Gastric Bypass Surgery

The average weight loss of gastric bypass surgery is 55-65% of excess weight after 5-10 years.

The most common surgical procedure for weight loss is gastric bypass surgery. Gastric bypass surgery involves stapling off a large portion of the stomach to reduce the amount of food that can be eaten and rerouting of the intestines to reduce the absorption of calories. The most common variation of gastric bypass surgery is the Roux-en-Y (RNY) gastric bypass procedure.

The RNY gastric bypass surgery is a bariatric (weight loss) procedure that has been performed for about 30 years. The operation is not a cosmetic procedure, but major gastrointestinal surgery that permanently and substantially alters the stomach and intestines. Thru the test of time, it has been accepted by most weight loss doctors and insurance companies as an effective treatment for morbid obesity when diets and exercise fail.

Although gastric bypass surgery yields impressive weight loss results, the changes to your digestion system are permanent and will affect your eating habits for the rest of your life. It is important to consider both the advantages and disadvantages of this procedure before making a decision.

Combination Restrictive and Malabsorptive Procedure

Gastric bypass surgery uses both a restrictive and malabsorptive approach to weight loss.

• A restrictive procedure is one that limits the amount of food that can be eaten at any one time. In gastric bypass surgery, this is done by creating a new smaller stomach that forces smaller meal portions.
• A malabsorptive procedure is one that reduces the amount of food absorbed by the digestive system. In gastric bypass surgery, this is done by bypassing the upper portion of the small intestine. Since the food passes thru less of the intestines where digestion takes place, food is only partially digested and there is less absorption of nutrients and calories.

In Roux-en-Y gastric bypass, the stomach is separated into two and the small intestine is cut in the middle. At the top of the stomach where the food enters from the esophagus, a new smaller stomach pouch is created using surgical staples to completely separate it from the remaining lower portion of the stomach. Then, the lower portion of the small intestines is attached to the new stomach. The length of either section of the intestine can be made longer or shorter to affect the levels of absorption. When a shorter length of intestines is bypassed it is called a proximal RNY gastric bypass, when more of the intestines is bypassed it is referred to as a distal RNY gastric bypass. Once the surgery is performed, the remaining lower portion of the stomach and the upper part of the small intestine is “bypassed” in the digestion process.

Gastric bypass surgery was initially performed using open surgery techniques, but most bariatric surgeons now perform the surgery using minimally invasive laparoscopic techniques (inserting special surgical instruments into the abdomen thru small incisions). With laparoscopic surgery, healing and recovery usually occurs quicker than with open surgery.

Advantages to Gastric Bypass Surgery

• More rapid weight loss following surgery than with purely restrictive methods
• Smaller stomach limits amount of food that can be eaten at any one time
• Intestinal rerouting limits amount of calories absorbed by the body
• Intake of sweets controlled because of Dumping Syndrome
• Resolves and/or improves certain obesity-related health conditions as weight loss occurs

Disadvantages to Gastric Bypass Surgery

• Complex operation, surgery risks include infection, leaks, and blood clots
• Vitamin and mineral deficiencies, can lead to metabolic bone disease and anemia
• May experience ulcers, bowel obstruction, or reflux
• Dumping Syndrome

Dumping Syndrome

Dumping Syndrome, which can cause nausea, diarrhea, and weakness, occurs when sweets enter the bloodstream too quickly. Gastric bypass surgery can cause dumping syndrome because the digestive system has been altered and foods enter the intestines more quickly. Dumping syndrome controls the intake of sweets and high calorie foods. It is considered both an advantage and disadvantage of gastric bypass surgery.

Patient Criteria for Gastric Bypass Surgery

Gastric bypass surgery is only recommended for morbidly and severely obese individuals (at least 100 pounds overweight for men and 80 pounds overweight for women) who are willing to make the necessary lifelong changes in diet, nutrition and exercise and have failed to lose weight under a medically supervised diet and exercise program. Because the procedure drastically alters the body, it should only be considered a last resort treatment for obesity. Patients who want to lose weight should discuss their weight loss options with their doctor who is in the best position to evaluate their health and make a recommendation for gastric bypass surgery.

Life After Gastric Bypass Surgery

Although gastric bypass surgery will help a person lose weight, achieving lasting weight loss and good health depends on a persons commitment to eating healthy and exercising on a regular basis. Diet will change to smaller portions, focused on healthy proteins and nutrient rich vegetables. Physical activity is important not only because it burns calories but because it helps protect and preserve muscle tissue during rapid weight loss. Nutritional supplements are required in order to provide the body with the vitamins and minerals it needs to survive. Periodic follow-up tests are necessary to monitor for nutritional deficiencies and long-term effects of weight loss surgery. Nutritional counseling and support groups will also play an important role in helping an individual adjust to the changes and life after gastric bypass surgery.