By pass means using the shortcut. Gastric Bypass means creating a passageway from the stomach to the intestines in general surgery. It is a method used in various diseases that block the stomach outlet. Gastric Bypass, as used in obesity surgery, is a surgical method in which most of the stomach is disabled and the food is digested using almost only half of the intestines. To Which Patients Is Gastric Bypass Surgery Applied? It can be applied to patients who are obese and cannot lose weight or who have complaints such as overweight and weight-related insulin resistance and joint disorders. It was the most commonly applied surgical method until five years ago. However, as the gastric sleeve became more popular, the frequency of its application decreased. It is now performed as a second surgery (revision surgery) in patients who regain weight after sleeve gastrectomy. Also, as a revision surgery, it can be applied to all patients who have previously undergone sleeve gastrectomy, gastric banding, gastric folding, or vertical gastroplasty. Again, all of these procedures can be performed laparoscopically (closed). Do diseases such as diabetes, asthma, blood pressure prevent Gastric Bypass surgery? On the contrary, these were diseases caused and exacerbated by obesity. These diseases are not an obstacle but a reason for surgery. How to prepare before Gastric Bypass surgery? What tests are performed? First of all, the following tests and investigations are applied to each patient before the surgery. Blood Biochemistry tests Hemogram Hormone tests Hepatitis tests Whole abdominal ultrasound Stomach endoscopy (with the anesthesiologist) ECG (Heart X-ray) Lung X-ray Lung breathing test If necessary, stress test and ECHO (Electrocardiography) All these After the tests, Anesthesiology, Internal Medicine, Cardiology, Chest Diseases and Endocrine specialists Inspections and investigations are carried out. As a result of these examinations, it is first checked whether there is any other underlying disease that may cause the patient to gain weight. If there is no such disease, the patient is examined for anesthesia like any patient who will undergo surgery, and it is checked whether there is any obstacle to the surgery. Relevant experts make recommendations about preoperative treatments, if necessary. In this way, problems that may occur during and after the surgery are minimized. How is Gastric Bypass surgery performed? The entire procedure is performed by laparoscopic (closed) surgery method. Laparoscopic surgery is performed by making many small incisions. Ports placed through these incisions are used to allow hand tools to reach the abdomen. One of these is a surgical telescope connected to a video camera, and the others are for insertion of specialized surgical instruments. The surgeon watches the operation on a video monitor. With experience, an experienced laparoscopic surgeon can perform many procedures laparoscopically, just like open surgery. Although the first gastric bypass was performed in 1967, laparoscopic gastric bypass, Roux-en-Y, was first performed in 1993 and is considered one of the most difficult operations to perform with restricted access surgery. However, the use of this method has made this operation very popular thanks to the shorter hospital stay, shorter recovery time, less scarring, and reduced possibility of surgical site hernia. It is separated by closing and cutting the uppermost part of the stomach where it meets the swallowing tube, leaving a small part of the stomach (5-10% of the entire stomach) on the side of the swallowing tube. Thus, a proximal gastric pouch (at the entrance to the stomach) smaller than 30 mL is created. This new stomach pouch has a volume smaller than approximately 1 tea glass. In this surgery Unlike gastric sleeve surgery, any part of the stomach is not removed and is left in place. By creating a gastric pouch, the existing stomach is disabled and nutrients are allowed to come here. Approximately 50-75 cm is cut from the part of the small intestine leading towards the distal (large intestine) and connected to the new stomach pouch created. The remaining end of the small intestine, from which bile and pancreatic fluid come, is approached and rejoined to the intestine 70-80 cm away. All these cutting, separating, joining and flaring operations are carried out with special, disposable, high-tech tools known as "stapler". What are the different applications of Gastric Bypass? a.Gastric bypass, Roux-en-Y (proximal): This variant is the most commonly used gastric bypass technique and the most performed bariatric procedure in the USA. It is the operation that causes the least nutritional problems. A proximal gastric pouch, smaller than 30 mL, is created at the entrance of the stomach. This new stomach pouch has a volume smaller than approximately 1 tea glass. By creating a gastric pouch, the existing stomach is disabled and nutrients are allowed to come here. Approximately 50-75 cm is cut from the part of the small intestine leading towards the distal (large intestine) and connected to the new stomach pouch created. The remaining end of the small intestine, from which bile and pancreatic fluid come, is approached and rejoined to the intestine 70-80 cm away. Gastric Bypass, Roux-en-Y (distal) Normal small intestine is between 600-1000 cm. The end of the intestine from which bile comes is connected to the intestine from which food comes from about 1 meter further. The combination of bile with food towards the end of the small intestine causes malabsorption (reduced absorption) mainly of fats and starches, but also of various minerals and fat-soluble vitamins. Unabsorbed fats and starch pass into the large intestine. This can provide faster weight loss. However, more serious nutritional problems (such as serious vitamin deficiency) may occur. In addition, the bacterial activity here may cause the production of irritating substances and the formation of foul-smelling gas. Loop Gastric Bypass (Mini Gastric Bypass) Here, the intestine is directly joined to the stomach without being