Surgical Procedures for Gastric Bypass

Morbid obesity is a complex, medical disease, which affects more than nine million people in the United States. It is not a moral problem due to a lack of will power. Studies have shown that diets, medications, behavioral modification or exercise programs have a 95% failure rate in this population, due to underlying physiologic, chemical and genetic factors.

Morbidly obese patients have a very high risk of associated health problems and early death; therefore the National Institutes of Health (NIH) (http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_b.pdf) has endorsed these two procedures as effective in the treatment of obesity: Vertical Banded Gastroplasty (VBG) and Roux-en-Y Gastric Bypass (RYGB). Either of these operations, depending on the circumstances, can be accomplished by an open or Laparoscopic technique.

Surgery is an aid to dieting and assists individuals in altering their eating habits by restricting food intake or limiting absorption of ingested food. These procedures assist a patient in reducing food and caloric intake. Each procedure is associated with medical risks and vary in the anticipated chance of success in losing weight.

Vertical Banded Gastroplasty (VBG)

	Average weight loss with the Gastric Bypass is approximately 70% of the excess weight.

The Vertical Banded Gastroplasty (VBG) and Lap VBG limit food intake by creating a small pouch in the upper stomach with a narrow outlet reinforced by a mesh band to prevent stretching. The pouch fills quickly and empties slowly with solid food, producing a feeling of fullness. Overeating results in pain or vomiting. This restricts food intake. This is the simpler of the two operations, with a generally lower risk of complication's and shorter hospital stay. Unfortunately, this operation does not produce as much weight loss as the Gastric Bypass, there tends to be a late weight gain and a common problem is vomiting because food does not pass easily through this small opening and therefore backs up. In addition, it has been found that another possible complication is a disruption or opening up of the staple line, so that food empties into the main stomach without passing through the banded opening.

Roux-en-Y Gastric Bypass (RYGB)

Roux-en-Y Gastric Bypass (RYGB) is a more complex operation, to provide more consistent and successful weight loss. The small upper pouch is completely separated from the distal stomach which is left in place. A "Y" shaped segment of small bowel is attached to the pouch with a narrow opening. This bypasses the mixing of food and digestive juices from the distal stomach resulting in poorer absorption of calories and nutrients. This both restricts food intake and interferes with absorption resulting in more consistent weight loss, but has a higher risk of complications or side effects. 80% of patients lose at least half their excess weight with the RYGB procedure.

The laparoscopic RYGB averages a 3-4 day hospitalization with a return to full activity in 7-10 days. A liquid and soft diet high in protein is suggested for 4 weeks after surgery, then the patient is placed on a solid diet.

The Laparoscopic Approach to Obesity Surgery

Laparoscopic operations are performed through several small incisions with the aide of a fiber optic video camera and special instruments which can reduce the trauma and discomfort associated with a long open incision. Hospitalization, post-op pain, and recovery time is usually reduced compared to traditional surgery. Laparoscopic obesity operations have only been performed since 1993. Therefore the American Society of Bariatric Surgeons (http://www.surgicalteam.com) recommends choosing a surgeon who is experienced in both laproscopic and open bariatric operations, and who understands the complexities of surgical treatment of obesity.

You should be aware that any surgery may have complications, and this is major surgery. Specific complications will be discussed further with you, but it is possible that death may result and the risk of death is approximately 1 in 300. You should therefore carefully weigh the benefits versus the risks. You should consider whether you have any alternative way to lose weight. Usually, if you are 100 lbs or more overweight, it is impossible to lose weight and keep it off by any means. If you do not have surgery you will probably continue to gain weight and develop other complications of obesity, which may seriously affect your health and may shorten your life. The decision to undergo the surgery should not be taken lightly as it is intended to be permanent and for life. The changes which it can produce in your life are generally very positive, but you should fully consider all the implications.

You should be aware that certain medications may cause bleeding during surgery and should not be taken after surgery, because they may cause ulcers. These medications, if taken, should be stopped at least 2 weeks before surgery. They are Aspirin, Motrin (Ibuprofen), Aleve and any other non-steroidal anti-inflammatory drugs such as Indocin, Clinoril, Naprosyn, and many others.

In addition, Cortisone, Hydro-Cortisone, Prednisone and other Steroids also interfere with healing. Tylenol and prescription drugs such as Darvocet are safe to take for pain relief. Please discuss any other medications you may be taking with your physician prior to surgery.

For more information on the BAPTIST HEALTH program for Gastric Bypass, call (501) 202-2121.