pain;
  • Mortality rate of the surgery is low: less than 0.1%;
  • The risk of serious surgical complications (ones that need reoperation, blood transfusion or a hospitalisation of more than 1 week) is low: 2%;
  • Reversal of the procedure and restoration of the original anatomy is possible;
  • There is a large amount of data published about the long term outcomes of the treatment compared to other types of weight loss surgery.

Cons

  • Long term usage of food supplements and vitamins is necessary for all patients;
  • Risk of anaemia (low haemoglobin), caused by low iron levels.  Women of child-bearing age most at risk;
  • Intolerance of certain food ingredients (lactose, fats, simple sugars);
  • Stomach ache episodes experienced by approx. 10% of patients;
  • Dumping syndrome experienced by approx. 20% of patients;
  • Small bowel obstruction experienced by approx. 2-3% of patients;
  • The risk of forming an ulcer in the stomach pouch (for smokers and chronic pain killer users);
  • The limit of consumption of alcohol, especially for men;
  • The need to take annual blood tests.

Possible complications

Early: peritonitis; post-surgery bleeding; thrombus of deep veins and lung artery; myocardial infarction; pneumonia; abdominal abscess; wound infections.

Delayed: ulcers on the connection of the stomach and small intestine; constriction of the connection of the stomach and small intestine and difficulties in  swallowing; low iron levels and haemoglobin; low levels of vitamin B-12; low levels of calcium and vitamin D; dumping syndrome; gallstones; bowel obstruction; excess skin; constipation; diarrhoea; loss of hair; alcohol addiction; weight regain or suboptimal weight loss.

To summarise, this is a surgery suitable for almost all patients; it results in remarkable and sustainable weight loss and good control of accompanying diseases, improved quality of life and increased life expectancy.