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Gastric bypass

Gastric bypass, also known as the Roux-en-Y procedure, is a form of bariatric surgery designed to treat severe obesity. The procedure involves modifying the digestive tract by creating a small gastric pouch connected directly to the small intestine, thus bypassing the majority of the stomach and the duodenum. This process not only limits the amount of food consumed but also reduces the absorption of calories and nutrients.
When should gastric bypass surgery be considered?

Gastric bypass is a treatment option reserved for patients with morbid or severe obesity for whom traditional approaches (diet, physical activity, drug treatment) have failed.


Eligibility criteria :

  • BMI ≥ 35 kg/m², with or without associated comorbidities (type 2 diabetes, hypertension, sleep apnoea, etc.).
  • Persistent obesity despite repeated efforts to lose weight during at least 2 years, intermittently or on an ongoing basis
  • No severe medical or psychological contraindications.

Before considering such an operation, a thorough multidisciplinary assessment is carried out, including:

  • A full medical examination.
  • A psychological assessment to ensure compliance with rigorous post-operative follow-up.
  • Nutritional preparation to adjust eating habits.
  • Care in an approved multidisciplinary centre.
Gastric bypass procedure

Generally carried out by laparoscopy, the procedure takes between 2 and 3 hours. It consists of :
1. Reducing the stomach into a small 25 ml pouch.
2. Diverting part of the small intestine to create a Y-shaped anastomosis between the gastric pouch and the jejunum.
The average hospital stay is 3 to 4 days, with a return to normal activity in 4 to 6 weeks.

Rehabilitation and recovery period

Post-operative rehabilitation is crucial to optimising results. It includes :

  • An initial phase of liquid nutrition followed by the gradual reintroduction of solid foods over several weeks.
  • Vitamin and mineral supplements to prevent deficiencies due to malabsorption.
  • Regular medical and dietary follow-up to monitor weight loss and adapt the treatment.
Benefits and risks

Gastric bypass offers significant weight loss (about 70% of excess weight within 12 to 18 months of the operation) and improvement or remission of many obesity-related comorbidities. However, like any surgical procedure, it carries risks, in particular

Immediate complications: infections, bleeding, leakage of digestive sutures, occlusions, ....
Chronic complications: 
Dumping syndrome: rapid passage of food through the small intestine, leading to nausea, cramps and diarrhoea, and sometimes fainting.
Internal hernias (rarely)
Weight regain: due to inappropriate eating habits or dilatation of the anastomosis.

Endoscopic revision by endosuture: an innovative solution

Over time, some patients may regain weight as a result of dilatation of the gastrojejunal anastomosis and the gastric pouch. These anatomical changes reduce the restrictive effect of the initial operation. Endoscopic revision by endosuture, or TORe (Trans-oral Outlet Reduction), is a minimally invasive procedure performed orally. It reduces the size of the anastomosis using an endoscopic suturing device. This innovative method offers a number of advantages:

  • A safe procedure via the natural route.
  • Less invasive than conventional revision surgery.
  • Faster recovery.
  • A reduction in gastric emptying and an increase in the sensation of satiety.

Studies show that TORe allows :

  • An average additional weight loss of 8 to 10 kg at 12 months.
  • An effective treatment for dumping syndrome.
  • An improvement in patients' quality of life.

It should be noted, that endoscopic revision by endosuture is a recent technique and has yet to prove itself in the long term.

Conclusion

Gastric bypass and endoscopic revision by endosuture are reliable solutions to severe obesity and its complications. A thorough medical assessment and a long-term commitment to a healthy lifestyle are essential to ensure their success.

FAQ sur le bypass gastrique

Qu’est-ce qu’un bypass gastrique ?

C’est une intervention qui réduit la taille de l’estomac et contourne une partie de l’intestin grêle pour limiter l’absorption calorique.

Quels sont les principaux avantages du bypass gastrique ?

Une perte de poids durable et une amélioration ou rémission des comorbidités liées à l’obésité.

Quelles sont les contre-indications du bypass gastrique?

Elles incluent des problèmes de santé graves, des troubles psychiatriques non stabilisés, ou une incapacité à s’engager dans un suivi postopératoire rigoureux.

Comment se déroule la récupération après un bypass ?

Une phase d’adaptation alimentaire progressive est nécessaire, avec un suivi médical et nutritionnel.

Qu’est-ce que le dumping syndrome ?

C’est une complication liée au passage rapide des aliments dans l’intestin, provoquant nausées, crampes et hypoglycémie et parfois malaises.

Combien de temps dure l’hospitalisation pour un bypass gastrique ?

En moyenne 3 à 4 jours, selon la technique utilisée et les conditions médicales du patient.

Que faire en cas de reprise de poids après un bypass ou syndrome de dumping réfractaire à la prise en charge nutritionnelle ?

Une révision endoscopique par endosuture (TORe) peut être envisagée pour réduire l’anastomose dilatée si tel est le cas.

Quels sont les résultats attendus du TORe ?

Une perte de poids et/ou stabilisation de poids, un traitement efficace pour le dumping syndrome, si existant.

Who should I see about these symptoms?

We recommend that you see the following health professional(s) :