GASTRIC BYPASS WITH RING
(CAPELLA STYLE)

It is not a new surgery. It is only a variant of the gastric bypass whose final objective is to improve health and quality of life avoiding complications due to obesity and premature mortality. Physical appearance benefits are important but secondary.

Gastric bypass is the oldest operation performed since 1966. It has passed the test of time. It is the only operation that has been carried out for more than 30 years. It is considered "the gold standard" of the obesity surgery. The procedure has been refined during the last years so that many details have been improved making it safer and more effective.

How the surgery is executed?

The surgery consists of reducing the stomach in addition to performing a procedure that decreases fat absorption. At the beginning, small amounts of food are eaten, a minimum inflation of the small stomach inhibits the center of desire for food, in the brain. A small amount of food will give the same sensation of a large amount of food with no weakness feeling and producing satiation and satisfaction for several hours.

The individual will have to adopt good alimentary habits and to masticate thoroughly in appropriate amounts for the small capacity of the stomach. This will not accept more than its capacity with the advantage of feeling satisfied and relaxed.

Another benefit is that 98% of the patients will no tolerate the sugar contained in chocolates, cakes, candies, etc. but will be able of tolerating sugar contained in fruits and nutrasweet. After one year and a half only small amounts of sugar are tolerated.

During the preoperative evaluation laboratory exams should be done. A complete cell blood test, chemical blood test, HIV test, coagulation test, liver test, thyroid test, chest X Ray, upper abdomen ultrasound (30% of patients has gallbladder stones), electrocardiogram and stress test.

If something turns out wrong it should be corrected before the gastric surgery. If everything is right surgery can be scheduled.

The procedure lasts about 2 and half hours
The cut is vertical above the navel
Hospital stay is 48-72 hours
Come back to work and drive approximately in 5 days

After a month and a half any type of exercise can be done that help weight loss. Vitamins are recommended at least for 2 years.

PATIENT SELECTION

The patient must accept control and follow-up for 1 and 1/2 year after the surgery, at the minimum. The 50% of the success belongs to the procedure itself and the other 50%, corresponds to the patient compliance to indications.

Individuals 35 and more kg of overweight with unsuccessful diet treatments

Body mass index 35+ kg/m2 are candidates to this kind of surgery for improving their quality of life and for preventing obesity complications including premature mortality

Diabetes and hypertension treatment goals are easier to achieve after the surgery

It is not indicated for psychiatric patients and illegal drug users

Age between 15 and 65 years

During the gastric surgery other procedures can be done such as: gallbladder extraction, herniplastia and fallopian tube occlusion

A female patient can get pregnant with no problem after one year of surgery

SURGERY RISKS

Morbidity is exactly the same as that of any abdominal surgery. Severe complications are breakouts and thrombosis that affect less than 1% of the patients. Obese patients present more severe health risks without the surgery than with the surgery.

1- Esophagus 2- Esophagus and stomach union 3- Small gastric pouch, new stomach 4- Interposition jejunal, separation of the new stomach from native stomach 5- Silastic band. The ring comes from the enlargement of the stomach exit 6- Native stomach. It is connected to the small bowel jejuno-jejuno anastamosis. Digestive juices are produced as usual. They will be blended with food coming from the small stomach 7- Gastro jejuno anastomisis. Union between small stomach and bowel 8. Duodeno 9. Jejuno jejuno anastomosis. Place where food and digestive juices are blended.