Gastric Bypass

Biliopancreatic diversion bypass, with or without duodenal switch (Scopinaro procedure) is nowadays the most effective technique in weight loss and in reducing the percentage of relapse into obesity. The technique is based on bypassing the part of the bowel that absorbs the food that has been consumed. The patient’s quality of life is improved compared to gastric banding, because the unwanted side-effects of constrictive techniques (vomiting, difficulty in swallowing, etc) are reduced, but diarrhea and borborygmi (stomach growling), especially after fatty meals or desserts, may be manifested. These patients have to take vitamins and trace elements (vitamin B complex, folic acid), calcium and iron tablets for the rest of their lives. If they fail to do so, the result will be anemia, secondary hyperparathyroidism and osteoporosis. Another advantage of this technique is that it allows the monitoring of the remaining stomach using a gastroscope. No surgical incision is required during the procedure, as it can be performed both laparoscopically and robotically, and patients are hospitalized for 3-4 days. There may be some immediate complications (anastomosis leakage, hemorrhage), which can be treated conservatively or with revision surgery. The overall percentage of complications is 4-6%. A large percentage of patients (90-95%) who have undergone this type of surgery are satisfied with the result.

Roux-en-Y Gastric Bypass

The main difference between this and the previous procedure is that the stomach stump is retained (no gastrectomy is performed). A small pouch is created at the top of the stomach, which is completely separated from the rest of the stomach and is anastomosed to a jejunum villus as per Roux-en-Y.

Modifying the technique and including the duodenum has resulted in preserving the pylorus, thus significantly reducing the complications of the method, as it has reduced the symptoms of acute dumping syndrome and anastomotic ulcers.

The procedure leads to the greatest and most long-lasting weight loss (at least 65% average weight loss for 5 years or more). It is usually accompanied by a cholecystectomy. Technically, it is a very difficult procedure and causes more metabolic disorders than the previously-mentioned techniques.