Gastric Bypass Surgery is a bariatric (a branch of medicine that deals with the causes, prevention, and treatment of obesity) surgery intended to help morbidly obese patients lose weight. Simply, it is a procedure where the stomach and small intestine are separated, the stomach is reduced into a small pouch, and then the intestine and stomach are reconnected at a new site in the small intestine bypassing most of the large intestine where much nutrient absorption occurs. It is a combination of the restrictive and malabsorptive surgery. The end result is that patients eat less after the procedure because they feel fuller sooner and more satisfied longer, which eventually leads to weight loss and reduction of health problems.

Previous Gastric Bypass Surgery Techniques

The first reported GBS was performed in 1954 by Dr. A.J. Kremen. It was a simple connection of the patient’s upper and lower intestine bypassing much of the area where nutrients are absorbed into the body. By 1963 Drs. Payne, DeWind and Commons introduced a procedure which became known as the jejunocolic shunt. This particular bypass procedure connected the upper small intestine to the colon and resulted in uncontrollable diarrhea in the patients. By 1967 Drs. Mason and Ito created and performed the mini-gastric bypass, which takes a loop of small bowel for reconstruction and minimized the side effects of the 1963 version of GBS. In an attempt to streamline the surgery further in 1973, Drs. Scott and Dean bypassed smaller lengths of intestine resulting in major dehydration, diarrhea and liver disease for patients.

Modern Day Techniques

In 1990 there was the gastric band by Drs. Kuzmac and Yap. In 1993 was the duodenal switch from Drs. Hess and Marceau, which ended stomach ulcers with the procedure. In 1996 was the procedure by Drs. Scopinaro and Gianetta, which is used in surgeries today. This is the Roux en-Y, which loops from the upper stomach to the small bowel. Clinical studies show this type of surgery has the most effective weight loss which creates the least nutritional deficiencies. But a more recent and less studied type of GBS called the “Mini-Gastric Bypass” is less invasive than the Roux en-Y and based upon two widely used, well known and reliable general surgical procedures; the Collis gastroplasty and an antecolic Billroth II loop gastrojejunostomy. It also requires a shorter surgery, hospital stay, and recovery.

What is the difference between open and laparoscopic techniques for GBS?

• Open surgery takes place through one large incision that begins directly below the patient’s breastbone and ends just above the navel. Open surgery has a greater surgical time, hospitilization, recovery time, and scarring than the laparoscopic version.

• Laparoscopic surgery takes place through several small incisions, called ports, in the abdomen and performing the operation by video camera aided by tubes and cameras. The advantages of the laparoscopic approach include less post-operative pain, a shorter recovery period, and less extensive scarring.

Who should consider Gastric Bypass Surgery?

According to the Centers for Disease Control and Prevention, a normal Body Mass Index (BMI) is 18.5 – 25, while a BMI of 30 and above qualifies as obese. Anyone with a BMI over 40 is considered morbidly obese and a candidate for weight loss surgery. In practical terms, this is a man who is 100 pounds overweight or a woman who is 80 pounds overweight. Medical professionals have determined that as this point individuals are at substantial risk for life-threatening complications of obesity. Individuals with a BMI over 35 with obesity related conditions (also called co-morbidities) may also qualify. Some examples or weight related co- morbidities are:

• diabetes
• hypertension
• high cholesterol
• sleep apnea
• chronic headaches
• venous stasis disease
• urinary incontinence
• liver disease

Benefits of Gastric Bypass Surgery

• Most patients will lose weight immediately and over a two year period will lose from 50-75% of their excess weight and, in some cases, even more.
• Most obesity related problems like sleep apnea, high blood pressure, diabetes, back and joint pain, and pulmonary issues improve and may even resolve.

Risks of Gastric Bypass Surgery

• Immediate surgical or post-surgical complications like loose staples, hernia, infection, etc.
• Increased risk of gallstones.
• Flatulence independent of food causes.
• Potential for nutritional deficiencies from poor nutrient absorption.
• Nausea from eating too fast or the wrong foods.
• The risk of death varies depending on age, general health and other medical conditions.
• Blood clots in the legs.
• Leaking at one of the staple lines in the stomach.
• Post-surgical pneumonia developed because of excess weight placing extra stress on the chest cavity and lungs.
• Narrowing of the opening between the stomach and small intestine.
• Dumping syndrome from eating fatty or sugary foods.