Brought to you by Robert L. Korn, M.D., F.A.C.S. Laparoscopic Bariatric Surgery, expert(s) at Gastric Bypass.

Gastric bypass surgery takes weight loss to the operating room

The weight-loss battle is familiar territory for many Americans. While diet and exercise help the vast majority to shed unwanted pounds and improve overall health, for some, not even this tried-and-true recipe is enough help. For the morbidly obese, whose weight has turned into a health hazard, surgical weight-loss procedures are the only effective hope. For these people, gastric bypass surgery may be the answer.

The gastric bypass procedure, also known as the Roux-en-Y gastric bypass, is an operation that helps obese patients achieve dramatic long-term weight loss. The procedure provides two major mechanisms that help patients eat less. First, after the gastric bypass procedure, patients have much less hunger and much less drive to eat. Second, the stomach is reduced in size, which allows patients to feel full after eating much smaller meals.

The procedure

Prior to any weight-loss operation, your doctor will give you a complete medical examination and evaluate your overall health. This will include a psychological examination to determine whether you are ready to adhere to a healthier lifestyle.

The first step in the procedure makes your stomach smaller. The surgeon uses a stapling device to divide the stomach into a small, new stomach and a larger residual stomach. After the stomach has been divided, the surgeon connects the intestine to the new, smaller stomach. The new stomach is called the pouch. When you eat, the food travels from the new pouch to the intestine, bypassing the residual stomach.

Laparoscopic gastric bypass

The gastric bypass procedure can be performed using the less-invasive laparoscope. This technique allows the surgeon to make smaller incisions, which lowers the risk of large scars and hernias after the procedure. First, small incisions are made in your abdomen. The surgeon then passes slender surgical instruments through these narrow openings. A small camera is also inserted through one of these incisions and the surgery is performed using a video monitor.

Laparoscopic gastric bypass is a far more effective weight loss operation than laparoscopic gastric banding. Data regarding both short-term (2 years) and long term (10 or more years) weight loss demonstrate better results with gastric bypass.

Not everyone is a candidate for the laparoscopic approach. You may not be a good candidate if you weigh more than 400 pounds or have a body mass index over 60. Patients who have had extensive previous abdominal surgery may also not be candidates for laparoscopy due to scar tissue. Weight-loss results for both the traditional open and the laparoscopic procedure are comparable. Your surgeon will determine the best and safest approach for you.

Who is a candidate?

Gastric bypass surgery may be an option if you are significantly obese and have tried unsuccessfully to lose weight on diet and exercise programs, and are therefore unlikely to achieve significant long-term weight-loss with non-surgical methods.

Gastric bypass surgery is not a quick fix for obesity. It is intended to help those with serious health risks who have not been able to lose weight through diet, exercise, and use of medications. Your commitment to diet and exercise must be very strong, because even after the surgery, you must adhere to these lifestyle changes. Lifestyle changes are a key component of permanent weight loss.

The procedure may be considered for obese individuals who have a body mass index (BMI) of 40 or more. Some one with a BMI of 40 is generally at least 100 pounds over their ideal body weight. Patients with a BMI of 35 or more may be candidates if they have severe illnesses secondary to the obesity such as diabetes, heart disease, or obstructive sleep apnea.

Risks

The risks of gastric bypass surgery include bleeding, infections, gallstones, gastritis, vomiting, anemia and early osteoporosis. The national mortality rate after gastric bypass is about 1%. Follow-up surgeries may also be required to correct complications or to remove excess skin. Dumping syndrome, which involves nausea, vomiting, a bloated feeling, dizziness and diarrhea, may also result from inappropriate consumption of high sugar content foods.

Recovery

Typical hospital stay after laparoscopic gastric bypass is 2-3 days. Patients are discharged when they are walking comfortably, consuming a liquid diet and using pills to control their discomfort.

You will remain on liquid or pureed food for several weeks after the surgery. Even after that time, you will feel full very quickly, sometimes being able to take only a few bites of solid food. This is because the new stomach pouch holds less than 1 ounce of food. The pouch will eventually expand, to hold 4-6 ounces of food. Before surgery, your stomach may be able to hold more than 32 ounces of food.

Your follow-up visits may include assessment of your iron, calcium and vitamin intake levels. You will require life-long vitamin, calcium and iron supplements. Long-term follow-up with a registered dietician with expertise in bariatric nutrition will promote your well-being.

Exercise, and the support of others (for example, joining a support group with people who have undergone weight-loss surgery) are both important to help you lose weight and maintain that loss after gastric bypass. You can generally resume exercise about one week after the operation. The morning after surgery, you will be able to take short walks at a comfortable pace. To be successful, you should build your exercise levels toward a goal of maintaining strenuous activity for 20-30 minutes 3-5 days per week.

Expectations after surgery

Often, the greatest rate of weight-loss occurs in the first six months. You should have regular follow-up visits with your doctor during the first year. Your physical, mental and nutritional status will be assessed to be sure that you are making optimal progress.

Realize that surgery is not a solution in and of itself. While it can help train you to eat much less, making a new life still requires that you do lots of work. To achieve long-term weight-loss and avoid complications from the procedure, you must exercise, eat properly and obtain appropriate follow-up care.

Results

Medical studies have shown that gastric bypass surgery significantly improves the life expectancy of obese patients. Many of the diseases that are secondary to obesity are either cured or brought under much better control within months of surgery. National data indicate that patients will lose, on average, about 70% of their excess weight in the first year. They will have lost about 80% of their excess weight by the end of the second year. Patients that have had the Roux-en-Y gastric bypass procedure have been shown to maintain about 55% loss of their excess weight at about 14 years after surgery. These weight loss results at 1, 2, and 10 or more years after surgery are far superior to the results after laparoscopic gastric banding.