General Practice 2022

Bypass gástric: what é, like é done, recoverçõo and complicateções

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Bypass gástric: what é, like é done, recoverçõo and complicateções
Bypass gástric: what é, like é done, recoverçõo and complicateções

Gastric bypass, also known as Roux-en-Y bypass or Fobi-Capella surgery, is a type of bariatric surgery that consists of reducing the size of the stomach and changing the intestines. These changes lead the person to eat less, in addition to decreasing the amount of calories that are absorbed by the intestine, which can lead to a loss of up to 70% of the initial weight.

This type of surgery is indicated for people with a BMI above 35 kg/m², especially when the person has serious he alth problems due to being overweight, when diet and exercise have not worked, or when other techniques of weight loss, such as placement of a gastric band or gastric balloon, did not have the desired results.

Gastric bypass surgery is one of the types of bariatric surgery most commonly performed by gastroenterologists and can be performed at SUS free of charge. Check out other types of bariatric surgery.

When is indicated

Gastric bypass surgery is performed by the gastroenterologist for the treatment of obesity, and the main indications include:

  • BMI is equal to 40 kg/m² or greater;
  • BMI is greater than 35 kg/m² and there are associated diseases such as diabetes, high blood pressure or severe sleep apnea, for example. Learn how to calculate BMI.;
  • Other forms of weight loss had no results such as placement of a gastric band or gastric balloon.

In addition, gastric bypass may be indicated for these people when diet and exercise have not been enough to reduce weight and improve he alth conditions.

Watch the following video and check in which situations bariatric surgery is recommended:

How it's made

The Roux-en-Y gastric bypass is a complex surgery that is performed by a gastroenterologist under general anesthesia and takes an average of 2 hours.

This surgery can be done in the conventional way, in which the surgeon makes a large cut in the abdomen, or by videolaparoscopy, in which 4 to 6 small cuts are made in the abdomen, which allow the passage of a microcamera, which allows the surgeon to visualize the interior of the abdomen, and the surgical instruments, which are commanded by the doctor.

During gastric bypass, the surgeon follows a few steps that include:

  1. Cutting the stomach and intestine: a cut is made in the stomach next to the esophagus, which divides it into two parts, a very small portion, in the form of a bag, and a large portion, which loses much of its function, ceasing to store food.In addition, a cut is also made in the first part of the intestine, called the jejunum;
  2. Joining a portion of the intestine to the smaller stomach: creates a tube-like passageway that carries food from the smaller stomach to the intestine;
  3. Join the intestine that was attached to the large part of the stomach to the tube created earlier: this connection allows food, which comes from the smaller stomach, to mix with digestive enzymes, digestion taking place.

Generally, videolaparoscopy is the most used technique for gastric bypass because it allows a faster recovery and reduces the risk of infections. Check out all the advantages of videolaparoscopy.

What is recovery like

The first 2 or 3 days of recovery from gastric bypass are performed in hospital, with the surgeon, anesthesiologist and nurse monitoring. During this period, serum is administered into the vein to hydrate and give the body energy to recover, painkillers if the person feels pain, and bandages on the belly that protect the scars against infections will be changed by the nurse whenever necessary.

During the first two days after surgery, food is not allowed, and after this period it is possible to start a liquid diet, including water and teas, as directed by the doctor. This diet gradually evolves towards more pasty or solid foods as the person recovers and the body adjusts to the new eating patterns, which can take about three months after surgery. Learn more about eating after gastric bypass.

Home care

After hospital discharge, some care should be followed daily at home to help with recovery:

  • Take your medication at the right times as directed by your doctor;
  • Changing the dressing at the he alth center one week after the surgery;
  • Follow the diet indicated by the nutritionist, which changes over the weeks;
  • Drink fluids to hydrate the body, in amounts recommended by the doctor, waiting about 30 minutes after a meal to drink fluids and avoid drinking 30 minutes before a meal;
  • Eat and drink in small portions and slowly to avoid nausea, vomiting, diarrhea or dizziness;
  • Avoid alcoholic beverages or beverages containing caffeine, such as coffee, black tea, or green tea;
  • Take the vitamin supplements prescribed by your doctor, such as iron, calcium or vitamin B12;
  • Take medicines that inhibit acid production, such as omeprazole, before meals to protect the stomach, as directed by a doctor;
  • Get up and take short walks every hour to prevent blood clots from forming in your legs. However, you should avoid long walks, efforts and carrying weight;
  • Avoid driving for the first 6 weeks after surgery and be careful not to put the seat belt over the scar;
  • Avoid exertion in the first 6 weeks after surgery.

Gastric bypass recovery is slow and can take between 6 months to 1 year, with weight loss being more intense in the first 3 months.

The results of this surgery will appear over the weeks, however, it may be necessary to have cosmetic surgery, such as a tummy tuck, 1 to 2 years later to remove excess skin.

Possible complications

The main complications of gastric bypass are infection at the scar site, temporary bowel obstruction, bleeding or infection in the abdominal cavity.

Furthermore, other complications can occur mainly if the person does not follow the diet correctly, if he eats too much or too little, or foods that should not be ingested, and include:

  • Dumping syndrome with symptoms such as nausea, intestinal cramps, fainting and diarrhea. Learn more about Dumping Syndrome and how to relieve symptoms;
  • Dehydration for not ingesting the amount of liquids recommended by the doctor;
  • Constipation due to lack of physical activity and low fiber or fluid intake;
  • Chronic anemia, mainly due to poor absorption of vitamin B12 by the stomach.

It is important to have medical follow-up after bypass surgery, performing the tests requested by the doctor to assess he alth and avoid the risk of complications.

Bypass or sleeve: what's the difference?

Both gastric bypass and sleeve are bariatric weight loss surgeries. However, in gastric bypass the size of the stomach is reduced and a direct connection is made between the stomach and the small intestine, to reduce the amount of food ingested and its absorption.

Gastric sleeve, on the other hand, is a surgical technique in which the doctor removes a large part of the stomach, allowing the person to eat less and lose weight, but does not make any changes in the intestine, not reducing food absorption.Learn more about the gastric sleeve and its benefits.

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