What is Gastric Bypass?
The Roux-en-Y gastric bypass procedure is generally considered to be the best surgical procedure for patients with very high BMIs. With this procedure, 75% of patients are expected to lose 75 - 80% of their excess body weight. As weight decreases and lifestyle habits improve, most patients realize drastic improvement in other areas of their health as well, including hypertension, diabetes, heart disease and more.

The Procedure
Gastric bypass helps patients achieve weight loss using both restriction and malabsorption.

Restriction: The surgeon sections off a portion of the stomach to create a small pouch about the size of a golf ball and creates a stoma, which is a small opening between the stomach and intestine. The small size of the stomach allows the patient to feel full after eating only a small amount of food. The stoma delays the emptying of the stomach, allowing the patient to feel fuller longer.

Malabsorption: A portion of the small intestine is divided and attached to the newly created stomach pouch, creating the Roux limb. This Roux limb "bypasses" the original stomach and longer portion of the small intestine. Since calories are absorbed in the small intestine, bypassing a lengthy portion of it means the patient's body absorbs fewer calories.

How the procedure is performed depends on each individual patient's anatomy, general health status, prior surgeries and overall goals. For instance, it can be performed as standard open surgery or laparoscopic surgery; the stomach compartments can be completely divided or simply partitioned off; the new stomach pouch and intestinal limbs may be connected to each other with either staples or sutures; the two intestinal limbs can be made longer or shorter. The procedure is not reversible.

 

What to Expect After the Procedure
Most patients lose weight quickly after surgery and continue to lose for 18 - 24 months. Although most ultimately regain 5 - 10% of the weight they have lost, many maintain a long-term weight loss of about 100 pounds.

THE FIRST FEW WEEKS
For the first few days after surgery patients will be on a liquid diet. They progress to a pureed diet, with softened food that can pass easily through the newly formed pouch. During this period dehydration can occur, so it is important to drink plenty of fluids; patients will be required to drink 32 ounces of liquid a day before being released.

ONE TO SIX MONTHS FOLLOWING SURGERY
At this stage patients progress to a transitional diet and begin to take in more regular table food. They learn eating techniques such as chewing food carefully, drinking between rather than with meals, and avoiding the foods (such as fatty and sweet foods) that can make them sick. Patients experience the most rapid weight loss at this stage, sometimes as much as 20 pounds per month. However, eating too much or too fast can cause low energy or an uncomfortable feeling. Diarrhea may occur, but this can be controlled by avoiding certain foods or by taking medication. If hair loss occurs, it typically begins to grow back within a few months.

SIX MONTHS FOLLOWING SURGERY
At this point most patients are on a long-term maintenance diet, which is how they should eat for the rest of their lives. The diet consists of regular table foods, but in small portions. In general, patients become comfortable eating these small meals and often say that successfully controlling their weight more than compensates for the enjoyment of eating a large meal.

LONG TERM
Patients may expect to lose approximately 70% of their excess body weight during the first 18 months following surgery. Some patients regain about 10% of their weight between years two and five, perhaps because the size of the stomach pouch increases or because they learn how to take in extra calories without becoming sick. Keeping medical appointments and engaging in support groups can help control this weight gain. In addition, because gastric bypass patients take in and absorb less food, vitamin, mineral and/or protein supplements can help prevent nutritional deficiencies.

Risks and Benefits of Gastric Bypass
The benefits of gastric bypass far outweigh the risks. However, it should be considered only after you have tried unsuccessfully to lose weight on diet and exercise programs and are not likely to be successful without surgical intervention.

Once you and your physician have decided on surgery, you should ask questions, understand your role in the procedure, recognize that surgery has its limitations and commit yourself to a long-term follow-up program in order to maximize your results.  It is also important to understand that the higher your Body Mass Index (BMI) and/or age, the greater your risk and that reactions to the stress of surgery and drugs used can be unpredictable.  Before surgery, you will be asked to sign a Consent Form stating you understand the risks involved.

Benefits of Gastric Bypass	Risks of Gastric Bypass
Reduced risk of shortened lifespan due to morbid obesity Improved ability to engage in physical activity Increased ability to maintain weight loss Increased self esteem and sense of well-being Improved quality of life Improvement in conditions related to morbid obesity, including: Hypertension (70 – 80% of patients will be off medications) Type-2 diabetes (over 90% of patients with type II non-insulin dependent diabetes will be off medications) 2 Glucose intolerance Sleep apnea Asthma Joint pain Arthritis Reflux Fatigue Shortness of breath	Standard risk of surgery (bleeding, infection, adverse risk of anesthesia) Staple leakage or separation requiring minor revision surgery Nutritional, vitamin or mineral deficiency due to decreased absorption Follow-up surgeries to correct complications or to remove excess skin (less likely if original surgery is performed laparoscopically) Gallstones due to significant weight loss in a short period of time Gastritis (inflammation of the lining of the stomach) Vomiting from eating more than the stomach pouch can hold Iron or vitamin B12 deficiencies that can lead to anemia Calcium deficiency that can contribute to early onset of osteoporosis or other bone disorder “Dumping Syndrome” 3
1Statistics show that approximately 1 in 300 die from gastric bypass surgery. 2In one study, blood sugar levels in 83% of obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had lived with diabetes for a long time. 3An intolerance to sugars, fats and some carbohydrates frequently developed after gastric bypass. Patients may experience nausea, flashing and sweating, light-headedness and watery diarrhea. These risks can be significantly reduced by following your dietitian's guidelines very carefully, especially during the first two months after surgery.

Disclaimer: As with any surgery, there are certain risks and complications associated with these procedures. Please talk to your doctor about your individual risk and candidacy for bariatric surgery.

Maximizing Your Outcome
Gastric bypass is not a magic bullet. It is a tool for weight loss and maintenance, but the overall results are up to you. Committing to a follow-up program is key, and we'll be with you every step of the way with tools and resources to help you maximize your success.