Prof. Dr. Toygar Toydemir
He received the title of Professor of General Surgery in 2020. Dr. Toydemir, who has extensive experience in reflux and obesity surgery, continues his work in these fields. You can read the rest of our article about Gastric Bypass prices, treatment process, and post-treatment precautions.
Read More Make an AppointmentGastric bypass surgery is an effective bariatric surgical procedure for the treatment of morbid obesity. In this operation, a small stomach pouch is created and connected to part of the small intestine. By reducing stomach capacity and limiting nutrient absorption, the procedure facilitates weight loss and helps control obesity-related conditions such as type 2 diabetes, hypertension, and sleep apnea. However, adjusting eating habits after surgery and maintaining lifelong vitamin-mineral supplementation are critically important. When performed with proper patient selection and by an experienced team, gastric bypass offers a safe and effective treatment option.
| Purpose | Reduce the size of the stomach and bypass part of the intestines to achieve weight loss; decrease obesity-related health issues. |
| Method of Application | Performed under general anesthesia using a laparoscopic approach. The stomach is converted into a small pouch and connected to the lower part of the small intestine, altering the flow of food. |
| Eligibility Criteria | – BMI ≥ 40 or BMI ≥ 30-35 with serious obesity-related health problems. |
| – For those seeking an effective surgical solution for conditions like diabetes and reflux. | |
| Duration of Surgery | Approximately 1.5-2 hours. |
| Length of Hospital Stay | 2-4 days. |
| Advantages | – Provides rapid and effective weight loss. |
| – High rate of improvement in obesity-related diseases such as type 2 diabetes and hypertension. | |
| – Hormonal changes can reduce appetite and increase insulin sensitivity. | |
| Disadvantages | – Technically complex surgery; surgeon experience is crucial. |
| – Vitamin and mineral deficiencies (especially B12, iron, and calcium) may occur. | |
| – Dumping syndrome (rapid gastric emptying) may develop. | |
| Possible Complications | – Bleeding, infection. |
| – Bowel obstruction, ulcer formation. | |
| – Risk of leaks at the suture sites. | |
| Postoperative Nutrition | – Gradual transition from liquid foods to puréed and solid foods. |
| – Lifelong vitamin and mineral supplementation is required. | |
| Physical Activity | Begin with slow walks after surgery; increase physical activity according to the healing process. |
| Follow-Up Process | – Regular check-ups with a doctor and dietitian are necessary. |
| – Vitamin and mineral levels are monitored through blood tests. | |
| Who Is Not Suitable? | – Individuals not suitable for general anesthesia. |
| – Individuals with severe intestinal or stomach issues. |
Gastric bypass surgery has undergone a remarkable evolution in the medical world as one of the cornerstones of modern bariatric surgery. Its origins date back to the 1950s, initially emerging as a byproduct of peptic ulcer surgery. Surgeons observed natural weight loss in patients who underwent stomach-reduction operations, inspiring the development of surgical methods for obesity treatment.
In 1954, Dr. Arnold Kremen performed one of the first bypass procedures by connecting the stomach and intestines. However, in 1966, Dr. Edward E. Mason developed a technique specifically designed for obesity treatment, known as the “Mason gastric bypass.” This procedure involved separating part of the stomach to create a small pouch and connecting it to the jejunum portion of the small intestine, marking a turning point in the evolution of bariatric surgery.
During the 1970s and 1980s, surgical techniques were refined to reduce complications. In 1977, Dr. Ward Griffen introduced the Roux-en-Y gastric bypass to decrease the risk of bile reflux. This method became a standard procedure in bariatric surgery. Around the same time, Dr. Mason developed the “vertical banded gastroplasty” (VBG). However, this method lost popularity over time due to inadequate long-term weight loss results.
The 1990s marked a turning point with the integration of laparoscopic surgery into bariatric procedures. In 1994, Dr. Alan Wittgrove performed the first laparoscopic Roux-en-Y gastric bypass. This minimally invasive technique shortened recovery time and increased patient comfort, thus gaining broader acceptance. In 1997, Dr. Robert Rutledge developed the mini gastric bypass (MGB) method, which gradually became recognized as an effective and safe alternative.
Today, gastric bypass surgery remains an effective option for the treatment of obesity and metabolic diseases. Ongoing research continues to enhance the safety of this procedure and improve patient outcomes.
