When you cannot control your weight through diet or exercise is when doctors prescribe Gastric Bypass Surgery. Also, patients who undergo serious health conditions due to obesity, such as type-2 diabetes or high blood pressure, undergo this surgery. This surgery ensures fewer complications and safety and is a very common operation done by doctors in India.

This piece will define you all about the surgery, its side effects and the cost in India. Read on to gather information on the same in case you are planning to do this surgery to reduce weight.

Roux-en-Y or gastric bypass surgery is a specific weight-loss surgery where the surgeon makes a minor pouch from your stomach. This new pouch directly connects your small intestine.

Post gastric bypass surgery, the food you swallow will go directly into this small pouch and then to the small intestine. This procedure will bypass most of your stomach and the first part of your small intestine.

This surgery is a very common bariatric surgery. Often patients with obesity or those suffering from severe medical issues due to obesity undergo this surgery.

Doctors prescribe gastric bypass surgery to reduce potential life-threatening issues due to being overweight. It helps to treat the following:

1. Gastroesophageal Reflux Disease

GERD or Gastroesophageal reflux disease happens when your stomach acid flows back frequently into the oesophagus. This acid reflux or frequent backwash can irritate the oesophagus lining, causing harm to your body.

2. Cardiovascular Disease

Being overweight can majorly cause coronary artery disease and stroke. These are high triglycerides, LDL cholesterol and low HDL cholesterol. Additionally, this leads to high blood pressure and impaired glucose tolerance or commonly called type-2 diabetes.

3. Nonalcoholic Fatty Liver Disease (NAFLD)

This is a condition where excess fat builds up in your liver. This issue can damage your liver causing inflammation and sudden pain in your stomach. NAFLD happens due to obesity and type 2 diabetes.

4. Sleep Apnea

This is a very serious sleep disorder which causes sudden starting and stopping of your breath. If you notice that you snore loudly and feel tired even after sleeping at night, it might be due to sleep apnea. Excessive weight and obesity is the main reason behind this issue.

5. Type-2 Diabetes

It is a chronic condition where your body uses sugar or glucose as fuel. This results in increased sugar circulation in your bloodstream leading to disorders in your immune, nervous and circulatory systems. Type-2 diabetes is a common chronic condition prevalent in most individuals.

Every type of bariatric surgery comes with its own set of benefits. Before undergoing any surgery, it is mandatory to consult your doctor. Learn everything about the sane and understand whether it suits your body.

Some of the common gastric bypass surgeries done by reputed hospitals in India are as follows:

1. Roux-en-Y Gastric Bypass Surgery

This term in French, denoting 'in the form of a Y', is a type of surgery to treat obesity and obesity-related diseases. A very common bariatric surgery, Roux-en-Y, is irreversible.

It works effectively by reducing your food consumption in one sitting, preventing nutrients from getting absorbed. In this surgery, doctors cut the top section of your stomach, sealing it from the rest. The new pouch is almost the size of a walnut and could hold an ounce of food.

After this, the surgeon cuts a part of your small intestine and connects it directly to your pouch. Therefore, when you consume food, it goes to this pouch and bypasses most of your stomach. Then it directly goes to the small intestine. There are no gastric bypass surgery complications here.

Benefits -

• This process is reliable and ensures long-lasting fat loss.
• It is a standardised technique that most surgeons follow to treat obesity and is safe.
• Caters to health conditions related to obesity.

Survival Rate After Surgery -

• As per a recent study, amongst 81,751 patients who underwent RYGB surgery, the mortality rate was approximately 0.15%.

Cost of Surgery -

Approximately ₹ 10,00,000 to ₹ 30,00,000

2. Sleeve Gastrectomy

Sleeve gastrectomy or laparoscopic sleeve gastrectomy is a process where your stomach is freed from its surrounding organs. Almost 80% of your stomach is removed in this process, making it like a tube-like pouch or a banana shape. This means the small pouch is unable to hold much food.

It also produces low ghrelin hormone, an appetite-regulating hormone that reduces your wish to eat. Patients undergoing this surgery require fewer days to stay in the hospital with reduced side effects of gastric bypass surgery.

