Other Associated Terms: Bariatric Surgery, Roux-en-Y, Extensive gastric bypass, Vertical Banded Gastroplasty, Bilopancreatic Diversion
Gastric Bypass surgery consists of a group of medical procedures that are used to address conditions of morbid obesity. Morbid obesity is an unusually severe amount of accumulated fat tissue that can lead to various health issues. The term used to encompass all of the various surgical procedures pertaining to morbid obesity is Bariatric Surgery. A gastric bypass is only one set of these operations.
A gastric bypass will first divide the stomach into two sections – a smaller upper pouch and a larger lower pouch. The small intestine will then be re-arranged so that both pouches can still be connected to it. There are several techniques that can reconnect the small intestine, which gives the different types of surgeries their names.
This, of course, leads to great reduction in stomach volume which also leads to the patient’s response to eating, in general. The loss of weight, on average has been shown to reduce long-term mortality by approximately 40%. However, there are possible complications that commonly arise and death from surgical procedures (in one month’s time) is around 2%.
The benefits of surgery will include, first of all, the social benefits of having lost a massive amount of weight – in the 100-200 lbs. range. The patient’s appearance will have improved and they can achieve a far more active lifestyle.
Self esteem will also improve because of this. Health issues will improve as risk factors for various major illnesses will dissipate, as well. As a cause of death in the United States, obesity is second only to illness resulting from cigarette smoking. The costs for obesity-related problems in the US are in the excess of $100 billion a year.
Ideal patients will be at least 100 pounds overweight, are 15-65 years old and have failed at least 6 diet attempts. They should also understand the risks of the surgery and be ready to alter their lifestyles post-operatively. Physicians will usually screen their patients by computing the relationship between their height and weight.
This is placed against a scale known as a BMI (Body Mass Index). Those patients who are candidates for surgery need to have a BMI of at least 40. However, there are cases where the patient has suffered a life-threatening illness (such as a cardio-pulmonary incident) and are allowed the surgical procedure if they have a BMI of 35 or above.
Since medical issues can be extensive and the surgery, itself, has risks associated with it, potential surgery candidates must undergo counseling and be screened thoroughly prior to the surgical procedure.
There are two major types of bypass techniques. The Extensive Gastric Bypass and the Roux-en-Y.
Extensive Gastric Bypass: Which is also known as bilopancreatic diversion, is a more complex procedure that will remove stomach portions and attach them directly to the patient’s small intestine.
Roux-en-Y: Is a more common procedure that creates a small pouch for food storage through the stapling of most of the stomach. Meals will then bypass the section of the intestines which would absorb nutrients, under normal conditions. There can also be a band added to the pouch’s bottom for restriction purposes. This will slow the pouch’s emptying and this is called a Vertical Banded Gastroplasty.
Taking the patient’s size into consideration, the Roux-en-Y will be performed through either a small incision utilizing laparoscopic techniques or through an open surgery procedure that uses a larger incision.
Banding or stapling part of the stomach will create the pouch. This limits the patient’s food intake. A Y-shaped small intestine section is then attached so that the pouch will allow even more food to bypass the area of the intestine designed to absorb calories and nutrients.
In the extensive gastric bypass, a section of the stomach is removed which creates the food pouch. Although this will lead to rapid loss of weight, the technique can also lead to nutritional problems – so it is not as commonly used.
Patients who have had gastric bypass surgery procedures will usually lose about 2/3 of excess weight within 2 years of surgery. The newly created food pouch will hold about an ounce of food and will expand to hold 2-3 ounces, over a period of time. Patients will eat less, since food will be delayed from emptying – causing the patient to feel full.
There can be long-term issues with anemia leading to osteoporosis and bone disease due to the non-absorption of nutrients. Because of this, patients will need to take nutritional supplements to prevent this from happening. Special medications and food may also be indicated for the life of the patient.
Close medical monitoring will also be required. Meals that are high in fat and sugar will most likely not be tolerated and will lead to long-term weight loss. The patient’s appetite may also be reduced with the change in the release of hormones that cause hunger.
Body-shaping surgery may be required once weight loss has been stabilized (normal for at least one year). This is designed to remove excess skin that was stretched when the patient was overweight.
Risks Associated with Gastric Bypass Surgery:
There is approximately a 2% mortality rate which exceeds other surgical procedures. Standard surgical risks include infections, breakdown of staples leading to leakage, opening of the wound, ulcers, clotting in the veins and heart problems. These and other complications occur in about 10% of patients.
The eating process will also be greatly affected. Patients will need to eat smaller meals throughout the day (8-10) and will not be able to drink liquids while eating, since the pouch won’t be able to hold both food and liquid. Patients will usually be advised to eat proteins at first, since protein is the most important nutrient.
Other risks include; the pouch stretching over time to its original size, disintegrations of the pouch band, staple disintegration, leaking of stomach acid to the other organs, stomach contents moving too rapidly causing weakness, nausea, flatulence and diarrhea. Nutritional issues can also lead to other health problems.
The procedure will involve extensive hospital time and follow up visits. Medical professionals will include surgeons, anesthesia specialists, psychologists, etc. Thus, the cost for gastric bypass can range from $20,000 to $55,000. You should also consider any lost time from work, as the recovery period lasts 90 days or more.
Things to Discuss with Your Doctor During Your Consultation:
Before deciding on a gastric bypass procedure, extensive consultation with your doctor is mandatory. You should discuss the surgical procedure itself, your reasons for wanting the procedure, desired outcome and issues surrounding recovery and long-term care. Anesthesia options will also be discussed.
Other things to discuss can include;
- Where will the surgery be performed and which procedure is best for you.
- What are the costs associated with the procedure to include everything associated with the surgery (hospital, X-Rays, etc.).
- What are the qualifications of the surgeon?
- What percentages of patients have complications and what are those complications?
You may also wish to speak with other bypass patients and ask for patient referrals. Any current medications or health issues should also be discussed with your doctor.