Gastric Bypass

About the Procedure

Gastric Bypass Surgery is performed to treat morbid obesity by creating a pouch from the original stomach and attaching it directly into the small bowel. Laparoscopic Gastric Bypass using the Roux-en-Y method is the most popular bariatric surgery performed each year. This procedure is done only after all other treatments have been tried and were unsuccessful. Obesity contributes to or causes other diseases, such as diabetes, high blood pressure, high cholesterol, sleep apnea, and gastrointestinal disorders. Successful weight loss through gastric bypass has been shown to significantly reduce obesity-related health problems, e.g., high blood pressure, high cholesterol, sleep apnea, diabetes, gastrointestinal disorders, within months and to improve life expectancy by nearly 40%. Gastric bypass surgery is considered to be one of the most difficult procedures to perform but, because of the improvement in length of hospital stay, lessened discomfort, a shorter recovery, and fewer scars, the popularity of this operation has greatly increased. Several options exist for this treatment but the "gold standard" for both open and minimally-invasive procedures is the Roux-en-Y.

A general surgeon trained in bariatric surgery and laparoscopic techniques performs this procedure in a hospital while the patient is under general anesthesia. The patient's abdomen is opened up with gas to assist the doctor; a tube with a balloon is inserted through the mouth into the stomach. The balloon is blown up to occupy the space equal to one tablespoon which is the amount of food the "new" stomach will hold. The stomach is separated into two sections - one is the size of the balloon, the second is the remaining area. With the small pouch now serving as the stomach, the remaining part no longer receives food but continues to have a blood supply and produce gastric juices which pass to the small intestines as previously done. Below the larger section, the small intestines is cut and attached to the pouch, by-passing the remaining section of stomach. The piece of the intestines still extending from the remaining stomach is re-attached to the intestines further along the tract and it looks like the letter "Y". A circular exit is created in the stomach pouch and it is joined with the upper end of the bowel (the Roux limb). At the completion of this bypass procedure, the pouch is tested by inflating it with air, running water over the stapled connection, and looking for air bubbles to escape. A tube is put in the new stomach to drain fluid. The procedure takes between two and three hours.

What to Know Before the Procedure

There are many risks associated with gastric bypass surgery. Some immediate post-operative complications are: abscesses caused by infected pockets of fluid in the abdomen, bleeding, leakage from the newly created stapled connections, bowel obstruction, injury to the stomach, intestines, and nearby organs, and depression. Complications which develop months and years after the surgery include: adhesions capturing part of the bowel causing an obstruction; scar tissue blocking the passage of food between the pouch and Roux; and gastrointestinal issues and nutritional deficiencies as a result of quick weight loss.

The most significant positive effect of gastric bypass surgery was shown in a clinical study where over 95% of patients showed outstanding improvements in high blood pressure, high cholesterol, diabetes, asthma, respiratory insufficiency, sleep apnea, and GERD, among others.

What to Know After the Procedure

Patients are moved to a recovery area for observation and will remain hospitalized for three to five days. Eating is introduced very slowly over a period of days until food is well tolerated. Having bypass surgery is not a fix-all for obesity. A lifetime commitment to exercise and a special diet are required.

If you Need to Travel Outside of your Local Hospital

Knowing the risks involved in this surgical procedure and being prepared in the event one or more of them should occur; having the support of family or friends; and feeling the surgeon has the skills and concern for the patient's health and well-being should be the primary concerns when having this procedure performed. Since many patients experience post-operative depression, finding themselves in an unfamiliar environment may exacerbate it. For those who are already prone to depression a quick return trip may help with this concern and may be a consideration in the decision about potential locations. If the decision is made to have this procedure performed abroad, be sure to speak with your doctor about surgical risks and complications as well as post-operative care and recovery. This may highly influence the amount of time necessary for your time away from home.