Benefits –

• Effective weight loss improves obesity-related health conditions.
• It might be used as a process for gastric bypass surgery or procedure SADI-S.
• Simple surgery requires a very short surgery time.
• Patients with higher risk can undergo this procedure.

Survival Rate After Surgery -

• There was a recent study where doctors examined approximately 156 patients who underwent this surgery. The mortality rate was 5.1% which is low.
• About 75% of patients cured from diabetes with HTA improvement in almost 72%.
• Patients suffering from sleep apnoea withdrew CPAP masks.

Cost of Surgery -

Approximately ₹ 2,30,000 to ₹ 3,50,000

3. Biliopancreatic Diversion With Duodenal Switch or BPD/DS

It is a surgery where doctors create a tube-shaped pouch. Just like sleeve gastrectomy, it is a two-way surgery process. The first part is making this pouch, and the second includes connecting the small intestine's rear to your duodenum near your stomach. This is a duodenal switch and Biliopancreatic diversion.

In this process, the majority of your intestine is bypassed. Undergoing this operation will reduce your consumption of food and reduce your absorption of nutrients as well. However, certain risks come with this surgery, including malnutrition and certain vitamin deficiencies. Some medical practitioners say almost 90% of patients have recovered after undergoing this surgery.

Benefits –

• One of the best surgeries that improve obesity and weight-related issues.
• Allows the hormones in your bowels to control hunger, and you feel full after eating.
• One of the most effective procedures to treat type-2 diabetes.

Survival Rate After Surgery -

• As per recent studies, almost 85% of patients have improved with this surgery.

Cost of Surgery -

Approximately ₹ 3,00,000 to ₹ 4,22,809

4. Adjustable Gastric Band or ADB

Although surgeons do not practise this surgery much, this surgery allows placing an adjustable silicone band. This band is placed on the top section of your stomach to reduce food consumption.

Then, doctors create a small pouch above the band that helps in controlling the amount of food intake, thus avoiding too much eating.

Benefits –

• No complication was found post-surgery.
• No division of the stomach is required in this operation.
• If required, a patient can remove the band.
• Has no risk of vitamin or mineral deficiency.

Survival Rate After Surgery -

• According to reports, almost 98% of patients came for follow-ups after 3 years of surgery, and almost 88% came after 5 years.

Cost of Surgery

Approximately ₹ 1,00,000 to ₹ 5,00,000

5. Single Anastomosis Duodenal-ileal Bypass With Sleeve Gastrectomy or SADI-S

A very recent procedure initiated by the American Society for Metabolic and Bariatric Surgery, this surgery takes very less time and ensures safety. There is only one surgical bowel connection doctors do during this operation. Like sleeve gastrectomy, doctors create a small pouch here first.

After that, doctors create a minor section of your small intestine. Then, they measure a section of the small intestine and attach it to your stomach. This is the only connection they make here through surgery.

Benefits –

• Effective for type-2 diabetes and treatment of obesity.
• Very easy to conduct and requires less time since only one connection exists.
• Patients who have undergone sleeve gastrectomy and want further weight loss can also choose to undergo this surgery.

Survival Rate After Surgery -

• According to studies, about 87% and 38% of patients had excess weight loss and total weight loss after undergoing this surgery at 5 years.
• Again, almost 80% and 34% of patients experience excess and total weight loss at 10 years.

Cost of Surgery

Approximately ₹ 2,93,000

Although this surgery is safe, there are certain precautions you must take before, during and post-surgery. You will have to consult your doctor, who will help you understand the theory and why you need this gastric bypass surgery. 

Here is what you need to follow:

• Medications - Your doctor will ask you to stop taking certain medications that might be harmful during surgery. They include NSAIDs or nonsteroidal anti-inflammatory drugs such as Motrin or Ibuprofen, Aleve or naproxen.
• Food and Drinks - Begin consuming a low-calorie liquid diet consisting of two protein shakes regularly. You can also include consuming eight glasses of water and tea (without sugar). However, you can consume black coffee too.
• Alcohol and Tobacco - Your doctor will ask you to stop taking alcohol and tobacco three months before the surgery. This is because alcohol can enhance complications during your surgery and slow down post-surgical healing.

