What's wrong with the diet? Physiological component of the diet.

Chapter 32. Bariatrics: effectiveness of gastric bypass

What we are researching: What is the effectiveness of gastric bypass?

What's new: What is the domino effect of gastric bypass surgery?

What we will learn: How can the risks associated with complications help us make wise choices?

1. Anastomotic leak is one of the most serious complications after bariatric laparoscopic* Roux-en-Y gastric bypass (LRYGB), which is associated with high morbidity and prolonged hospital stay (Jacobsen HJ et al. 2014) [1].

* Laparoscopy is a type of surgery that gets its name from the laparoscope, a thin instrument with a tiny video camera and light at the end. When the surgeon inserts it through a small incision into your body, he can look at a video monitor and see what is happening inside you. Without these tools, they would have had to make a much larger hole. Thanks to special instruments, there are fewer incisions and the surgeon also does not need to enter your body. (WebMD with health information and the most popular consumer-driven health site. https://www.webmd.com/digestive-disorders/laparoscopic-surgery).

2. Types of operations. Let's look at the various bariatric surgeries that are most common in the United States as of 2020. These include a duodenal switch (DS), laparoscopic gastric bypass (LRYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB)*. This chapter will focus on the bariatric procedure of laparoscopic gastric bypass (RYGB) (hereinafter referred to as gastric bypass) **. Let us briefly explain the ore the effectiveness and side effects of gastric bypass. After considering all the above operations, we will know their results 1 – 2 years after the operation, when maximum weight loss is achieved (Chapter 35. "Bariatrics: Summary of Effectiveness") [2, 3, 4, 5, 6]. Let's draw conclusions that will help you make a wise choice. So, what is gastric bypass surgery?

*All descriptions of types of surgical procedures and estimates of the number of operations are taken from the official ASMBS/Resources/Metabolic and Bariatric Surgery website: https://asmbs.org/resources/metabolic-and-bariatric-surgery

** Bariatric surgery on the duodenal switch covers 31 chapters of this book.

3. Laparoscopic gastric bypass (LRYGB). As of 2019, the estimated number of surgeries was 17.8%. What irreversible changes are made to internal organs? The stomach is cut down to the size of a walnut and then attached to the middle of the small intestine, bypassing the duodenum and part of the small intestine (fr. 31.4). How effective is this surgery in reducing body weight?

4. Efficiency. Maximum weight loss reached up to 32%±8 (%TWL) [6]. This effect is achieved due to two anatomical changes. One of them concerns a significant reduction in the stomach to the size of a walnut. This surgical procedure is called restrictive. Restriction of the stomach leads to rapid satiety and a decrease in the calorie content of digested food. The second anatomical change is that bypassing the duodenum (the beginning of the small intestine) and another part of the small intestine results in significantly reduced absorption. This procedure is called malabsorption. The combination of these anatomical changes helps to reduce signs of comorbidities associated with morbid obesity, such as in the case of duodenal switching [2, 5, 7, 8].

What side effects did the researchers find?

5. Side effects. Serious complications (21%) are caused by the above anatomical changes [5]. Places of new connections made with sutures/staples disrupt the integrity of the gastrointestinal tract (anastomotic leak) (3–5%). It is the cause of internal intestinal hernia * (3.1%), which can lead to intestinal obstruction ** and perforation  Δ [7]. Intestinal obstruction is another serious concern due to the difficulty of diagnosing it, especially if it is associated with an internal intestinal hernia. What is the difficulty of diagnosis?