Gastric bypass surgery
Definition
Gastric bypass is surgery that is
done to help you lose weight. After the surgery, you will not be
able to eat as much as before, and your body will not absorb all
the calories from the food you eat.
See also: Laparoscopic gastric banding
Alternative Names
Bariatric surgery - gastric
bypass; Roux-en-Y gastric bypass; Gastric bypass -
Roux-en-Y
Description
This surgery helps you lose
weight by changing how your stomach and small intestine handle the
food you eat.
- After the surgery, your stomach
will be smaller. You will feel full or satisfied with less
food.
- The food you eat will no longer
go into some parts of your stomach and small intestine that break
down food. Because of this, your body will not absorb all the
calories from the food you eat.
You will receive general anesthesia before this surgery. This will
make you unconscious and unable to feel pain.
Gastric bypass can be done in 2
ways. In open surgery, your surgeon will make a large incision
(cut) to open up your belly. Your surgeon will do the bypass by
directly handling your stomach, small intestine, and other
organs.
Another way to this surgery is to
use a tiny camera, called a laparoscope, which is placed in your
belly. This is called laparoscopy.
In this surgery:
- First, your surgeon will make 4
to 6 small incisions in your belly.
- Then your surgeon will pass the
laparoscope through one of these incisions. It will be connected to
a video monitor in the operating room. Your surgeon will look at
the monitor to see inside your belly.
- Your surgeon will use thin
surgical instruments to do your bypass. These instruments will be
inserted through the other incisions.
- You will probably stay in the
hospital a shorter time and recover more quickly after laparoscopy,
compared to open surgery. There are also fewer incision problems
after this surgery. You will also have smaller scars and a lower
risk of developing hernias after
laparoscopic surgery.
Laparoscopy may not be safe for
you if you:
- Have had abdominal surgery in
the past. This is because you may have scar tissue from earlier
surgery.
- Have severe heart and lung
disease
- Weigh more than 350
pounds
There are 2 basic steps during
both kinds of gastric bypass:
- The first step makes your
stomach smaller. Your surgeon will use staples to divide your
stomach into a small upper section and a larger bottom section. The
top section of the stomach (called the pouch) is where the food you
eat will go. This pouch is about the size of a walnut. It holds
only about 1 ounce of food.
- The second step is the bypass.
Your surgeon will connect a part of your small intestine, called
the jejunum, to a small hole in your pouch. The jejunum is farther
down from where your stomach normally attaches to your small
intestine. Food you eat will now travel from the pouch into this
new opening into your small intestine. When food travels this way,
it bypasses the lower part of your stomach and the first part of
your small intestine. Because of this, your body will absorb fewer
calories.
This surgery takes about 4
hours.
This surgery may increase your
risk for gallstones. Your doctor may
recommend having a cholecystectomy
(surgery to remove your gallbladder) before your bypass
surgery.
Why the Procedure Is Performed
Weight-loss surgery may be an
option if you are very obese and have not been able to lose weight
through diet and exercise.
Gastric bypass surgery is not a
"quick fix" for obesity. You must be committed to diet and exercise
because you must continue dieting and exercising after the surgery.
You may have complications from the surgery if you don’t. One
problem some people have is throwing up if they eat more than their
new small stomach can hold.
People who have this surgery
should be mentally stable and not be dependent on alcohol or
illegal drugs.
This procedure may be recommended
for you if you have:
- A body mass index (BMI) of 40 or more. Someone
with a BMI of 40 or more is at least 100 pounds over their
recommended weight. A normal BMI is between 18.5 and
25.
- A BMI of 35 or more and a
serious medical condition that might improve with weight loss. Some
of these conditions are sleep apnea,
type 2 diabetes, and heart disease.
Risks
Gastric bypass is major surgery
and has many risks. Some of these risks are very serious. You
should discuss these with your surgeon.
The risk of the surgery itself or
for problems after surgery may be greater than normal if you
are:
- Unable to walk even short
distances. This increases your risk of blood clots, lung problems,
and pressure sores (also called bed sores).
- A child who is still
growing
- An adult older than 60 to 65
years
Risks for any anesthesia
are:
Risks for any surgery
are:
Risks or problems that may occur
during or soon after gastric bypass surgery are:
- Injury to the stomach,
intestines, or other organs during surgery
- Leaking through the staples in
the stomach after surgery. This may require an emergency
surgery.
- Depression
The risks or problems of
weight-loss surgery that may occur over time are:
- Breakdown of the pouch, which
would require another surgery to repair it
- The opening between your stomach
pouch and the small intestine may get narrower. This could require
another surgery.
- Anemia from low iron or vitamin B12
levels
- Low calcium levels, which can
cause early osteoporosis or other
bone disorders
- Gallstones and gallbladder
attacks, which occur more often when you lose weight
quickly.
