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Health Update: Gastric Bypass Surgery

Health Update: Gastric Bypass Surgery

Gastric bypass and other weight-loss surgeries create changes to your digestive system to assist you to lose weight by limiting how much you can eat or by reducing the absorption of nutrients, or both. Gastric bypass and other weight-loss surgeries are performed when diet and exercise haven't worked or when you have serious health problems because of your weight.

There are many types of weight-loss surgeries, referred to collectively as bariatric surgery. Gastric bypass is one of the most common types of bariatric surgery in the United States. Many surgeons prefer gastric bypass surgery because it generally has fewer complications than do other weight-loss surgeries. Nonetheless, all forms of weight-loss surgery, including gastric bypass, are major procedures that can pose serious risks and side effects. Also, you must make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of bariatric surgery.

Types of Gastric Bypass Surgery

  • Roux-en-Y gastric bypass (RGB): This operation is the most common gastric bypass surgery performed in the U.S. Initially, a small stomach pouch is created by stapling part of the stomach together or by vertical banding. This limits how much food you can eat. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum as well as the first portion of the jejunum. This causes reduced calorie and nutrient absorption. This procedure can now be done with a laparoscope in some people. This involves using small incisions and generally has a more rapid recovery time.
  • Extensive gastric bypass (biliopancreatic diversion): In this more complicated gastric bypass operation, the lower portion of the stomach is removed. The small pouch that remains is connected directly to the final segment of the small intestine, consequently completely bypassing both the duodenum and jejunum. Although this procedure effectively promotes weight loss, it is not as commonly used because of the high risk for nutritional deficiencies.

Gastric bypass surgery that causes malabsorption and restricts food intake produces more weight loss than restriction operations like gastric banding, which only decrease food intake. People who have bypass surgery generally lose two-thirds of their excess weight within two years.

In general, gastric bypass and other weight-loss surgeries could be an option for you if:

  • Your body mass index (BMI) is 40 or higher (extreme obesity).
  • Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea. In some instances, you may be eligible for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.

Keep in mind that gastric bypass isn't for everyone who is severely overweight. You may need to meet certain medical guidelines to qualify for weight-loss surgery. You likely will have to go through extensive screening procedures to see if you qualify. The process also encompasses making permanent changes that lead to a healthier lifestyle. You may be required to participate in long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and your medical conditions.

Risks of Gastric Bypass Surgery

People who undergo gastric bypass surgery are at risk for:

  • Pouch stretching (stomach gets bigger overtime, stretching back to its original size).
  • Band erosion (the band closing off part of the stomach disintegrates).
  • Breakdown of staple lines (band and staples fall apart, reversing the procedure).
  • Leakage of stomach contents into the abdomen (this is dangerous because the acid can eat away other organs).
  • Nutritional deficiencies causing health problems.

Gastric bypass surgery also may produce "dumping syndrome," whereby stomach contents move too quickly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming extremely weak. Gallstones can occur as a reaction to rapid weight loss. They can be dissolved with medication taken after the surgery.

Conditions related to nutritional deficiencies can include anemia secondary to the limited absorption of vitamin B-12 and iron, as well as osteoporosis and metabolic bone disease due to the lack of calcium absorption. People who undergo this procedure are required to take nutritional supplements that usually prevent these deficiencies.

The more extensive the gastric bypass surgery, the greater the risk for complications and nutritional deficiencies. Those who undergo extensive bypasses of the normal digestive process require not only careful monitoring, but also may necessitate the lifelong use of special foods and medications.