It is one of the most commonly performed surgical procedures to combat morbid obesity. Patients with a body mass index (BMI) of 35 or higher (typically those who are 80-100 pounds over the average body weight to height ratio) have lost weight and kept it off after undergoing this procedure.
Benefits of gastric bypass weight loss surgery include:
- Loss of 75 percent or more excess body weight on average
- Resolution of medical problems such as Diabetes, High Blood Pressure, High Cholesterol, Obstructive Sleep Apnea, and improvement or resolution of many other health conditions.
- Less stress to the lower back and joints
- Ability to find and wear better-fitting clothes
- Increased self-esteem
- Overall healthier lifestyle
The Roux-en-Y Gastric Bypass works in several ways.
Restriction – Eat less
Malabsorption – Absorb less
Metabolic – decreased hunger, decreased storage of calories as fat
Restriction comes in the form of not being able to eat very much food due to the small size of the pouch that is created. Malabsorption occurs as the gut is not able to entirely absorb even the small amount of food you have eaten. The Roux-en-Y gastric bypass works by re-routing, re-connecting, or re-wiring your intestines, so that your new stomach is only about the size of your thumb and holds only 1 to 2 tablespoons of food. This may sound concerning, but indeed this surgery has proven to be very safe and effective. This surgery is also a metabolic surgery that recalibrates the neuro-hormonal pathways that your body uses to regulate weight and distribution of energy.After surgery, you will need to re-learn how to eat so that you eat very small portions. We teach you to incorporate high protein and nutrient-rich foods into your meals, such as lean meats and vegetables. While a patient might initially only be able to eat a couple of tablespoons of food, at one year postoperatively, patients are eventually able to consume a meal comparable to a “child size portion” or about the size of the palm of your hand (not including the fingers). This small portion will leave you feeling satisfied and without feeling residual hunger. Your gastric pouch empties into the small intestine, where the food then mixes with bile and other enzymes. Beyond this point, digestion is normal. Because food can only be absorbed once it is converted to a liquid form, there is a dramatic reduction in the absorption of food that is consumed. Despite what you may have heard, you can expect the absorption of medications to be normal, and most patients do not need to adjust their current dosages to accommodate for the malabsorption. It is, however, very important to take a multi-vitamin every day for the rest of your life, in addition to extra supplementation of Vitamin B-12, Calcium Citrate, Vitamin D, and Iron. This is of critical importance since the main areas involved in absorption of these micronutrients and minerals (calcium, folic acid, vitamin B 12, and iron) are the stomach and duodenum (small intestine) which are essentially no longer being exposed to the food that is consumed.
One of the advantages of the bypass is that patients lose more weight than with some of the other bariatric operations. In addition, the weight loss is rapid. You can expect your maximum weight loss to be achieved in about 18 months, and you can expect to lose approximately 70% of your excess weight. What does this mean? If you are a male and you currently weigh 300 pounds and are 5 feet 8 inches tall, your BMI would be 45.6. By calculating, you can see that you are 132 lbs over your ideal body weight. In other words, 300 – 168 = 132 pounds. With a gastric bypass, you can expect to lose 70% of those 168 pounds, around 92-95 pounds.
One can see that initially weight loss with a gastric bypass is very rapid. Somewhere about 18-24 months you will completely stop losing weight and actually you will gain a small amount of weight back. The reason that this is important to know is that many times patients get scared or concerned about how fast they are initially losing weight with a gastric bypass. Patients sometimes feel that they have lost too much weight. Gastric bypass can have dramatic impacts, beyond weight loss itself, which can significantly improve the status of certain medical conditions. Reflux, heartburn, and diabetes are profoundly improved and even cured in most cases after gastric bypass. This is most evident in the fact that diabetic patients who are on medications are often able to be discharged no longer requiring medication to control their blood sugar and this occurs long before the patient has had any significant weight loss.
Because the Gastric Bypass Surgery is a technically challenging operation, there are some increased risks as compared to the adjustable gastric banding, or sleeve gastrectomy. There is approximately 0.5% risk of leaking from one of your two new connections. We do everything we can in the operating room to prevent these leaks from happening. However, even when everything goes as planned, patients can develop complications. There is also a small risk of ulcers at your top connection which is called your gastrojejunostomy. For this reason, we stress that you NOT take any non-steroidal anti inflammatory drugs such as Aspirin, Ibuprofen, or Motrin – as these medications can create ulcers. It is important to check with a physician prior to taking any medications, even over the counter meds.
Although not truly a risk, “Dumping Syndrome” is a fairly common complication/side effect after having a Gastric Bypass. Up to 85% of patients will be able to feel a dumping syndrome after gastric bypass surgery. Symptoms of “dumping” can include a very unpleasant sensation of a rapid heart rate, nausea, vomiting, abdominal pain, and sometimes diarrhea. Dumping Syndrome usually occurs when a patient eats foods that are high in sugar, particularly refined sugar. This occurs because the intestines are not used to seeing this sugar so early in the digestive process without at least being partially digested. The intestines can react aggressively for the first year after surgery. Although “dumping” is generally felt to be quite unpleasant, for many patients it is considered to be an advantage as it helps them to modify their eating behaviors. It is important to know that you can “dump” from anything that has sugar, even over-ripe fruit! Often times, there are hidden sugars in food like Chinese food or sauces that can also cause unexpected “dumping”. See our dietitian to help prevent dumping syndrome from occurring.