divided into two. Although it is simpler to create, this method causes bile and pancreatic enzymes to escape from the small intestine to the stomach and then to the esophagus, causing serious inflammation and ulceration in the esophagus. Although it is simpler to implement, it is not a preferred method. A leak test is performed during Gastric Bypass surgery and then on the 2nd day. The purpose of the leak test performed during surgery is to determine whether there is a problem with the staples or whether there is a leak in the suture line. If there is a leak, additional stitching is placed on the relevant part to prevent leakage. Again, before starting liquid foods after the surgery, a leak test is performed to ensure that the necessary precautions are taken and intervened in a timely manner. Are there any stitches required in Gastric Bypass surgery? It is controversial to place additional stitches on special materials called staplers in obesity surgeries. Some surgeons think that stitching reduces the possibility of bleeding and leakage and that stitches should be placed on every patient. Some surgeons say that although stitching reduces the possibility of bleeding to some extent, it does not reduce the risk of leakage; on the contrary, it may cause more leakage and bleeding after vascular injury while stitching. Our clinical approach is between these two. Although we do not put additional stitches on every patient, if the stapler line does not seem safe enough to us, we definitely put additional stitches. The fact that our results are much better than the world averages is due to the method we use. It shows that n is more successful. The most important point here is that the surgeon performing the surgery must have the ability and experience to intervene and correct all kinds of problems. Why are blood thinners used in Gastric Bypass surgery? During any surgery, there is a possibility of a blood clot in the vein and blocking any vein. This can cause serious problems when it is a blood vessel that feeds vital organs such as the heart, lungs and brain. As the weight of patients increases, the risk of embolism also increases. For this purpose, these patients are given blood thinners regardless of the surgery they undergo. Although it slightly increases the risk of bleeding, its benefit is much higher. The use of blood thinners begins before surgery and continues for two more weeks. The duration of use may be longer in patients at high risk, such as patients with cardiovascular disease or those who have previously experienced an embolism. Is there any pain after Gastric Bypass surgery? Since Gastric Bypass surgery is performed laparoscopically (closed), that is, by entering through millimetric holes, the pain after the procedure is very less compared to open surgeries. However, the statement "There was surgery, of course there will be pain" is extremely wrong. No patient should suffer from pain in the twenty-first century. Pain is completely prevented by administering painkillers to each patient after surgery. The important point here is this. Everyone's pain threshold is different. Again, drug tolerance and drug bioavailability are different. Therefore, treatment cannot be standard. Pain relief treatment should be arranged individually according to the needs of each patient. Will there be any scars after Gastric Bypass surgery? Since the incisions are very small, the aesthetic results are also extremely good. After a few months, these lines will become almost invisible. After the wounds heal, you will be recommended a cream to leave fewer scars. Much better if you use it for three months You get aesthetic results. When will nutrition start after Gastric Bypass surgery? You will start taking liquid food after the leak test is performed on the 2nd day of the surgery. After the first two weeks of liquid nutrition, you will be fed soft (mashed) food for another two weeks. You will be in constant communication with our dietitians throughout this entire process. What will nutrition, vitamin and mineral supplements be like after Gastritis Bypass surgery? Patients are given protein supplements for the first 15 days. Various vitamin and mineral supplements are given to patients, especially in the first year. These are not standard for every patient, and decisions are made according to the patient's condition and what and how much he needs after the examinations performed during routine checks. Can I stand up and return to work immediately after Gastric Bypass surgery? Since the surgery is performed laparoscopically (closed), you can stand up and walk an hour or two after the surgery. Even during your stay in the hospital, you will not be a care patient and you will be able to do your own self-care. Patients who work at a desk or work in jobs that do not require heavy effort can start back to work within a week. Patients who require it must take a break from work for at least a month. Patients are given a rest report for a sufficient period of time after the surgery. When will stitches be removed after Gastric Bypass surgery? There is no need to remove stitches, as self-absorbing stitches are often used. Non-absorbable stitches are used for a different reason. When you come for a follow-up on the tenth day, the stitches are checked and removed if appropriate. When can you take a bath after Gastric Bypass surgery? You can take a bath when you leave the hospital. There is no problem for the stitches to remain open and get wet. After the shower, dry them with a clean towel, apply baticon on them and dry them. wait for him to hope. Baticon does not leave permanent stains on your laundry. After the tenth day, there is no need to use baticon anymore. Can I use medication after Gastric Bypass surgery? Do not use any medications other than those we recommend for the first month. If a medicine is recommended by another physician, be sure to consult us. You can use any kind of medication after the first month. However, try not to use too much painkillers and stop taking medication.
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