- Gastritis (inflamed stomach lining),
heartburn, or stomach ulcers
- Poor nutrition
- Vomiting from eating more than
your stomach pouch can hold
- Dumping syndrome. This is when
the contents in your stomach move through your small intestine
quickly. This causes discomfort and poor nutrition.
- Incisional hernia, which is much
more common when an open procedure is done. An incisional hernia is
a bulging of tissue through the site of your incision.
- Kidney stones
Before the Procedure
Your surgeon will ask you to have
tests and visits with your other health care providers before you
have this surgery. Some of these are:
- A complete physical
exam
- Blood tests, ultrasound of your
gallbladder, and other tests to make sure you are healthy enough to
have surgery
- Visits with your doctor to make
sure other medical problems you may have, such as diabetes, high
blood pressure, and heart or lung problems, are under
control
- Nutritional
counseling
- Classes to help you learn what
happens during the surgery, what you should expect afterward, and
what risks or problems may occur afterward
- Visiting with a mental health
provider to make sure you are emotionally ready for major surgery.
You must be able to make major changes in your lifestyle after
surgery.
If you are a smoker, you should
stop smoking several weeks before surgery and not start smoking
again after surgery. Smoking slows recovery and increases the risks
of problems. Tell your doctor or nurse if you need help
quitting.
Always tell your doctor or
nurse:
- If you are or might be
pregnant
- What drugs, vitamins, herbs, and
other supplements you are taking, even ones you bought without a
prescription
During the week before your
surgery:
- You may be asked to stop taking
aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin),
and any other drugs that make it hard for your blood to
clot.
- Ask your doctor which drugs you
should still take on the day of your surgery.
- Prepare your home for after the
surgery
On the day of your
surgery:
- Do not eat or drink anything
after midnight the night before your surgery.
- Take the drugs your doctor told
you to take with a small sip of water.
- Your doctor or nurse will tell
you when to arrive at the hospital.
After the Procedure
Most people stay in the hospital
for 3 to 5 days after surgery. In the hospital you:
- Will be asked to sit on the side
of the bed and walk a little the same day you had
surgery
- May have a catheter (tube) that
goes through your nose into your stomach for 1 or 2 days. This tube
helps drain fluids from your belly.
- Will not be able to eat for the
first 1 to 3 days. After that you can have liquids, and then puréed
or soft foods after that.
- May have a catheter connected to
the larger part of your stomach that was bypassed. It will come out
of your side and will drain fluids.
- Will wear special stockings on
your legs to help prevent blood clots from forming.
- Will receive medicine through
shots to prevent blood clots
- Will receive pain medicine. You
will take pills for pain or receive pain medicine through an IV, a
catheter that goes directly into your veins.
You will be able to go home when
you:
- Can eat liquid or puréed food
without vomiting
- Can move around without a lot of
pain
- Do not need pain medicine
through an IV or given by shot
Outlook (Prognosis)
Most people lose about 10 to 20
pounds a month in the first year after surgery. Weight loss will
decrease over time, so sticking to your diet and exercise early on
will provide the largest weight loss. You may lose half or more of
your extra weight in the first 2 years. You will lose weight most
quickly just after surgery, when you are still on a liquid diet or
pureed diet.
Losing enough weight after
surgery can improve many medical conditions you might also have.
Conditions that may improve are asthma, type 2
diabetes, high blood pressure,
obstructive sleep apnea, high cholesterol, and gastroesophageal
disease (GERD).
Weighing less should also make it
much easier for you to move around and do your everyday
activities.
Bypass surgery alone is not a
solution for weight loss. It can train you to eat less, but you
still have to do much of the work. To lose weight and avoid
complications from the procedure, you will need to follow the
exercise and eating guidelines that your doctor and dietitian gave
you.
References
Buchwald H, Estok R, Fahrbach K,
Banel D, Sledge I. Trends in mortality in bariatric surgery: a
systematic review and meta-analysis. Surgery,
2007;142:621-632.
Leslie D, Kellogg TA, Ikramuddin
S. Bariatric surgery primer for the internist: keys to the surgical
consultation. Med Clin North Am.
2007;91:353-381.
Townsend Jr. CM, Beauchamp RD,
Evers BM, Mattox KL. Townsend: Sabiston Textbook of
Surgery. 18th ed. Philadelphia, Pa: Saunders; 2008.
Review Date: 2/12/2009
Reviewed By: Crystine Lee, MD, Department of Surgery, Marin General
Hospital, Greenbrae, CA. Review provided by VeriMed Healthcare
Network. Also reviewed by David Zieve, MD, MHA, Medical Director,
A.D.A.M., Inc.
The information provided herein should not be used during any
medical emergency or for the diagnosis or treatment of any medical
condition. A licensed medical professional should be consulted for
diagnosis and treatment of any and all medical conditions. Call 911
for all medical emergencies. Links to other sites are provided for
information only -- they do not constitute endorsements of those
other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the
information contained herein is strictly prohibited.
