Dr Cierny often favours Gastric bypass as a solution for those patients who suffer or have a predisposition to get severe metabolic complications in connection with obesity, especially Type 2 Diabetes, Chronic Hypertension, Sleep Apnoea, Dislipidemia and other forms of “metabolic syndrome”. Whilst other forms of surgery can very often help resolve some of these conditions, the evidence for Bypass suggests some severe conditions can be resolved quicker and more effectively for patients who have this procedure.
He also suggests Bypass for patients for whom he believes restrictive bariatric surgery is not expected to be sufficient.
Gastric bypass surgery aims to achieve sustained weight loss two ways – in effect a “two pronged attack”.
Firstly the patient has restriction, being able only to eat a small amount of food,and being able to feel full quickly because of a very much reduced size of stomach pouch.
Secondly, unlike all the other forms of Bariatric Surgery we and Dr Cierny offer, Bypass helps the patient achieve weight loss by malabsorption: the length of the small intestine, through which food passes after it leaves the stomach, and through which all the nutrients in the food (calories) are absorbed into the body, is reduced, so a patient after bypass has a shorter length of small intestine, and so can gain fewer calories from the food they eat.
Because Gastric Bypass involves not only surgery to the stomach but also the cutting and re-joining of the small intestine, it is more complicated than the purely restrictive surgeries such as Gastric banding, Gastric Plication (Wrap) and Sleeve Gastrectomy.
Dr Cierny currently performs two different types of bypass, and will suggest the one most suitable to you when you complete the medical questionnaire.
General Information on types of gastric bypass performed by Dr Cierny
Gastric bypass procedures are operations that first divide the stomach into a small upper pouch and a much larger lower “remnant” pouch and then re-arrange the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different names. Dr Cierny carries out the following two types of Bypass
1. Roux Y Gastric Bypass this is the more complex, it has two anastomosis (joins): Gastro- entero anastomosis (end-to-end) and Entero-entero anastomosis (end-to-side).
The construction of intestine has a shape of “Y” with the Entero-enteroanastomosis between the alimentary limb (cca 150 cm long) bringing food from the upper small gastric pouch through the Gastro-enteroanastomosis and the biliopancreatic limb (cca 50 cm long) bringing bile and alimentary tract juices. Both intestinal limbs join together to the common limb where the process of resorbtion of nutrients is enabled.
2. Omega Loop Gastric Bypass (called Mini Gastric Bypass) is not so complex, as there is only one connection between the upper gastric pouch and small intestine by means of end-to-side Gastro-enteroanastomosis cca 200 cm from the small intestine origin. The small intestine makes a shape of letter “Ώ“(omega).
Any gastric bypass leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and physical response to foods, esp. incretin secretion with neuro-hormonal changes. This type of operation belongs to the group of bariatric surgery based on both restriction and partial malabsorbtion (limiting the volume of the food intake and decreasing the intestinal resorbtion), unlike the sleeve gastrectomy, the gastric banding and the gastric plication.
Whatever procedure you have, the surgery is only the first step, and if you are to succeed long-term with your weight loss you must understand that surgery is not a magic wand or a miracle cure, it is a tool to allow you to lose weight easily and keep it off – how well you use this tool is up to you! If you are determined to make the most of it, with our help you will succeed, but you need to make full use of the support we give, and you need to be fully ready in your own mind before you have the surgery for the changes it will bring.
Having said this, you should understand that Gastric bypass – whichever type – is a major surgery, and we believe you would be most likely to benefit from either Roux-en Y or Omega Loop (Mini) Gastric Bypass if:
- You have a BMI of 40 and above. Patients with a BMI of between 35 and 40 with co morbidities i.e. other serious health problems associated with your weight* (-see explanation in Technical details page below) may be able to have the bypassbut a Gastric Plication (Wrap) is the more usual procedure for the “lower” BMI patients.
- You are at least 18 years old, and under 60.
- You have been overweight for more than 5 years.
- Your serious weight-loss attempts have had only short-term success.
- You are not suffering from any other diseases that may have caused your obesity.
- You do not suffer from Hiatus Hernia, or other gastric problems which may prevent a surgery from being offered (in which case a plication may possibly be the solution instead)
- You understand that a Bypass is a more complex and longer surgical operation than a Gastric Band , it requires a greater degree of post operative attention in the hospital
- You are prepared to make substantial changes in your eating habits and lifestyle.
- You are prepared to stay in touch with us and with Dr Cierny in the months and years after your procedure to provide feedback and report on your state of health and general well being, and to give us regular weight loss records. This is a very important part of your post-operative care.