Gastric Bypass

Gastric bypass procedures are any of a group of similar operations used to treat morbid obesity—the severe accumulation of excess weight as fatty tissue—and the health problems it causes. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations. A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower remnant pouch and then re-arranges the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different bypass names. Any bypass leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food. The resulting weight loss, typically dramatic, markedly reduces comorbidities. The long-term mortality rate of gastric bypass patients has reduction of up to 40 percent. The gastric bypass, in its various forms, accounts for a large majority of the bariatric surgical procedures performed. An increasing number of these operations are by limited access techniques, termed laparoscopy. Laparoscopic surgery uses several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision—with the option of using an incision should the need arise. The gastric bypass reduces the size of the stomach by well over 90 percent. A normal stomach can stretch, sometimes to over 1000 ml, while the pouch of the gastric bypass may be 15 ml in size. The gastric bypass pouch is formed from the part of the stomach, which is least susceptible to stretching. That, and its small original size, prevents any significant long-term change in pouch volume. What does change, over time, is the size of the connection between stomach and bowel, and the ability of the small bowel to hold a greater volume of food. Over time, the functional capacity of the pouch increases, and by that time, weight loss has occurred, and the increased capacity serves to allow maintenance of a lower body weight. When the patient ingests just a small amount of food, the first response is a stretching of the wall of the stomach pouch, stimulating nerves, which tell the brain that the stomach is full. The patient feels a sensation of fullness, as if they had just eaten a large meal—but with just a thumbful of food.

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Surgery

An act of performing surgery may be called a surgical procedure, operation, or simply surgery. In this context, the verb operates means to perform surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments or surgical nurse. The patient or subject on which the surgery is performed can be a person or an animal. A surgeon is a person who performs operations on patients. In rare cases, surgeons may operate on themselves. Persons described as surgeons are commonly physicians, but the term is also applied to podiatrists, dentists and veterinarians. A surgery can last from minutes to hours, but is typically not an ongoing or periodic type of treatment. The term surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian. At a hospital, modern surgery is often done in an operating theater using surgical instruments, an operating table for the patient, and other equipment. The environment and procedures used in surgery are governed by the principles of aseptic technique: the strict separation of sterile free of microorganisms things from unsterile or contaminated things. All surgical instruments must be sterilized, and an instrument must be replaced or re-sterilized if it becomes contaminated i.e. handled in an unsterile manner, or allowed to touch an unsterile surface. Operating room staff must wear sterile attire scrubs, a scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask, and they must scrub hands and arms with an approved disinfectant agent before each procedure. Prior to surgery, the patient is given a medical examination, certain pre-operative tests, and their physical status is rated according to the AS A physical status classification system. If these results are satisfactory, the patient signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. If the surgery involves the digestive system, the patient may be instructed to perform bowel prep by drinking a solution of polyethylene glycol the night before the procedure. Patients are also instructed to abstain from food or drink to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the patient vomits during or after the procedure. In the pre-operative holding area, the patient changes out of his or her street clothes and is asked to confirm the details of his or her surgery. A set of vital signs are recorded, a peripheral IV line is placed, and pre-operative medications are given. When the patient enters the operating room, the skin surface to be operated on, called the operating field, is cleaned and prepared by applying an antiseptic such as chlorhexidine gluconate or povidone-iodine to reduce the possibility of infection. If hair is present at the surgical site, it is clipped off prior to prep application. The patient is assisted by an anesthesiologist or resident to make a specific surgical position, sterile drapes are used to cover all of the patient's body except for the head and the surgical site or at least a wide area surrounding the operating field. The drapes are clipped to a pair of poles near the head of the bed to form an ether screen, which separates the anesthetist/anesthesiologist's working area from the surgical site. Anesthesia is administered to prevent pain from incision, tissue manipulation and suturing. Based on the procedure, anesthesia may be provided locally or as general anesthesia. Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia, the surgical site is anesthetized, but the patient can remain conscious or minimally sedated. In contrast, general anesthesia renders the patient unconscious and paralyzed during surgery. The patient is intubated and is placed on a mechanical ventilator, and anesthesia is produced by a combination of injected and inhaled agents. An incision is made to access the surgical site. Blood vessels may be clamped to prevent bleeding, and retractors may be used to expose the site or keep the incision open. The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then peritoneum. 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