Gastric bypass surgery in the context of "Obstructive sleep apnea"

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⭐ Core Definition: Gastric bypass surgery

Gastric bypass surgery refers to a technique in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch, where the small intestine is rearranged to connect to both. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different gastric bypass procedures (GBP). Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and physical response to food.

The operation is prescribed to treat severe obesity (defined as a body mass index greater than 40), type 2 diabetes, hypertension, obstructive sleep apnea, and other comorbid conditions. Bariatric surgery is the term encompassing all of the surgical treatments for severe obesity, not just gastric bypasses, which make up only one class of such operations. The resulting weight loss, typically dramatic, markedly reduces comorbidities. The long-term mortality rate of gastric bypass patients has been shown to be reduced by up to 40%. As with all surgery, complications may occur. A study from 2005 to 2006 revealed that 15% of patients experienced complications as a result of gastric bypass, and 0.5% of patients died within six months of surgery due to complications. A meta-analysis of 174,772 participants published in The Lancet in 2021 found that bariatric surgery was associated with 59% and 30% reduction in all-cause mortality among obese adults with or without type 2 diabetes respectively. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes.

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Gastric bypass surgery in the context of Bariatric surgery

Bariatric surgery (also known as metabolic surgery or weight loss surgery) is a surgical procedure used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size (stomach reduction surgery), reduction of nutrient absorption, or a combination of these. Standard of care procedures include Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, from which weight loss is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.

In morbidly obese people, bariatric surgery is the most effective treatment for weight loss and reducing complications. A 2021 meta-analysis found that bariatric surgery was associated with reduction in all-cause mortality among obese adults with or without type 2 diabetes. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes. The risk of death in the period following surgery is less than 1 in 1,000. Bariatric surgery may also lower disease risk, including improvement in cardiovascular disease risk factors, fatty liver disease, and diabetes management.

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