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Obesity is defined as an excess of fat mass that is quantified by Body Mass Index. BMI. Bariatric surgery is currently the most effective way to get rid of fat, and its indication depends on the BMI when it exceeds 35 or 40. Indeed, there is a bariatric band surgery known as Gastric Bypass. It consists on reducing the volume of the stomach and modifying the food circuit. Nourishment does not pass through the stomach and the higher part of the digestive tract, though it goes straight into the middle part of the small intestine. Due to gastric restriction, the amount of food ingested will decrease and the patient will feel satiety more quickly. In addition, malabsorption leads to a reduction in the amount of food that is assimilated. The roux-en-Y gastric bypass technique makes the patient lose about 60 to 75% of excess weight. In order to determine oneself BMI their body mass index, the person should simply divide their weight by their height squared. But, specifically, the bypass is recommended for those who suffer from massive obesity, and who in addition have gastro-oesophageal reflux or who cannot stop to nibble, and are addicted to sweets.
The price of a Bypass in Tunisia coupled with a week of recovery or vacation in a 5 stars hotel is at least % cheaper than the sole procedure in Europe and for the same medical quality.
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How is a Bypass surgery performed?
There are 2 types of bypass: the mini bypass and the classic bypass. The latter is well requested by patients and is frequently performed by surgeons. Classical bypass is hardly reversible, whereas mini bypass is relatively easily reversible. Bypass, also known as Gastric Short Circuit, is a complex procedure that requires hospitalization from 2 to 4 days in average. The procedure is performed under general anesthesia by minimally invasive means, and lasts 2 to 3 hours. It is performed by laparoscopy, a camera is inserted through a small hole in the abdominal wall, while the working instruments are inserted by five small other holes. The size of the stomach is reduced by section and only a small gastric pouch with a volume of 20-30 ml is preserved. The intestine is then cut and connected to the gastric pouch. Thus, a part of the intestine is short-circuited on 75 cm.
Regarding the mini bypass operation, it has become more requested by patients as an alternative the classic gastric bypass. In fact, its principle remains the same, but the mini bypass intervention does not reduce as much of the size of the stomach as the classic surgery. Furthermore, its incision is a little different and its procedure is simpler, especially that this technique is reversible. Instead of two stitches, a single one takes place between the small intestine and the stomach. Thus, the intestinal loop is then in Omega-shape and not in Y. This technique lasts about ½ h to 1 hour, while the classic bypass takes 2 to 3 hours generally.
Scars related to Gastric Bypass Surgery
The patient will have 3 to 5 small scars on the abdomen, which are sutured by dissolvable threads that disappear alone, or staples or non-absorbable threads which have to be removed. The stitches used depend on the patient age, the thickness of their skin. The bandages can be changed every 2 or 3 days. The patient can use waterproof wound dressings that allow them to take showers without any constraints. The surgeon may prescribe to the patient a silicone ointment to be applied twice a day morning and evening on the scars as from the 7th postoperative day.
Post operative effects and recovery after bariatric bypass surgery
After the procedure, the patient will spend a few hours in the recovery room, before being removed to their private room. There will be a small tube called Redon instead of a catheter in the nose. Indeed, it is placed at the end of the procedure and emerges through a small hole in the abdomen. Redon is used to aspirate secretions and will be removed on the 2nd or 3rd day. In addition, pain medication will be administered intravenously. The patient will spend the evening of the operation on an empty stomach. Besides, the surgeon will prescribe medications for local care, pain relievers, vitamins and trace elements. It is essential to stop any physical activities for two to three weeks. The first day after the procedure the patient can drink a little water after the surgeon's agreement. The following two days, the patient is allowed to drink only beverages and starting from the 3rd day, they can introduce a little more consistent food such as soup, compote, yoghurt, low-fat dairy products, etc. Then they can eat everything provided that they chew the food well with little amount. It is advised to mix or mill meat for a month.
Result and outcome after Bypass Procedure
Bypass acts by several mechanisms that combine a gastric restriction, malabsorption, dumping Syndrome, decrease in the rate of ghrelin. The bypass leads to a very important weight loss. In the order of 5 kilograms per month, during the first 6 months, then a weight loss of 2 to 4 kilograms per month. According to scientific data, the bypass makes - on average - 70% of excess weight lost in 1 year. Under nourishment and vitamin shortage are not uncommon, thus vitamins and oligo-foods are essential. The modification of the food circuit is responsible for reducing the digestion of so-called "fat-soluble" vitamins (vitamins A, D, E K), and certain nutrients and trace elements. These different products must be brought in addition to the diet and in the form of capsules.
Advices before and after Bypass Gastric Surgery
Before undergoing a bypass gastric surgery, it is essential to consult various professional doctors such as surgeon, nutritionist, dietitian, psychiatrist or psychologist, etc. who will inform and examine the patient. They will also prescribe different examinations according to the needs i.e blood tests, endoscopy esosastroduodenal, evaluation of the respiratory and cardiac function, etc. Thanks to these examinations and analysis, the surgeon will draw a complete assessment of the obesity and the state of health of the patient and detect any impairments (nutritional deficiencies or vitamins, diabetes, hypertension, hypercholesterolemia, cardiac disorders, sleep apnea syndrome or other respiratory disorders, articular disorders, etc.). The patient must not drink or eat from midnight the day before the operation.
After the bypass intervention, drinks must be taken in small quantities but regularly during the day. In order to avoid a dumping syndrome (malaise, nausea, sweating, digestive disorders ...) the meals must be taken slowly, whereas they must not be too fat or sweet. The first month will allow the patient to get used to their new digestive circuit. It is advised to eat very slowly to fill the small stomach, which is in the process of healing.