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Gastric Bypass Surgery
Gastric Bypass Surgery
is the most common form of weight loss surgery in the United States
because it results in reliable weight loss with acceptable risks
and minimal side effects. In gastric bypass surgery, the surgeon
staples off a large section of the stomach, leaving a tiny pouch.
Patients simply can't eat as much as they did before surgery, because
this small pouch can only accommodate a few ounces of food at a
time, and they subsequently lose weight. Additionally, because most
of the stomach and some of the small intestine has been bypassed,
some of the nutrients and  calories
in your foods will not be absorbed. Appropriate candidates for this
surgery are those who are 100 pounds or more overweight.
It is important that patients who have had a gastric
bypass procedure make a lifelong commitment to making the necessary
changes in their diet. This includes maintaining an adequate intake
of protein, taking vitamin and mineral supplements including a multivitamin,
B12, iron and calcium, and avoiding sweets and fatty foods.
Laparoscopic Gastric
Bypass Surgery
Since 1997, the Center for Obesity Surgery has been performing
a laparoscopic gastric
bypass procedure. In laparoscopic surgeries, surgical instruments
are inserted through small incisions rather than a large one. Patients
benefit by having a faster recovery time than with traditional surgery,
a lower risk of hernia, and less scarring. Laparoscopic surgery
also protects the patient's immune function, whereas open surgery
can compromise the immune system and even promote the growth of
any existing tumors. Possible complications of bowel obstruction
and leaks should be discussed with your physician.
Success Rates for Gastric
Bypass Surgery
Weight loss surgery is considered successful when 50% of excess
weight is lost and the loss sustained up to five years. For example,
a patient who is 100 pounds overweight should lose at least 50 pounds;
a patient who is 200 pounds overweight should lose at least 100
pounds. And they should be able to maintain loss successfully for
the following five years.
Estimated weight loss in the first 1- 2 years after a Roux-en-Y
Gastric Bypass Surgery
is approximately 1/2 to 2/3rd of excess weight . 50% excess weight
loss has been documented 10 years and more after Gastric
Bypass.
Risks of Gastric
Bypass Surgery
Gastric Bypass
Surgery achieves weight loss by decreasing intestinal absorption
of food; instead of following its usual path, food bypasses a portion
of the stomach and small bowel. In addition to surgical complications,
some people experience long-term deficiencies of vitamin B12, folate,
and iron. "Dumping syndrome," in which the consumption
of sugar causes abdominal cramping and diarrhea, can also occur.
Some people will also regain some weight in subsequent years.
- 2% - Major wound infection
- 20% - Incisional Hernia (rate for open gastric
bypass)
- 12% - Stomal Stenosis (causes temporary vomiting after
surgery)
- 9% - Ulcer
- 2% - Gallstones (with anti-gallstone medication)
- 0.5% - Blood clots in the lungs
- 1.5% - Leak from the hookup/peritonitis
- 1% - Death
What is Morbid Obesity?
Medically, the word "morbid" means causing disease or
injury. Morbid Obesity is a serious disease process, in which the
accumulation of fatty tissue on the body becomes excessive, and
interferes with, or injures the other bodily organs, causing serious
and life-threatening health problems, which are called co-morbidities.
Morbid Obesity is also called Clinically Severe Obesity, and is
recognized by the consensus of medical opinion as a very serious
health problem, a disease process. In most cases, the underlying
cause is genetic -- you inherit the tendency to gain weight, and
once the problem is established, there is very little that will
power can do about it -- any more than a diabetic might control
his blood sugar by will power.
Is it genetic?
Numerous scientific studies have established that there is a
very powerful genetic predisposition to Morbid Obesity:
- Children adopted at birth show no correlation of their body
weight with that of their adoptive parents, who feed them, and
teach them how to eat. They show an 80% correlation of their body
weight with their genetic parents, whom they have never even met.
- Identical twins, with the same genes, show a much higher similarity
of body weights, than do fraternal twins, who have different genes.
- Certain genetic populations, such as the American Indians of
the Southwest, have a very high incidence of severe obesity. They
also have a markedly increased incidence of diabetes and heart
disease.
- Mice can be bred, which are very obese (they look like little
powder puffs). This is the result of a defect in a single gene,
called the ob gene, which is associated with the ability to make
a hormone, called leptin. The problem in humans is much more complicated
genetically, with over 100 genes involved in some aspect of obesity.
- Another hormone has recently been discovered, called ghrelin,
which stimulates appetite in normal persons. Persons who lose
weight by dieting have persistently elevated ghrelin levels, urging
them to eat more. Persons who undergo a gastric
bypass have a decrease in ghrelin levels by about 77%, indicating
one mechanism of how the operation reduces appetite.
How do you know if you are Morbidly Obese?
- Are you more than 100 lb over your "ideal body weight"?
This is a weight established actuarially, at which you are likely
to live the longest, not what you wish you could weigh - which
is usually less.
- Another alternative criterion is called the Body Mass Index
(BMI). If this is greater than 40, surgery should be considered.
If it is greater than 35, and is accompanied by serious co-morbidity,
surgery may be indicated. To find out your BMI, and visit a very
informative site, visit Dr. C.Everett Koop's Shape-Up America
site.
- Do you have co-morbidities of your serious overweight? We look
for health effects that are known to be caused by, or aggravated
by serious obesity. (See Health Effects of Serious Obesity).
- Have you tried dieting, especially medically-supervised dieting,
and been unable to achieve a sustained healthy body weight. Everyone
knows diets don't work in the morbidly obese, and there has actually
never been a scientific study reported which shows that they do,
but you should at least have tried it.
What can you do to regain your health?
- You could go on another diet. Unfortunately, although diets
work for a little while, the effects seldom last, and the answer
to Morbid Obesity really needs to last a lifetime. No diet program,
even the drug programs such as the Phen-Fen, or Redux, programs,
are sufficiently powerful, or adequately long-lasting, to produce
the necessary sustained weight loss in the severely obese. There
has never been a scientific study which has shown that dietary
management is beneficial or effective, over the long term, in
the severely obese person.
- You could look at how much your health is at risk, and consider
taking some risk now, to achieve a more lasting solution: surgery
to change your body's physiology, and to help you to gain control
of your weight.
A person who chooses surgery can reasonably anticipate loss of
at least 50% of excess body weight (average loss is 80%), as well
as improved health, and the chance to live life in a normal-sized
body.
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