Both for aesthetic and health reasons, there are now non-surgical methods to get rid of excess weight. For patients who are not suitable for non-surgical obesity treatments, gastric bypass surgery is offered as an alternative. Gastric bypass, a type of weight-loss surgery, is among the most preferred procedures both worldwide and in Turkey, allowing patients to lose excess weight and achieve an ideal body.

What is Gastric Bypass Surgery?

In general surgery, “creating a new passage from the stomach to the intestines” is called bypass. When this technique is used for weight loss, it is referred to as gastric bypass surgery.

Gastric bypass works by bypassing a large portion of the stomach and rerouting the intestines so that food is only partially absorbed, helping with weight loss.

How Does Gastric Bypass Work?

In gastric bypass, both food intake and absorption are restricted. About 95% of the stomach, the duodenum, and the first meter of the small intestine are bypassed. The gastric pouch created is about 15–30 mL in volume and signals the brain when the stomach is full. This procedure is ideal for people who have difficulty feeling full or tend to overeat. By directing food to the more distal part of the intestines, weight loss is achieved, making gastric bypass a highly recommended surgery among obesity specialists.

How is Gastric Bypass Performed?

Gastric bypass is often performed laparoscopically. Small incisions are made in the skin to allow the use of a video camera, surgical telescope, and instruments. A small portion of the stomach near the esophagus is separated, creating a gastric pouch of less than 30 mL. The rest of the stomach is temporarily bypassed but not removed. The small intestine is then connected to the new gastric pouch using a stapler.

Different Types of Gastric Bypass

• Roux-en-Y (Proximal): The most commonly used technique, especially in the U.S., involves cutting 50–75 cm of small intestine and connecting it to the new gastric pouch. The bile and pancreatic secretions are reconnected further along the intestines.

• Roux-en-Y (Distal): A longer segment of the small intestine is bypassed to the small gastric pouch, resulting in faster weight loss due to reduced fat and starch absorption. This method may cause vitamin deficiencies and is used selectively.

• Loop Gastric Bypass (Mini Gastric Bypass): The intestine is directly connected to the stomach without dividing it. Although less common, it may be used when necessary. It may cause discomfort due to bile and pancreatic enzymes reaching the stomach and esophagus.

Who is Eligible for Gastric Bypass?

Gastric bypass is performed on patients with obesity, especially those unable to lose weight and suffering from obesity-related health issues such as insulin resistance or joint problems. A BMI of 35 or higher may be sufficient for surgery if comorbidities are present. The procedure can also help with conditions like hypertension or asthma, worsened by obesity.

Preoperative and Postoperative Overview

Patients undergo several tests to ensure they are suitable for surgery:

• Abdominal ultrasound

• Pulmonary function test

• Stomach endoscopy (with anesthesia specialist)

• EKG (Electrocardiogram)

• Blood chemistry tests

• Chest X-ray

• Hemogram

• Hepatitis tests

• Hormone tests

• Stress test and echocardiography if needed

All results are evaluated by specialists in anesthesia, internal medicine, pulmonology, cardiology, and endocrinology. If no conditions prevent surgery, a joint decision is made to proceed.

Postoperative Care, Pain Management, and Nutrition

Pain management is tailored to each patient. Laparoscopic incisions are minimal, and sutures are typically unproblematic. Scars fade over a few months.

Post-surgery, a leak test may be performed, and if no issues are detected, patients start a liquid diet. For two weeks, pureed foods are recommended under dietitian supervision. During the first year, patients receive vitamin and mineral supplements as needed, which should not be skipped.