Multidisciplinary Clinic of Metabolic & Bariatric Surgery

Weight Reduction Procedures

Laparoscopic Adjustable

Gastric Banding (LAGB)

Laparoscopic Sleeve

Gastrectomy

Laparoscopic Gastric

Bypass

Intragastric Balloon

(IGB) Program

Risk of Surgery

Who Need Surgery

Choice of Procedures

Metabolic Surgery

Life after Surgery

LAPAROSCOPIC GASTRIC BYPASS

Although LAGB and LSG are effective against most of our patient with morbid obesity, it still has its limitations. Restrictive procedure cannot limit fluid calories and patients with poor compliance of dietary advice are at risk of inadequate weight loss or pouch dilatation secondary to binge eating behavior. Gastric bypass, on the other hand, is a hybrid procedure combining gastric partition (restrictive) and foregut bypass (malabsorptive). Firstly, we divide the stomach into a small upper pouch and a much larger, lower "remnant" pouch, and then re-arrange the small intestine to allow food to enter distal small bowel without passage of remnant stomach, duodenum and proximal jejunum. There are two forms of reconstruction techniques.

Roux-en Y Gastric Bypass

Mini-gastric Bypass

Expected weight loss:

Usually loss ~50 – 70% of the excessive body weight in 2 years.

Advantages:

1.	Faster and more weight loss.
2.	More effective control of diabetes after surgery.
3.	More reliable weight loss for high BMI patients.

Disadvantages:

1.	Need division and re-join of bowel, more complex and higher surgical risk of development of complications.
2.	A condition known as "dumping syndrome" can occur as the result of rapid emptying of stomach contents into the small intestine which lead to nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating sweets and high fat diet.
3.	Because the part of the bowel is bypassed, nutrition problems may happen if they do not follow doctor's treatment. Absorption of iron and Vitamin B12 is affected which may lead to anemia. Reduced the ability to absorb calcium and may also lead to bone disease especially in post-menopausal women. However, most of these problems can be prevent by vitamin and minerals supplements.
4.	since most of the stomach is bypassed during surgery, any disease process (ulcer, cancer) will not be able to examine by ordinary investigation tools (contrast X-ray, upper endoscopy).