The gastric bypass procedure is a type of bariatric surgery or weight loss surgery designed to reduce your food intake if you have tried and failed to lose weight through diet and exercise. Gastric bypass can greatly improve the quality of life not only because of an improvement in appearance and an increase in mobility, but also because it can reduce the number and severity of health problems that overweight people are prone to suffer, such as diabetes and heart/circulation problems.
It is a complex procedure performed under general anesthesia — you sleep through it. Time in surgery is approximately one to four hours, followed by a one- to seven-day stay in the hospital. Currently, two techniques are available for gastric bypass:
(Another form of weight loss surgery that does not involve a bypass is Lap-Band surgery.)
The Roux-en-Y bypass is more common and considered less complicated than the biliopancreatic diversion bypass, since Roux-en-Y does not remove portions of the stomach.
The traditional Roux-en-Y-gastric bypass is performed through open surgery with one long incision. The Roux-en-Y gastric bypass can also be performed laparoscopically. The laparoscopic Roux-en-Y-gastric bypass uses multiple smaller incisions (instead of one long incision) — a laparoscopic tool is inserted, which offers a visual guide to the inside of the abdomen during the procedure. The laparoscopic Roux-en-Y produces less scarring and lets you recover faster than the traditional Roux-en-Y-gastric bypass. But the laparoscopic approach is still new, so long-term results have not been fully evaluated.
The biliopancreatic diversion bypass is performed through open surgery with one long incision, leaving a permanent scar. It is less common and more complicated than the Roux-en-Y-gastric bypass. In the biliopancreatic diversion, portions of the stomach are removed and the bypass is attached to the distal illium. This procedure is not widely used, because there is more risk of nutritional deficiencies.
In both techniques, a small stomach pouch is created, to curb food intake, by stapling a portion of the stomach. Then, a Y-shaped part of the small intestine is attached to the stomach pouch so that food can bypass the duodenum, as the bypass extends to the initial portion of the jejunum. The bypasses of the small intestine are formed to decrease the absorption of food nutrients. These techniques significantly restrict food intake and reduce hunger to promote healthy weight loss. The majority of the weight loss is evident within one year and is usually completed by the end of the second year.
As with any surgical procedure, there are known risks. Besides the standard risks of most procedures, including bleeding and infection, there are complications specific to Lap-Band surgery. Slippage of the band can occur as you lose weight and the stomach goes above the band, causing heartburn or vomiting. This can usually be fixed laparoscopically. Rarely, the band may erode into the inside of the stomach.
Laparoscopic surgery is not always possible. Your surgeon may need to use an "open" method. This happened in about 5% of the cases in the U.S. clinical study. Other problems can occur that are directly related to the Lap-Band System:
Using a qualified surgeon will be critical to your success as a Lap-Band patient. Not only will this reduce your risk of complications, but also it will ensure that you lose as much weight as you can. Be sure to verify the number of procedures your surgeon has done, and find out about his office support for Lap-Band patients.
After gastric bypass surgery, many patients spend two to three days in the hospital, or one to two days for the laparoscopic procedure. On average, most people require two to five weeks of recovery before returning to normal activities. For a number of days, the abdomen will be swollen and sore, and the patient often feels discomfort. Your doctor can prescribe medications to help you manage the discomfort.
All the techniques will leave a permanent scar, but scarring is normally covered by clothing.
Aftercare treatments typically include a dietary plan, regular exercise, behavioral-modification therapy, and vitamin supplements. Your weight loss surgeon or plastic surgeon might require the use of a dietician, an exercise program, and possibly a psychologist for an extended period of time to assist you in your recovery.
Injecting saline into the port inflates the band, making the passage to the lower part of the stomach smaller, which further restricts food intake. Fluid can easily be removed in the doctor's office if it is too tight.
Following surgery, you should be able to return to work within a week, with minimal discomfort. You will need to follow a nutrition plan (which may include vitamin supplements) prescribed by your surgeon and/or nutritionist. The nutrition plan will likely include a liquid diet for a few weeks, until you can tolerate soft foods, and later solid foods. A specific exercise program, as well as behavioral-modification therapy, may also be recommended.
Frequent office visits are mandatory to adjust the band. Your surgeon or his assistant will be able to inject the port in the office. On average, patients require six to eight adjustments of the band during the first 18 months following Lap-Band surgery.
Patients typically lose 50% to 60% of their excess body weight within two years after the procedure. Additional plastic surgery may be indicated, depending on how much weight is lost.