Like most surgeries, gastric bypass surgery has certain side effects and risks. The side effects of gastric bypass surgery are as follows:

• Lung problem or breathlessness
• Blood clotting
• Excessive bleeding
• Infection and swelling near the incision area
• Gastrointestinal complications and leakages
• Diarrhoea, vomiting and nausea
• Gall-bladder stones or hernia
• Hypoglycaemia
• Ulcers
• Stomach perforation

These are some of the gastric bypass surgery risks you might experience post-surgery. In that case, it is necessary to immediately consult a doctor.

Doctors conduct an appropriate evaluation of your health condition before the surgery. This will help your doctor to determine what complications your body has. If you have diabetes, you must take certain steps to control your blood sugar levels.

Here are the tests your medical practitioner will do:

• A complete blood count or CBC test
• Urine analysis
• Chemistry Panel
• Chest X-ray
• Electrocardiogram or ECG
• Ultrasound test
• Pulmonary function testing
• GI evaluation
• Sleep Studies

Well, before the operation, you might face certain discomfort or nervousness. This is only because of the anxiety that happens due to overthinking. Your doctor will make you stable by speaking with you in this case. You will have nurses to assist you during this period as well.

As nurses take you to the operation theatre in a bed, the following are the things that you can expect during the surgery:

• During surgery the medical team will give you general anaesthesia before the surgery begins.
• Your doctor will then make laparoscopic incisions across the top section of your stomach.
• Then, the small intestine is cut, and part of it is directly connected with the pouch. Due to this, the food that you consume bypasses most of the stomach and goes directly into the intestines.
• As the operation is complete, your surgeon will close all incisions made in the abdomen. The oxygen mask will be kept for a few hours, and anaesthesia will be stopped.
• As you regain consciousness in recovery, a medical team will always monitor your health.
• The recovery from gastric bypass surgery is faster as the process is simple and usually takes a few hours.

When you are in the recovery room, a nurse will be present there to monitor your health condition. Once you recover, the medical team will shift you to a general ward, where you might have to stay for five to six nights.

• A physical therapist will assist you in walking and moving post-operation and after a few days.
• You can start drinking liquids such as water, decaffeinated coffee and tea.
• You have to consume certain oral medications to avoid painful swells.
• An incentive spirometer or a special breathing device will be given to you for use to keep your lungs healthy.
• Post-discharge, you will be given a diet plan by a dietician, which you must follow strictly.
• Your nutritionist will also prescribe vitamins you can consume after that and suggest food you can take post-discharge.
• Consuming the correct proportionate of proteins (almost 60 gms) is a must these days.

In addition, you might require frequent health check-ups to monitor your body condition. However, you may witness excessive weight loss in the first six months. In addition, your body will adapt to the changing conditions soon after.

Gastric bypass surgery requires frequent doctor consultation. After the surgery, if you find these below symptoms, you must call a doctor:

• Sudden bowel obstruction, Diarhhea and nausea
• Pain in your lower abdomen
• Hypoglycaemia or low sugar level
• Bleeding from the incision area
• Excessive weight loss
• Redness or irritation in incision area due to infection

If you still have reservations regarding gastric bypass surgery and find them too complicated, you can find other alternatives. However, it depends on your medical conditions and your doctor's analysis.

The following methods are often used as substitutes for gastric bypass surgery:

• Intragastric Balloon Therapy

Approved for patients with a body mass index of 30 to 40, this process includes gas-filled balloons or fluids. These fluid-filled balloons are inserted inside a patient's abdomen and a tiny camera. This is done from the patient’s mouth to the abdomen.

After positioning this balloon, the physician fills it with saline solution. This allows a reduction of the patient's stomach size and thus lower food consumption. This process is reversible and is intended to be kept in the exact place for over six months before removal.

• Endoscopic Sleeve Gastroplasty

A minimally invasive weight loss process is somewhat similar to the traditional sleeve gastrectomy. However, while an incision is made in the traditional method, this method doesn’t involve any incision, and the upper endoscopy is done.

A thin tube is inserted into the mouth of the patient and led through the abdomen. This procedure involves minimal risk and is intended for patients with BMI greater than 30.