It’s over a year since I wrote about the gastric bypass
so I thought it was time for an update as there has been a significant development in how the operation is performed. Single incision laparoscopic surgery (SILS) has been around for a few years but Healthier Weight surgeon Mr Ameet Patel was the first person in the UK to perform a Single Incision Laparoscopic
Roux-en-Y gastric bypass operation in November 2010. Mr Patel had already performed over 130 single incision laparoscopic gastric band
operations before developing the procedure for the more complex gastric bypass surgery.
Single incision laparoscopic surgery has been used for some time in general and colorectal surgery, urology and paediatrics. The world of weight loss surgery has been a little bit slower to adopt the approach in part due to the technical challenges that larger patients pose with greater central adiposity (fat around the middle) and often a larger liver. There is no doubt it is technically more challenging for the surgeon. It is possible that patients may experience less post operative pain and fewer post operative infections but this has not yet been demonstrated. What is absolutely clear is that patients are delighted with the cosmetic result.
In the US, the gastric bypass – for many years regarded as the “Gold Standard” in weight loss surgery – has now been overtaken by the gastric band. In Europe, we are beginning to see trends in the opposite direction, towards gastric bypass surgery and away from the gastric band. Part of the explanation for these contrasting trends is the entirely mistaken belief that a gastric bypass offers a “cure” for obesity and requires almost no follow-up or monitoring. This is incorrect. There is no such thing as a cure for obesity; there are only procedures that will help people manage their weight problem more effectively. Bypass patients – as with all surgical weight loss patients - require lifelong monitoring if they are to avoid the nutritional complications and weight regain which is observed in up to one third of gastric bypass patients. At Healthier Weight we place as much emphasis on close follow-up up of the gastric bypass patient as we do on the patient with a gastric band.
For older, heavier patients (BMI 45+) with a history of weight problems and co-morbidities such as type 2 diabetes, the gastric bypass offers the best possible option to get weight under control and to reduce dramatically the associated health risks. But to achieve the very best long term results from gastric bypass weight loss surgery, close monitoring and long-term follow-up are absolutely essential.
Dr David Ashton
6th June 2011