Gastric bypass surgery is particularly effective for individuals with morbid obesity and serious health problems related to obesity. Determining suitable candidates requires a comprehensive assessment of the individual’s overall health, level of obesity, and accompanying diseases. One of the key criteria in this evaluation is the Body Mass Index (BMI).
A BMI ≥ 40 kg/m² places an individual in the severe or morbid obesity category. Obesity at this level significantly reduces quality of life and increases the risk of premature mortality. When diet, exercise, and medication fail to yield sufficient results, surgical intervention can be an effective solution.
Individuals with a BMI ≥ 35 kg/m² who have obesity-related comorbidities may also be candidates for gastric bypass. These conditions include:
Type 2 Diabetes Mellitus: Gastric bypass surgery can improve blood sugar control and potentially lead to remission of diabetes.
Hypertension: High blood pressure often improves with weight loss.
Dyslipidemia: Decreases in LDL cholesterol and triglyceride levels reduce cardiovascular risks.
Obstructive Sleep Apnea: This condition, caused by excessive weight obstructing the airway, typically improves after weight loss.
Non-Alcoholic Fatty Liver Disease (NAFLD): Weight loss following surgery improves liver function and overall health.
In addition, patients who have not achieved successful weight loss with non-surgical methods are significant candidates. A psychological evaluation is also critical for understanding the patient’s capacity to adopt necessary lifestyle changes after surgery. The ability to adhere to postoperative care and lifelong medical follow-up must also be considered.
Although gastric bypass is an effective method for treating morbid obesity, it is not suitable for everyone, and certain contraindications must be taken into account. This surgical procedure should not be performed on individuals with severe cardiac insufficiency, uncontrolled coronary artery disease, or advanced-stage lung disease. Likewise, those undergoing active cancer treatment or those with liver cirrhosis accompanied by portal hypertension face high surgical risks, making the operation inadvisable.
Individuals with uncontrolled alcohol or drug dependency are not suitable candidates because they are unlikely to maintain the lifestyle changes required after surgery. Severe psychiatric disorders, particularly major depression or psychotic disorders, can adversely affect postoperative care and follow-up. These individuals should stabilize their psychiatric conditions before considering surgery.
Inflammatory diseases affecting the gastrointestinal system, such as Crohn’s disease, can increase the risk of postoperative complications. Bleeding disorders (coagulopathy) or intolerance to general anesthesia may also prevent the safe completion of surgery.
Women who plan to become pregnant are advised to postpone the surgery because pregnancy after the procedure can pose risks for both mother and baby. Determining each patient’s suitability for surgery requires a thorough evaluation and a multidisciplinary approach.
Preoperative Preparation:
Before gastric bypass surgery, the patient undergoes a comprehensive assessment, including nutritional and psychological evaluations, as well as a review of underlying medical conditions. A low-calorie diet is usually recommended prior to surgery to reduce liver size and facilitate the procedure. Patients are also thoroughly informed about potential complications, helping to manage expectations and increase compliance.
Surgical Procedure:
The surgery is performed under general anesthesia using a laparoscopic approach, which offers patients less pain, a shorter hospital stay, and faster recovery. First, a small pouch is created from the upper portion of the stomach, usually holding about 15-30 milliliters. This new stomach pouch restricts food intake and promotes weight loss.
Roux-en-Y Configuration:
In the second stage of the operation, the small intestine is reconfigured. The jejunum is divided at about 45 cm, creating a segment known as the Roux limb. This limb is connected to the newly formed stomach pouch, allowing food to bypass the remaining part of the stomach and the duodenum, entering directly into the small intestine. To allow digestive enzymes to mix with the food, the proximal end of the jejunum is connected farther down on the Roux limb. This means the lower portion of the stomach and roughly 2 meters of the small intestine are bypassed.
Completion of the Procedure:
All surgical connections are checked for bleeding and leakage. An intraoperative leak test helps detect any complications early. At the end of the procedure, the trocar sites are carefully closed, and the patient is taken to the recovery phase.
Procedure Variations:
The operation may be performed using different techniques based on the patient’s needs. Proximal RYGB provides balanced weight loss and is the most commonly used method. Distal RYGB can result in more significant weight loss but carries a higher risk of nutrient deficiencies.
