Page 16 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 1 - Introduction
patients underwent a RYGB in 2016 42. The RYGB is performed laparoscopically and patients can be released from the hospital after one night. Figure 1 shows a schematic overview of the RYGB procedure. First, a small gastric pouch is constructed (1).Then the jejunum is transsected (2), pulled up to the gastric pouch and the gastro-jejunos- tomy is created (3). The length of the alimentary limb is than measured and an ente- ro-enterostomy is performed (4). Thus, resulting in a small stomach, the pouch, from which the food directly enters the jejunum, bypassing the remaining stomach and the initial loop of the small intestine. The procedure is both restrictive, patients can eat less, and malabsorptive, nutrients are not properly absorbed. In addition, the RYGB induces changes in the gut hormones, bile acids, gut microbiota and energy balance. This complex system is probably the main cause for weight loss, however it is not completely understood yet 41,54-56.
Figure 1: The Roux-en-Y gastric bypass.
Complications after RYGB
In the Netherlands short term complication rates are quite low; there is a severe post- operative complication rate of 2.87% and a mortality rate of approximately 0.05-0.1% 1. Surgical complications on the longer term include ulcer disease (4.7%), internal herniation (1-3%) and post-prandial hyperinsulinemic hypoglycaemia (0.20-0.36%) 57,58. In addition, about one in every 10 patients will have to undergo a cholecystecto- my because of the development of cholelithiasis 59. The most common complications after bariatric surgery are the nutritional deficiencies. These deficiencies can occur in up to 50% of the population, especially when patients are non-compliant to sup- plementation regimes 60,61. The most prevalent deficiencies are of iron, vitamin B12, calcium and vitamin D 62-64. Another problem is that a large part of the post-bariatric population will develop excess skin, this will be addressed below 8-11. Thus, in addition to the positive consequences, a RYGB can also have several negative side-effects.
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