Gastric Bypass

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Gastric Bypass

 


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Gastric Bypass is the most performed bariatric procedure in the United States. Although its technical complexity, it is commonly performed in our Center in laparoscopy. The gastric bypass procedure consists of:
First, a small stomach pouch, approximately 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

 

The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.

 

Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
Weight loss is achieved by the drastic reduction of caloric introit. The rapid transit of food from stomach to the small bowel determines an immediate satiety.
After this procedure it is mandatory the compliance to lifelong nutrient supplementation, which are not absorbed with food.
 

– Multivitamins and iron daily.
– calcium 1200-1500 mg pro/die + vit. D Vitamin D should be taken with your calcium supplement. If you prefer, you can take a combination calcium-vitamin D supplement to avoid taking multiple pills, so long as it contains the proper dosages.

 

Iron:
– if the saturation is ‹ 10% and ferritin ‹ 10 ng /ml or if saturation ‹ 7% it is not considered the ferritin
supplement with ferrous sulfate 325 + 250 of vitamin C each day
 

Folic acid:
If insufficient levels: first supplement vit.B12 and then assume 1 mg of folic acid each day for 3 months
 

VitaminB12:
– if neurological symptoms are present (or if levels < 100 μg/dl ) vit.B12 1000 μg/week I.M. for 4 weeks – if levels 100-150 pg /dl vit. B12 1000 μg I.M. per month and recontrol after 3-4 months – if levels 150-250 pg /dl vit.B12 1000 μg per os or sublingual or spray and recontrol after 3-4 months