Gastric bypass surgery is an effective method for treating morbid obesity, but like any surgical procedure, it carries certain risks and side effects. In the early period, complications such as anastomotic leaks may occur. This situation, involving leaks at the stomach and bowel connection points, can lead to serious outcomes in rare cases. Bleeding may occur due to manipulation of the surgical area and can sometimes require additional intervention. There is also a risk of infection, which can manifest as pneumonia, urinary tract infections, or sepsis; however, these risks are reduced with the use of antibiotics and early mobilization. Venous thromboembolism, involving clot formation in the legs that can lead to pulmonary embolism, is another concern; prophylactic blood thinners are administered to mitigate this risk.
Among gastrointestinal complications, dumping syndrome is prominent. Caused by rapid emptying of the stomach, it can result in nausea, diarrhea, and abdominal cramps, typically managed through dietary modifications. Anastomotic (the stomach-intestine connection) strictures and anastomotic ulcers may develop due to wound healing and acid exposure in the surgical area. These can usually be treated with endoscopic procedures and proton pump inhibitors.
Nutritional deficiencies arise primarily from reduced absorption of iron, calcium, vitamin B12, and fat-soluble vitamins, potentially leading to anemia, osteoporosis, or neurological issues. Regular supplementation and medical monitoring minimize these risks. Protein deficiencies can be controlled with a balanced diet and supplements.
In the long term, gallstones and kidney stones may form more frequently due to rapid weight loss and metabolic changes. Additionally, impaired calcium absorption can negatively affect bone health. Although rare, thiamine (vitamin B1) deficiency can cause serious neurological problems.
Psychologically, the lifestyle changes and adaptation process after surgery can increase the risk of alcohol dependence and may lead to mental health challenges.
Gastric bypass surgery is highly successful in providing long-term weight loss and improving obesity-related diseases. Research shows that it offers patients significant benefits in terms of both physical health and quality of life.
Weight Loss:
Patients who undergo Roux-en-Y gastric bypass (RYGB) typically experience significant weight loss within the first two years post-surgery. Studies indicate that 10 years after surgery, the average excess weight loss (EWL) is about 60%, and total weight loss (TWL) of around 25% can even be maintained at 20 years. These findings strongly suggest that RYGB supports sustained weight loss in the long run.
Improvement in Obesity-Related Diseases:
One of the most noteworthy aspects of RYGB is its success in controlling chronic diseases related to obesity. The surgery has pronounced positive effects on conditions such as type 2 diabetes, hypertension, and hyperlipidemia. According to research by the American Society for Metabolic and Bariatric Surgery, the remission rates of type 2 diabetes can remain high for up to 15 years following the procedure. Hypertension resolution rates may reach as high as 75% after surgery.
Effects on Mortality and Morbidity:
Another long-term success indicator of RYGB is the significant reduction in mortality and morbidity. Bariatric surgeries reduce the risk of early death due to obesity and extend lifespan. A meta-analysis published in The Lancet found that RYGB reduced mortality by 59% in patients with type 2 diabetes and by 30% in those without diabetes.
The preoperative preparation process for gastric bypass surgery is crucial for ensuring a safe and successful operation. It begins with a thorough medical evaluation, during which the patient gains an understanding of the benefits, risks, and requirements of the procedure. Under the guidance of the surgical team, patients undergo a comprehensive assessment that may include blood tests, an ECG, a chest X-ray, and endoscopy. Individuals with obesity-related conditions like sleep apnea may require a polysomnography (sleep test).
Preoperative nutritional counseling helps patients adapt to essential dietary changes. A low-calorie, low-carbohydrate diet is commonly recommended, which shrinks the liver and facilitates the surgical process. Consuming protein-rich foods helps maintain muscle mass, while avoiding processed foods and sugary beverages is vital.
Lifestyle changes increase the long-term success of the surgery. Regular physical activity improves cardiopulmonary capacity, and smokers must quit to prevent surgical complications. Psychological evaluation is also important, assessing the patient’s mental readiness and motivation for adapting post-surgery.
In addition to physical preparation, patients should participate in educational programs recommended by the surgical team. These programs offer detailed information about postoperative care, dietary changes, and lifestyle adjustments. Support groups can also provide emotional assistance.
Finally, adherence to the surgical team’s advice regarding preoperative medication management, fasting, and hygiene procedures is essential. Following these guidelines increases the operation’s success and ensures patient safety.
Successful recovery and long-term results after gastric bypass surgery depend on consistent care and patient adherence. Dietary management is of paramount importance. Patients start with a liquid diet post-surgery, then progress to puréed foods and eventually to solid foods. At this stage, it is crucial to focus on high-protein, low-sugar, and low-fat foods that suit the smaller stomach capacity. Lifelong commitment to dietary guidelines is essential to protect nutritional health and support weight loss goals.
