The gastric bypass procedure (here the proximal Roux-en-Y gastric bypass, pRYGB for short) exists in different variants and, like the gastric sleeve procedure, is one of the most frequently performed procedures in obesity and metabolic surgery worldwide. The procedure offers very good results regarding weight reduction and treatment of diabetes mellitus type 2.
The principle of gastric bypass surgery
The gastric bypass procedure was first described in 1966 by Edward Mason and has undergone many modifications since then. The first laparoscopic gastric bypass surgery was performed by Wittgrove in 1994. The procedure then quickly developed into a standard procedure for the treatment of obesity. The procedure eliminates a large part of the stomach, duodenum and small intestine from the food passage. After the procedure, the food passes through the oesophagus and a small part of the stomach, the so-called stomach pouch, before it reaches the small intestine directly.
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Complications after gastric bypass surgery
Compared to gastric sleeve surgery, gastric bypass has a slightly higher incidence of complications. Immediate postoperative problems that require postoperative treatment include leakage of suture rows, postoperative bleeding and abscesses. Life-threatening complications are very rare in both procedures.
Mechanism of action
With the creation of a gastric bypass, various mechanisms of action are combined. The amount of food that can be ingested is restricted by the small stomach pouch. Since the ingested food from the stomach pouch passes directly into the small intestine, a malabsorptive component is added and hormonal signals additionally change the regulation of the feeling of hunger and satiety.
Results after gastric bypass surgery
The gastric bypass offers very good results regarding weight reduction and remission of a pre-existing diabetes mellitus type 2. The average weight loss of patients after 2 years is approx. 60 - 75 % of the overweight comparable to approx. 12 - 14 BMI points. A pre-existing diabetes mellitus type 2 shows, according to studies, an improvement or complete remission in 75 - 77 % of cases, with which gastric bypass is superior to the gastric sleeve.
Other obesity-related diseases such as high blood pressure, fat metabolism disorders and sleep apnoea also improve significantly. Signs of malnutrition are more frequent after gastric bypass than after gastric sleeve (anaemia, iron and vitamin B12 deficiency). The patient who has undergone gastric bypass surgery, therefore, needs consistent supplementation of vitamins and micronutrients as well as lifelong aftercare.
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