It's always best to lose weight through a healthy diet and regular physical activity. But if you're among those who have tried and can't lose the excess weight that's causing your health problems, weight-loss (bariatric) surgery may be an option. Gastric bypass, which changes the anatomy of your digestive system to limit the amount of food you can eat and digest, is the favored bariatric surgery in the United States.
Most surgeons prefer this procedure because it's safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes. Gastric bypass isn't for everyone with obesity, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle.
Gastric Bypass Candidates
|Body mass index (BMI) is a measure of body fat based on height and weight that applies to both adult men and women.
- Your body mass index (BMI) is 40 or higher (extreme obesity).
- Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problems such as diabetes or high blood pressure
Prepare for Gastric Bypass Surgery?Surgical candidates go through an extensive screening process. Not everyone who meets the criteria for gastric bypass is psychologically or medically ready for the surgical procedure. A team of professionals, including a physician, dietitian, psychologist and surgeon, evaluate whether the surgery is appropriate for you. This involves identifying which aspects of your health would be expected to improve after surgery and what aspects of your health may increase the risks of surgery.
Surgery is recommended when the perceived benefits of surgery outweigh the recognized risks.Your willingness and ability to follow through with the recommendations made by your health care team and to carry out prescribed changes in your diet and exercise routine help determine your readiness for surgery. The surgery may not be recommended or may be postponed if there's any sign that you aren't psychologically or medically ready for surgery. It's important to follow your doctor's directions in preparing for gastric bypass surgery. This includes restrictions on eating, drinking, starting a program of physical activity, and limiting or stopping the use nicotine products.
In gastric bypass (Roux-en-Y gastric bypass) the surgeon creates a small pouch at the top of your stomach and adds a bypass around a segment of your small intestine. The surgeon staples your stomach across the top, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold about an ounce of food. The pouch is physically separated from the rest of the stomach.
Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. This redirects food, bypassing most of your stomach and the first section of your small intestine, the duodenum (doo-o-DEE-num). Food enters directly into the second section of your small intestine, the jejunum (jay-JOO-num), limiting your ability to absorb calories. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in your small intestine.
Some surgeons perform this operation by using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen (laparoscopic gastric bypass). The tiny camera on the tip of the scope allows the surgeon to see inside your abdomen. Compared with traditional "open" gastric bypass, the laparoscopic technique usually shortens your hospital stay and leads to a quicker recovery. Fewer wound-related problems also occur. Not everyone is a candidate for laparoscopic gastric bypass, however. Talk to your doctor about whether this approach is appropriate for you.
During Gastric BypassGastric bypass surgery is performed under a general anesthesia. This means you inhale analgesics as a gas or receive them through an intravenous (IV) line so that you're asleep during the surgery. During surgery, a tube is passed through your nose into the upper stomach pouch. Occasionally, this tube stays in overnight. The tube is connected to a suction machine after surgery to keep the small stomach pouch empty so that the staple line can heal.
You may have another tube in the bypassed stomach. This tube would come out of the side of your abdomen and is removed four to six weeks after surgery. Some skin irritation may develop around this tube. Gastric bypass surgery takes about 90 minutes. After surgery, you wake up in a recovery room, where medical staff monitor you for any complications. Your hospital stay may last from three to five days.
Gastric Bypass Surgery ResultsYou won't be allowed to eat for one to two days after the surgery so that your stomach can heal. Then, you'll follow a specific dietary progression for about 12 weeks. This begins with liquids only, proceeds to pureed and soft foods, and finally to regular foods. With your stomach pouch reduced to the size of a walnut, you'll need to eat very small meals throughout the day. In the first six months after surgery, eating too much or too fast may cause vomiting or an intense pain under your breastbone. The amount you can eat gradually increases, but you won't ever be able to return to your old eating habits. You may experience one or more of the following changes as your body reacts to the rapid weight loss in the first three to six months:
- Body aches
- Feeling tired, as if you have the flu
- Feeling cold
- Dry skin
- Hair thinning and hair loss
- Mood changes
Benefits of Gastric Bypass SurgeryIn addition to dramatic weight loss, gastric bypass surgery may improve or resolve the following conditions associated with obesity:
- Type 2 diabetes
- High blood cholesterol
- High blood pressure
- Obstructive sleep apnea
- Gastroesophageal reflux disease (GERD
Risks of Gastric Bypass SurgeryAs with any major surgery, gastric bypass carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Possible risks specific to this surgery include:
- Death. A risk of death has been associated with gastric bypass surgery. The risk varies depending on age, general health and other medical conditions. Talk to your doctor about the exact level of risk gastric bypass surgery may pose for you.
- Blood clots in the legs. Blood clots in the legs are more likely to occur in very overweight people. Blood clots can be dangerous. In some cases, they travel to the lungs and lodge in the lungs' arteries causing a pulmonary embolism — a serious condition that damages lung tissue and can lead to death. Walking and using leg wraps that apply intermittent pressure to the leg can help reduce this risk of blood clots in the legs.
- Leaking at one of the staple lines in the stomach. This severe postoperative problem would be treated with antibiotics. Most cases heal with time. Sometimes, the leak can be serious enough to require emergency surgery.
- Pneumonia. Excess weight places extra stress on the chest cavity and lungs. This means a higher risk of developing pneumonia after the surgery.
- Narrowing of the opening between the stomach and small intestine. This rare complication may require either an outpatient procedure to pass a tube through your mouth to widen (dilate) the narrowed opening or corrective surgery.
- Vitamin and mineral deficiency
- Bleeding stomach ulcer
- Hernia at the incision site
- Intolerance to certain foods
Weight-loss Surgery OptionsThough it's the most commonly used, gastric bypass is just one kind of weight-loss surgery. Other types include:
- Adjustable gastric banding, which is also commonly referred to as the Lap Band Surgery. The surgeon uses an inflatable band to partition the stomach into two parts. He or she then wraps the band around the upper part of your stomach and pulls it tight, like a belt, creating a tiny channel between the two pouches. The band keeps the opening from expanding and is designed to stay in place indefinitely. But it can be adjusted or surgically removed if necessary. Most surgeons perform this operation using a laparoscope.
- Vertical banded gastroplasty. This operation divides the stomach into two parts — limiting space for food and forcing you to eat less. There is no bypass. Using a surgical stapler, the surgeon divides your stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch — the rest of your stomach. Partly because it doesn't lead to adequate long-term weight loss, surgeons use it less commonly than gastric bypass.
- Biliopancreatic diversion. In this procedure, a portion of your stomach is removed. The remaining pouch is connected directly to your small intestine, but completely bypasses your duodenum and jejunum where most nutrient absorption takes place. This weight-loss surgery offers sustained weight loss, but it presents a greater risk of malnutrition and vitamin deficiencies and requires close monitoring.
After Gastric Bypass SurgerySurgery for weight reduction isn't a miracle procedure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after gastric bypass surgery depends on your commitment to making lifelong changes in your eating and exercise habits. But the feeling of accomplishment as you lose weight and your improved health are significant benefits and are well worth your efforts.
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