Because of the changes in the digestive system, nutritional supplements are essential to prevent deficiencies in B12, iron, calcium, and vitamin D. Patients should regularly take multivitamins, calcium citrate, and B12, with additional supplements as needed. Regular blood tests help monitor these levels and detect any deficiencies early.
Physical activity plays a critical role in maintaining weight loss and overall health. Patients are encouraged to engage in aerobic exercises such as walking or swimming and to incorporate strength training to support muscle mass. Exercise programs should be tailored to individual capacities.
Psychological support is also important. Patients may encounter emotional challenges during the weight loss process and can benefit from counseling or participation in support groups. Finally, regular follow-up appointments with the healthcare team are indispensable for monitoring weight loss, nutritional status, and early detection of potential complications.
In which cases is gastric bypass preferred over sleeve gastrectomy?
Gastric bypass surgery is often preferred for patients with severe gastroesophageal reflux disease (GERD), as it can alleviate reflux symptoms more effectively than sleeve gastrectomy. Additionally, for patients with type 2 diabetes, gastric bypass has higher success rates in achieving diabetes remission compared to sleeve gastrectomy. However, gastric bypass is a more complex procedure with higher risks of complications and nutritional deficiencies, so the choice of surgery should be made carefully, considering the patient’s health condition.
Why is vitamin and mineral supplementation necessary after surgery?
Vitamin and mineral supplementation is needed after gastric bypass because changes in the digestive system reduce nutrient absorption. Research indicates that 52% of patients still have low vitamin D levels 12 years later, even when taking calcium and vitamin D supplements, while the rate rises to 78% among those not taking supplements. Iron deficiency affects 20.1% of patients, zinc deficiency 18.3%, copper deficiency 14.4%, phosphorus 7.5%, and calcium 7.4%. Vitamin B12 deficiency can reach up to 60%, and vitamin B1 (thiamine) around 27%. Such deficiencies can cause serious health problems like anemia, neurological disorders, and bone disease, making lifelong supplementation and regular follow-ups essential.
What should the diet look like after gastric bypass surgery?
After gastric bypass surgery, patients go through a staged dietary transition to adapt to the healing process and new eating habits. For the first 1-2 days, a clear liquid diet is followed, including water, broth, and sugar-free gelatin. Over the next 1-2 weeks, a full liquid diet includes protein-rich liquids, milk, and protein drinks. Then, puréed foods such as soft-cooked eggs and puréed vegetables are introduced for 2 weeks. After 3 weeks, soft foods like ground meat and cooked vegetables can be eaten. By 4 weeks, most patients move on to solid foods; meals should be small and frequent (3-6 times a day), starting with 1-2 ounces per serving and gradually increasing to 4-6 ounces. High-protein foods should be prioritized, fatty and sugary foods avoided, and there should be at least a 30-minute gap between eating and drinking. Lifelong vitamin and mineral supplements, especially B12, iron, calcium, and vitamin D, are necessary due to changes in digestion and absorption.
What are the long-term success rates of this surgery?
Gastric bypass surgery is notable for its long-term success rates. Patients lose about 65-80% of their excess body weight, and obesity-related conditions—such as high cholesterol, hypertension, sleep apnea, and type 2 diabetes—often improve significantly. Remission rates for type 2 diabetes can reach up to 90%. Research has shown that even after 12 years, patients maintain successful weight loss and improvement in conditions like diabetes and hypertension. In a long-term study of Roux-en-Y gastric bypass, type 2 diabetes remained in remission for 15 years, and weight loss was maintained for 20 years. Although some patients regain weight 3-7 years post-surgery, with an average regain of about 3.9%, the overall health benefits, reduced mortality rates, and improved quality of life demonstrate the long-term effectiveness of this procedure.
Is there a risk of the stomach expanding again after gastric bypass surgery?
After gastric bypass surgery, the stomach pouch is typically about 15 mL in size, making it less susceptible to expansion. Over time, the capacity of the stomach pouch may gradually increase as the intestines adapt, but this change is generally minimal. Significant enlargement of the pouch is rare and is usually associated with overeating or natural expansion of the connection between the stomach and intestines. Adhering to recommended dietary guidelines and portion sizes is crucial for preserving the benefits of surgery and preventing excessive pouch enlargement.
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