The Gastric bypass is the process of bariatric surgery that is characterized by the creation of a small gastric reservoir and anastomosing it to a jejunal loop situated downstream of the first portion of the intestine. This assembly, shown schematically in figure above, the most effective therapeutic option for morbid obesity!

Gastric bypass (GBP) released over 40 years in open surgery, enjoys undisputed efficacy that made the test of time and is today the most commonly used method of bariatric surgery in the USA. Synthetic gastric bypass assigned four mechanisms that influence the growth rate of obese patients:

a. Restricting food intake - the small size of the newly created stomach will limit the amount of food eaten at one meal.

b. Maldigestion of food - digestion is delayed, an important food bypassing the absorption area of sweets and fats (first portion of the small intestine). Thus, although sweets are calorie consumption is permitted for absorption is greatly diminished!

c. Satiearly satiety is explained by blocking the receptors that stimulate gastric ghrelin production ic enterohormonii produced by the intestine in the presence of food ingested.

d. Dumping-like syndrome. This early food in the small intestine (short-circuiting stomach) stimulates the production and release of entero-hormones, blood circulation path, reach the brain (hypothalamus) and cause a feeling of fullness installation! If the patient will consume sweets in excess of intestinal mucosa early contact with these high calorie foods will produce hormones that will determine entero-vegetative disorders known as dumping syndrome: dizziness, nausea, palpitations, diarrhea stool! Due to the occurrence of this discomfort patients avoid eating sweets GBP concentrated, which in terms of weight loss is an important advantage!

The mean duration of surgery laparoscopic gastric bypass is approximately 2 hours and 30 minutes, and postoperative hospital stay is 3-4 zile.Dieta strictly based on liquid and semisolid, to spare the stomach and intestines operated and gastric antisecretory treatment required for 4 saptamani.Pentru an indefinite period (several years or permanently) the patient will have to take vitamin and mineral replacement!

Gastric bypass surgery effectiveness:

The GPB surgery statistically is credited with a decrease in the percentage of overweight located between 72- 82%, and the disappearance of comorbidities up to 90%!

This type of surgery is recommended for patients with morbid obesity who have disordered eating behavior and not willing to change (sweet eaters, binge eaters) are completely sedentary and obese patients with diabetes or associated with severe reflux disease gastresofagian.

Also recommended for obese patients to undergo a procedure that was restrictive bariatric surgery (gastric band) which proved insufficient therapeutic or within a therapeutic strategy (or Gastric Bypass 2-stroke), ie super morbidly obese patients presenting (BMI> 50 kg / sqm) super-super obese (BMI> 60 kg / sqm), extreme obesity (BMI> 70 kg / sqm) with indication of GBP, but assigns a very important risk surgical anesthetic. To reduce the risk of installing the intra- and postoperative complications serious sequential surgical approach is recommended.

First time the operator performs a technically simpler process whose efficiency will cause the patient to lose weight. (gastric sleeve). After the patient will lose a significant proportion of overweight, improves comorbidities and surgical anesthetic risks will be significantly reduced.

Under these conditions, making the second-stage surgery, which will complete realization process choice - GBP by laparoscopic approach - will be more easy, involving low morbidity and mortality.

For the same reasoning, if the operative risk is exaggerated therapeutic recommend 3 stages, the first being the endoscopic placement of an intragastric balloon.

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