Gastric bypass, also known as the Roux-en-Y, is a combination procedure that uses the restrictive and malabsorptive elements of weight loss surgery. Gastric bypass involves stapling the stomach to make a smaller pouch. Then, most of the stomach and part of the intestines are bypassed by attaching, usually by stapling, a part of the small intestine to the smaller stomach pouch. The result is that patients cannot eat as much as they could prior to the surgery, and their bodies absorb fewer nutrients and calories.
Gastric bypass is the most common weight loss surgery being performed in the United States and is regarded as the Gold Standard in obesity weight loss surgery. At Surgical Healing Arts Center, this procedure can be performed laparoscopically, which is a minimally invasive technique, or via the traditional “open” procedure. Some significant advantages of a laparoscopic procedure include smaller incisions, a faster recovery time and less risk of incisional hernias. The majority of patients are likely to undergo the laparoscopic approach. However, it is important to note that not all patients will be candidates for the minimally invasive approach. Your surgeon will help you to determine your best option.
Advantages of Gastric Bypass
- Rapid initial weight loss
- Higher total average weight loss than reported with other forms of bariatric surgery
- Minimally invasive approach is possible
- Technique has been used longer in the U.S. than other forms of bariatric surgery
- Cutting and stapling of the stomach and bowel are required
- High risk of complications during surgery than with other procedures
- Portion of the digestive tract is bypassed, reducing absorption of essential nutrients
- Medical complications may arise due to nutritional deficiencies
- Extremely difficult to reverse
- Higher mortality rate than with other weight loss surgical procedures
Using the laparoscopic approach, your surgeon will make several small, one- to two-inch incisions on your outer abdominal cavity and insert small ports into the incisions. Special laparoscopic instruments will then be inserted through the ports to perform the procedure. First, the surgeon will insert a small video camera into the patient’s inner abdominal cavity, enabling the surgeon to view the cavity on a video monitor. Then, the surgeon will create a small pouch—about the size of a hardboiled egg—at the top of the patient’s stomach. Then, a small part of the small intestine is attached to this upper pouch of the stomach. This allows food to enter the small intestine for absorption and bypass the remainder of the stomach and first part of the small intestine.
The smaller stomach pouch limits or restricts the amount of food that the patient can consume. The smaller amount of food also bypasses a good portion of the small intestine, creating a mild malabsorption. In other words, the food skips over part of the small intestine during the digestive process, causing your body to absorb less calories and nutrients than it would have prior to the surgery. The smaller stomach pouch and shorter digestive time often lead to successful weight loss in more than 90 percent of patients.
The remaining portion of the stomach, called the “gastric remnant,” will no longer store any food, but it continues to produce gastric juices. There is no reason to remove it.
Expected Weight Loss
The gastric bypass procedure can successfully put patients on the road to recovery from clinically severe obesity. However, surgery alone will not ensure long-term success. Surgery is merely a tool that is used to help patients do the work. To reach a healthy weight, patients much adjust their eating habits and exercise patterns.
Most patients lose nearly half of their excess weight in the first year following the surgery and continue to lose weight after this point. There is no guaranteed amount of weight loss. Weight control is the personal responsibility of the gastric bypass patient.
Habits that contribute to successful weight loss include eating three small, well-balanced meals and no more than one snack each day. Patients should avoid carbonated, caffeinated or sugary beverages, as well as alcohol. Patients tend to regain weight if they begin eating larger portions, grazing or snacking between meals, consuming high fat or “junk” foods or drinking high-calorie beverages.
A regular exercise program is very important for promoting and maintaining weight loss. Studies have shown that patients who exercise for 45 minutes at least three times per week lose an average of 18 percent more excess weight than patients who do not exercise regularly.
More than 50 percent of patients achieve good to excellent weight loss results following gastric bypass surgery. Expected weight loss is 55 to 75 percent of the patient’s excess weight.
It has been proven that patients who participate in an extensive after-care program following gastric bypass surgery lose more weight. However, this success depends entirely on whether the patient follows a very restricted diet for the rest of his or her life and makes major lifestyle changes.
Risks and Early Complications
Risks and complications, including death, are associated with all major surgical procedures. Severe obesity increases the risks of some complications.
All major abdominal surgeries carry a certain risk for pneumonia. However, this risk is increased during gastric bypass surgery due to the additional stress the patient’s excess weight places on the abdominal wall and chest cavity. The team at Surgical Healing Arts will teach the patient breathing exercises before and after surgery to help reduce the risk of developing pneumonia. These exercises include deep breathing, sitting up, standing and walking the same day of your surgery.
Another potential risk is venous thrombosis, or blood clots in the leg. In very rare instances, a piece of the blood clot may break off and travel from the veins in the legs to the heart and lungs. This event, called a pulmonary embolism, can be very serious. Our team uses strict measures to help prevent a pulmonary embolism by immediately exercising the patient’s leg muscles to promote blood flow. Walking immediately after surgery is a vital component of these measures. The attending nurse will make certain that you are out of bed and walking within four hours after the surgery. You will also wear leg wraps, or sequential compression devices, while recovering in bed. These leg wraps will automatically compress your calf muscles to promote blood flow. If possible, you will also receive a daily injection of blood thinners during your brief hospital stay to further minimize the potential development of blood clots.
Incision infections occur in about five percent of patients who have undergone weight loss surgery. One likely contributing factor is that most patients seeking weight loss surgery have diabetes and are prone to wound infections. The team at the Surgical Healing Arts will closely monitor each patient to ensure that any signs of infection are treated promptly.
Gastrointestinal connections, such as the one made during gastric bypass surgery, always have a risk of leaking. The surgeon will perform various tests to determine that the new gastric bypass is securely intact. A leak can be very serious and could require further testing or emergency surgery.
According to reports, five percent of patients who have undergone gastric bypass surgery have developed an ulcer at the site where the small intestine is attached to the upper part of the stomach pouch. The ulcer could lead to abdominal pain, persistent nausea or bleeding. This complication can usually be controlled through medications. In rare instances, another surgery may be required.
A small percentage of patients may develop narrowing, or “stricture,” of the opening between the new gastric pouch and the small intestine. If narrowing occurs, an outpatient procedure involving mild sedation is routinely used to widen the opening. Multiple treatments may be required, and in some rare cases, additional surgery may be needed to correct this complication.
Vitamin, Mineral and Protein Deficiencies
More common but no less serious side effects include vitamin, mineral and protein deficiencies. Deficiencies of calcium, iron (needed to make red blood cells), vitamin B12 (needed to make white blood cells and help the nervous system), and protein (for healing and muscle building) are well known issues associated with gastric bypass surgery. Therefore, all patients will require life-long vitamin, calcium, iron, vitamin B12 and protein supplements. Patients will be required to have frequent visits with their surgeon or physician to help prevent any nutritional deficiencies.
Transient Side Effects
After surgery, your body needs time to heal. This process takes tremendous amounts of energy. Furthermore, your body is limited in the amounts of nutrients and calories it can absorb as a result of the gastric bypass surgery. During the first three to six months following surgery, some patients have noted symptoms that include the following:
- Feeling tired, almost like they have the flu
- Dry skin
- Hair thinning or loss
- Loss of taste or appetite