Gastric bypass surgery
Gastric Bypass Review: In this review we look at the most popular kind, which is called "roux-en-Y gastric bypass" or "RGB," and biliopancreatic diversion, which is more extensive and complicated than RGB. It's best to consider all aspects of weight loss surgery, the positive and the negative, the advantages and the disadvantages.
So, is this an option that you should consider? Here we objectively review gastric bypass surgery for weight loss. This most popular form accounts for about 80% of all weight loss surgery in the United States. So, who is a suitable candidate? Does it work well for people who are overweight?
So, let's find out more.
The bypass procedure
The most popular kind of gastric bypass surgery, which is called "roux-en-Y gastric bypass" or "RGB," involves bypassing most of the stomach and dividing the stomach to create a small stomach pouch. These two parts are performed during the same surgery.
The new, small stomach pouch is created by dividing the stomach into a larger and a (much) smaller part. The smaller part is stapled or sewn together to make a small pouch that can only hold a cup or so of food.
With such a small stomach to restrict food intake, the patient will feel full very quickly and eat less. So patients are required to eat smaller meals more frequently (which is just what we recommend elsewhere on this website, without turning to surgery, for everyone who is serious about lasting weight loss).
The new, small stomach pouch is disconnected from the duodenum, which is the first part of the small intestine, and reconnected to the jejunum further down the small intestine.
After this procedure, food passes directly from the stomach pouch into the jejunum thus bypassing the normal route into the duodenum and then on to the jejunum. The effect of this bypass is to reduce the absorption of calories and nutrients from foods.
Obviously, this is serious surgery.
One-third of these surgeries are performed by making a large incision in the middle of the belly. Two-thirds of them are performed using instruments inserted through small incisions in the belly [laparoscopically], which results in fewer complications and a more rapid recovery time.
The other type of this surgery
"Biliopancreatic diversion gastric bypass surgery" is more extensive and complicated than RGB. Instead of connecting the small pouch that remains of the stomach to the jejunum, it is connected directly to the final segment of the small intestine, which bypasses both the duodenum and jejunum.
This results in weight loss, but it's not used as frequently as RGB because of its risk for nutritional deficiencies and because it's more complicated surgery.
In general, the more extensive the surgery, the greater the risk of complications.
In particular, the more extensive the bypass surgery, the greater the risk of nutritional deficiencies.
Nutritional deficiencies can cause health problems. For example, anemia is caused by too little absorption of vitamin B-12 and iron. Osteoporosis and metabolic bone disease can be caused by too little absorption of calcium.
So even apparently successful surgery of this type can cause problems. For example, rapid weight loss can cause gallstones. Furthermore, gastric bypass operations that move stomach contents too rapidly through the small intestine cause "dumping syndrome," which has a host of unpleasant symptoms.
It's not difficult to understand why anyone who undergoes biliopancreatic diversion gastric bypass surgery needs close monitoring throughout life as well as the use of special foods and medications.
Biliopancreatic diversion surgery accounts for only about 5% of all weight loss surgeries in the United States.
By definition, successful gastric bypass surgery results in a reduced absorption of nutrients such as iron and calcium. Regularly taking supplements and getting blood tests can reduce the risk of the decreased absorption itself causing health problems.
Advantages & benefits for those who are obese
There are two critical facts.
First, as we state elsewhere in this website, diets without exercise don't enable people to lose weight and keep the weight off. They don't work for overweight people, and they don't work for the obese or morbidly obese.
There are relatively few morbidly obese people who manage by their own efforts to achieve permanent weight loss, in other words, to drop a significant amount of weight and keep it off. Unfortunately, that happens only infrequently.
Second, on average, patients who undergo gastric bypass surgery lose 60% of their extra weight.
For example, a patient who weighed 400 pounds and was 200 pounds overweight could rationally expect to lose 120 pounds.
Though that patient would still be 80 pounds overweight, losing 120 pounds could make an enormous difference.
Physically, many health problems related to obesity, such as high blood pressure, asthma, sleep apnea, and diabetes, improve and sometimes even disappear.
Psychologically, most weight loss surgery patients report significant increases in the quality of their lives.
Even those who suffer from being severely overweight or obese tend to underestimate how much their condition impacts the quality of their lives.
Therefore, weight loss surgery can be a solution for people with serious problems. If you have a serious problem with your weight, we advise you to discuss it with the appropriate health care professionals and seek more than one opinion.
Suitable candidates for gastric bypass surgery?
We don't know. You will need expert advice. For more about the need to seek expert medical opinion in relation to weight loss surgery, see our liposuction review. You will find the link to that page at the bottom of this page.
This much is obvious: if you are healthy and only slightly overweight and if all you are trying to do is to avoid a comprehensive program of diet and exercise such as the one promoted on this website, weight loss surgery won't give you what you are seeking.
As we noted in the previous section, on average, it will not get your weight down to where it should be. The person in the example remained 80 pounds too heavy.
The only realistic option to remove the rest of the fat would be sticking for life to a comprehensive program of diet and exercise such as the free one promoted here at the lasting-weight-loss.com website.
What it means is that such a person should have realistic expectations. 10% of those who undergo weight loss surgery have complications, which are usually relatively minor such as bleeding, wound infections, digestive problems, and ulcers.
However, 1 to 5% have serious or life-threatening complications such as serious infections or bleeding, leaks in the surgical connections, blood clots, and heart attacks.
If you and your medical counselors decide in favor of the surgery, we suggest the following:
Ensure that it is performed at a center or hospital that does more than 100 weight loss surgeries per year and that the surgeon is highly experienced.
The disadvantages & risks
One potential risk is leakage of acidic stomach contents into the abdomen. The acids can dissolve other organs.
The new, small stomach pouch can stretch and, over time, return to being as big as it was before surgery.
The band that closes off the larger part of the stomach can erode. If it disintegrates, the stomach will return to the volume it had before surgery.
The band and staples fall apart, and the stomach returns to its former size.
The greatest risk is death. In one study of over 16,000 Medicare patients who had weight loss surgery during a recent five-year period, 4.6% died within one year of the surgery. In another study of non-Medicare patients, less than 1% died within one year of the surgery. Under the most favorable circumstances, the mortality risk is 1 in 200.
Three risk factors have been identified in this context: advanced age, being male, and lower volume of weight loss surgery done by the surgeon and medical center.
Furthermore, weight loss surgery is for people who are obese. In general, obese people have more health problems and more hospitalizations than people of normal weight. Poorer overall health is a risk factor for any surgery.
Despite these risks, this type of surgery is growing in popularity. There were over 177,000 weight loss surgeries in the United States in 2006.
Web pages to related to this page
To help you further, choose from the main menu or see the following pages of our website.
Our recommended books for this topic
This is a video of gastric bypass surgery being performed and narrated by a bariatric surgeon.
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