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Roux-en-Y Gastric Bypass


How does it work?

Gastric Bypass is an example of a combined restrictive and malabsorptive surgery. In addition to restricting food intake by constricting the stomach, this type of surgery also connects the stomach with a further segment of the small intestine than usual. The larger the bypass distance, the greater the effect of this portion of the combined surgery. However, the ability of body to absorb nutrients is progressively diminished.

The success rate of a gastric bypass surgery is typically greater than with other bariatric surgery options. However, the surgery is relatively invasive, encompassing a dual phase of compartmentalizing the stomach and establishing a direct connection from the resulting artificial pouch in the upper end of the stomach to the lower intestine.

As with other restrictive surgeries, the success rate of Laparoscopic Gastric Banding is roughly 80% in accomplishing weight loss, and roughly 30% in accomplishing weight loss to the extent of reaching a normal weight category. Note, however, that as a result of this surgery, the risk of complications run as high as 10%.

The nature of this surgery requires a lifetime commitment to certain nutritional supplements and ongoing monitoring by physicians to ensure proper nutritional balance.

Benefits

  • Reduces stomach capacity and the associated food intake volume by over 90%.
  • Provides a feeling of contented fullness with just a token amount of food.

Risks

  • The mortality rate for this operation is 0.5%, that is 1 in 200 patients may die as a result. This figure, according to some researches may be actually as high as 2%, or 1 in 50.
  • Infections may occur in the surgical incisions as a result of bowel bacteria contamination. Infections of the surrounding organs are also a realistic possibility.
  • Various other complications may result due to the reconfiguration of the stomach in relation to the small intestine: hernias, bowel obstruction, etc.
  • In case the small intestine does not properly fuse to the stomach post-operation, leakage of fluid from the gastrointestinal tract may occur, resulting in infections and other complications. This occurs in as many as 2% of all operations.
  • The nature of the operation leads to the "Dumping Syndrome" in some people. This is a condition where food travels too quickly through the lower intestine, causing discomfort and a variety of possible side-effects.
  • The bypass upsets the natural process of nutritional absorption, requiring a strict regiment of supplement intake to prevent the effects of malnutrition.

What do experts say about the surgery?

The directory of bariatric surgery at Duke University, Eric DeMaria, M.D, states: "Currently, there is no clinically useful system to help determine which patients would be at highest risk of dying after gastric bypass surgery." DeMaria states that in a research conducted at Duke, "The researchers found that 31 of patients (1.5 percent) died within 90 days of surgery."

In spite of this, DeMaria is confident that the mortality is not a direct result of the surgery but of the general health condition of the people who underwent the procedure. "Our findings show that for the low-risk group of patients, gastric bypass surgery is a very safe option. For those patients in the highest risk category, we should look at performing lower-risk or a number of smaller procedures to reduce the potential risk."

Less optimistically, the lead author of a separate study at the University of Cleveland, Elmar Merkle, M.D, states that: "This should not be considered a cosmetic procedure. People need to be aware of the potential complications of this surgery. It basically should be the last option we can offer the morbidly obese, after other less invasive interventions such as diet and exercise have been tried."

Cost

Approximately $20,000 to $35,000.

Sources

  • American Obesity Association. AOA Advisor: Obesity Surgery. Retrieved Nov 4, 2006
    from http://www.obesity.org/education/advisor.shtml
  • DukeMedNews. New Scoring System Predicts Gastric Bypass Surgery Risk. Retrieved Nov 4, 2006
    from http://www.dukemednews.duke.edu/news/article.php?id=9768
  • Innovations Report. Gastric bypass surgery is riskiest for those who need it most. Dec 12, 2003. Retrieved Nov 4, 2006
    from http://www.innovations-report.de/html/berichte/medizin_gesundheit/bericht-23832.html
  • Wikipedia. Gastric bypass surgery. Retrieved Nov 4, 2006
    from http://en.wikipedia.org/wiki/Gastric_bypass_surgery

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