Gastric bypass is the favored bariatric surgery in the United States. Surgeons prefer this surgery 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. Before deciding to go forward with the surgery, it's important to understand what's involved and what lifestyle changes you must make. In large part, the success of the surgery is up to you.
Laparoscopic surgery is performed using several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is also called limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision — with the option of using an incision should the need arise.
The Laparoscopic Gastric Bypass, Roux-en-Y, first performed in 1993, is regarded as one of the most difficult procedures to perform by limited access techniques, but use of this method has greatly popularized the operation, with benefits which include shortened hospital stay, reduced discomfort, shorter recovery time, less scarring, and minimal risk of incisional hernia.
Before gastric bypass, food enters your stomach and passes into the small intestine. After surgery, food is redirected so that it bypasses most of your stomach and the first section of your small intestine (duodenum). Food flows directly into the middle section of your small intestine (jejunum), limiting absorption of calories.
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 stomach and 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 only 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 connection redirects the food, bypassing most of your stomach and the first section of your small intestine, the duodenum. Food enters directly into the second section of your small intestine, the jejunum, 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. Because of its low complication rate and high degree of success, the Roux-en-Y is generally accepted to be the best and safest bariatric procedure.
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.
In some patients the laparoscopic method does not work effectively. Factors that may increase the possibility of choosing or converting to the "open" procedure may include:
A history of prior abdominal surgery causing dense scar tissue
Roux-en-Y gastric bypass procedure If bariatric surgery is performed laparoscopically and complications occur during the operation, your doctor may choose to perform open surgery.
The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open (conventional) procedure is strictly based on patient safety.
As with any major surgery, there can be complications. One of the most common in the Roux-en-Y procedure is blood clots in the legs. This occurs in about 0.2 percent of people undergoing the Roux-en-Y procedure. The clots have the potential to travel to the lungs, where they can have serious consequences. In order to prevent this you will be given blood thinners following surgery. You may also be asked to wear compression stockings. These are very tight stockings that have been proven to reduce blood clots in postoperative patients. Your doctor will want you to get up and walk as soon after surgery as possible. Early ambulation has also been proven to reduce the risk of blood clots. Finally,
although the risk of blood clots is highest in the days immediately following surgery, if you notice unexplained swelling in your legs or sudden shortness of breath once you are home from hospital, contact your physician and get yourself evaluated. Another risk is that occasionally food or liquids will leak out of the stomach instead of traveling directly into the jejunum. While this can be a serious complication occurring in about 1 percent of procedures, it can generally be
corrected. If this happens to you, you will need to return to the operating room. In general, one day after your gastric bypass surgery you will go down to the radiology department and drink something called gastrographin (this is a liquid that will show up on an x-ray). After you drink the gastrographin you will have an x-ray to make sure there is no leakage. If there is a problem, it can be addressed immediately.
Weight loss with the Roux-en-Y procedure is quite good, with most people losing between 65 to 75 percent of their excess weight within the first year. While some people do gain a considerable amount of weight back over the following three to five years, most do not. The first six months after the surgery is known as the rapid weight loss phase.
Immediately following surgery your stomach will be quite swollen and you simply will not be hungry. At this stage you will be taking in liquids only and your weight will fall dramatically. As you begin to eat real food weight loss slows a little, but you can expect very steady and substantial weight loss for the first six months. At about six months many
people find that their appetite returns. Nonetheless weight loss generally continues for another six months, but at a slower rate. In general, after about a year, further weight loss becomes more difficult without real effort. By a year most people will have lost about 65 to 75 percent of their excess weight. This means that in order to achieve their ideal body weight they need to continue to lose. Unfortunately, at about a year a person’s new stomach will have stretched a bit, making it much easier to consume larger portions.
At this point food choices and exercise help determine if a person will achieve his or her ideal body weight.
Within the first two years of surgery, you can expect to lose 50 percent to 60 percent of your excess weight. If you closely follow dietary and exercise recommendations, you can keep most of that weight off long term.
The improvements observed in type 2 diabetes, high blood pressure and high blood triglycerides may significantly decrease the risk of cardiovascular events in people who have undergone gastric bypass surgery compared with those people who did not have surgery. Also, gastric bypass surgery may reduce the risk of dying of diabetes, heart disease and cancer. The surgery has also shown to improve mobility and quality of life for people who are severely overweight.