Gastric bypass procedures are the most commonly performed types of bariatric surgery, accounting for nearly 80 percent of all such procedures. It is intended for morbidly obese patients who have not found success at weight loss through diet and exercise alone. This procedure is performed to decrease stomach size as well as the length of the small intestine. This approach is known as both a malabsorptive and a restrictive method of bariatric surgery because it both restricts the amount of food that can be eaten and limits the absorption of this food in the intestine.
Are You a Candidate?
You may be a good candidate if you are at least 80 to 100 pounds overweight and have tried dieting and exercising without successfully losing weight. Most candidates for gastric bypass surgery have a body mass index (BMI) of at least 35 to 40. In order to undergo this procedure, patients must also be willing to commit to diet and lifestyle changes both before and after surgery.
Gastric Bypass Procedure
Gastric bypass surgery is either performed through a lengthy incision in the abdomen (a technique known as open surgery) or through a smaller incision aided by a camera and specialized surgical instruments (known as laparoscopic surgery). It requires general anesthesia and between three to five hours depending on the surgeon and the particular surgical technique being performed.
Laparoscopic Roux-en-Y Gastric Bypass
The gastric bypass procedure for weight loss involves several steps. Initially, the size of the stomach is reduced by dividing it with gastric staples. Doing this creates a small stomach or gastric pouch (called a “gastrojejunostomy”) at the upper part of the stomach. Next the small intestine is divided into two parts – the Roux limb and the biliopancreatic limb. The Roux limb is brought up and connected to the newly created pouch so the pouch can empty food contents into the bowel. The end result of the altered digestive tract is that the lower stomach and part of the small intestine is bypassed. “Roux-en-Y” refers to the Y-shaped appearance of the altered small intestine after the bypass is performed.
Open Gastric Bypass Roux-en-Y
With the Roux-en-Y gastric bypass procedure, traditional surgical methods are utilized rather than the newer, laparoscope-assisted (or minimally invasive surgery) methods, which involve smaller incisions and the use of a camera and video monitor. It is important to understand that newer does not mean better for every patient. The decision for open versus laparoscopic gastric bypass surgery is oftentimes made between the patient and the surgeon after thorough explanation and careful consideration. Each method has its own benefits and risks. Some patients may be offered the open gastric bypass surgery due to a high BMI or because of previous abdominal surgery.
Surgical alterations and results of laparoscopic and open gastric bypass surgery are basically the same, only the access to the inside of the body is different. The stomach size is reduced and the small intestine is divided and re-routed the same in both operations. The result is that the lower stomach and part of the small intestine is bypassed. Roux-en-Y” refers to the Y-shaped appearance of the altered small intestine after the bypass is performed.
Extensive Gastric Bypass (Biliopancreatic diversion)
In some cases a bariatric surgeon may suggest an open BPD instead of a laparoscopic procedure for obesity patients. This typically depends on the patient’s BMI and co-morbidities. Additionally, a larger incision might be necessary if a laparoscopic BPD cannot be accomplished using small incisions. BPD or biliopancreatic diversion is also known as the Scopinaro procedure. This is a malabsorptive procedure that involves removal of the lower part of the stomach and attachment of the intestine directly to the stomach. A large portion of the small intestine is re-routed as well. During this operation, a larger part of the stomach is removed than in the BPD-DS procedure, and calorie and nutrient absorption is more dramatically curtailed. Weight loss initially occurs primarily because the patient is eating smaller quantities of food. Long-term weight loss is maintained because all the calories are not fully absorbed. Weight loss is up to 8o% of excess weight lost 10 years after surgery. Although, this weight loss is accompanied by a much greater risk of malnutrition and loose, fatty stools.
The cost of your procedure will depend on which of the above methods is used. Your surgeon will discuss both options with you during your consultation and determine which is the right one for you.
The risks of surgery must be weighed against the known health risks of obesity. Patients who undergo surgery often find that the procedure has a positive effect on a range of medical conditions associated with obesity, such as heart disease and diabetes. However, the procedure can also come with negative health effects such as infection, ulcers, stomach perforations, and gallstones. After surgery, meals high in sugar or fat may cause ‘dumping,’ the symptoms of which include diarrhea and abdominal cramps. If the necessary nutritional supplements are not taken after surgery, malnutrition or nutritional deficiencies can occur.
- Gastric bypass is described as the “gold standard” for weight loss surgery.
- After two years, average weight loss is documented to be around 70-80% of excess weight.
- Hypertension and diabetes can be improved
- Dumping can occur with foods high in fat and sugar which can help modify eating behavior
- Leaks can occur in the areas where the surgeon has cut the bowel.
- Fluid can drain from the incision, known as a seroma. Wound infection is also a possibility.
- Vitamin/mineral and iron deficiencies can occur.
- Without attention to new eating behaviors and exercise, after 12-18 months, 10-30% of the weight lost can be regained.
- Hernia can occur around the incision.
Most patients spend one to three nights in the hospital following gastric bypass surgery. Patients can then expect about six to eight weeks for a full recovery, although many are able to return to work after about two to three weeks. After surgery, patients must make significant lifestyle changes. This is particularly true with regards to food because the stomach can only hold a few ounces so patients must commit to eating small meals that are low in sugar and fat. In addition, they must take daily dietary supplements to replace nutrients no longer absorbed by the intestine.
Over time, patients can expect to lose about 50 to 80 percent of their excess weight depending on their starting weight and commitment to the lifestyle changes necessary for weight loss.
What’s the Cost?
The average cost for gastric bypass surgery is about $18,000 to $30,000. The cost depends on the specific technique chosen and the surgeon performing the procedure among other variables. Part or all of the procedure may be covered by health insurance. In order to qualify for insurance coverage, you may need to submit medical tests or a letter from your doctor attesting to the medical necessity of the surgery.