Roux-en-Y gastric bypass

Operating principle

The Roux-en-Y gastric bypass ( RYGB ), short gastric bypass (English Gastric bypass ), is provided as a surgical procedure in which the forestomach is separated from the rest of the stomach and is sewn on the thus formed small forestomach an intestinal loop, the internationally most commonly performed surgical operation technique in the context of bariatric surgery . In extremely obese people, weight loss can be achieved with it, because it changes the natural route of food through the gastrointestinal tract and thus leads to deliberate malabsorption and at the same time causes the patient to ingest smaller amounts of solid and liquid food . The procedure is considered the last resort when conservative methods of weight loss have failed.

technology

An essential feature of the technique, which is carried out in different variants, is a surgically created miniaturized stomach (gastric pouch ), which is then connected ( anastomosed ) with a loop of the small intestine (alimentary loop). A second section of the small intestine is then used to collect the digestive juices (biliodigestive loop) in order to deliver them about 100-150 cm distal to the alimentary loop via another connection. It is only from this point on that digestive juices and food can be found together again in the small intestine (common channel). Since the stomach pouch has a much smaller volume than the stomach itself, the patient then only takes in much smaller amounts of food. In 2011, a gastric bypass was placed in 1,974 cases in Germany in obese patients.

Mode of action

It is still often claimed that weight loss after gastric bypass surgery is primarily due to less food (smaller stomach) and poor digestion (shortened small intestine). However, recent clinical and animal studies have shown that these long-standing conclusions about the mechanisms of gastric bypass (RYGB) may not be correct. More and more research suggests that the changes in body weight and metabolism caused by an RYGB cannot simply be explained by the fact that less food fits in the stomach and digestion is worse. A study in rats found that RYGB resulted in a 19% increase in calorie consumption and a 31% increase in basal metabolic rate. Rats fed only as much food as RYGB operated rats consumed lost only 47% of the weight of the operated rats. The decreased food intake after a RYGB only partially explains the weight loss. There is no clinically significant evidence that low calorie absorption contributes to weight loss. The cause of weight loss after gastric bypass appears to be a change in weight regulation, eating behavior, and calorie consumption.

Current studies show that gastric bypass is always accompanied by a change in the intestinal flora , more precisely the microbial profile in the digestive tract . In addition, it was shown that this change in the composition of the microorganisms of the digestive tract significantly contributes to weight reduction and obesity after an R / Y gastric bypass surgery: Researchers estimate that the changed microbial environment accounts for over 20% of the effect of the operation could.

Effects

The operated patients can start to eat solid food again after just a few days. Relatively feared with R / Y gastric bypass is the so-called dumping syndrome , the so-called fall emptying of liquid and solid food from the stomach into the small intestine with its consequences.

The weight reduction is probably faster and greater in many patients than with the so-called restrictive techniques, such as by reducing the size of the stomach , which creates a restriction in the amount of food consumed. However, there are also reports of patients who gain about five to ten percent of their lost weight after several years. As with all obesity surgical measures with the exception of the gastric band , vitamins (especially vitamin B12 ), trace elements (especially copper ) and protein must be supplied for life . There is evidence of an increased risk of kidney stones .

See also

• Gastric band
• Sleeve stomach

literature

• Richard Daikeler, Götz Use, Sylke Waibel: Diabetes. Evidence-based diagnosis and therapy. 10th edition. Kitteltaschenbuch, Sinsheim 2015, ISBN 978-3-00-050903-2 , p. 124 f.

Individual evidence

1. ↑ W. Piper: Internal medicine . Springer, 2006, ISBN 3-540-33725-3 , p. 450; books.google.de
2. ^ RA Weiner et al .: Obesity surgery: surgical technique - complication management - follow-up care . Urban & FischerVerlag, 2009, ISBN 3-437-23025-5 , p. 79 ff .; books.google.de
3. ↑ Obesity treatment ( Memento of the original from January 7, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved December 26, 2012. 
4. ↑ Stylopoulos Nicholas, Nicholas Hoppin, Alison G., Kaplan Lee M .: Roux-en-Y Gastric Bypass Enhances Energy Expenditure and Extends Lifespan in Diet-induced Obese Rats . In: Obesity . 17, No. 10, 2009, pp. 1839-1847. doi : 10.1038 / oby.2009.207 .
5. ^ AP Liou et al .: Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity . In: Sci Transl Med . 5, No. 178, 2011, p. 178ra41 .. doi : 10.1126 / scitranslmed.3005687 . PMID 23536013 .
6. ↑ Microbes Affect Weight Loss . In: The Scientist . Retrieved April 8, 2013.
7. ↑ Doctors Zeitung , July 2, 2008, p. 5, quoted from: JACS , 206, 2008, p. 1145
8. ^ RA Weiner et al .: Obesity surgery: surgical technique - complication management - follow-up care . Urban & FischerVerlag, 2009, ISBN 3-437-23025-5 , pp. 95 ff .; books.google.de

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