Gastric Bypass

What is gastric bypass?

Gastric bypass is a surgery that can help adults and some adolescents who are very obese (morbidly obese) achieve significant weight loss. In gastric bypass surgery, the stomach is attached directly to the middle of the small intestine. This reduces the amount of calories and nutrients that are absorbed by the body. Gastric bypass surgery may include a stomach stapling procedure. Stomach stapling helps you lose weight by reducing the size of your stomach and the amount of food you can eat at one time. Gastric bypass has serious risks but the benefits can be significant. Benefits include long-term weight-loss and resolution of serious diseases associated with obesity, such as type 2 diabetes, hypertension, and high cholesterol.

Gastric bypass can be a life-saving treatment option for people whose obesity seriously threatens their health and have tried unsuccessfully to lose weight using diet, exercise, behavioral and nutritional counseling, and medication. Long-term weight loss can also lower your risk of heart disease.

Gastric bypass is only one part of a complete treatment plan that includes a lifelong commitment to healthy dietary and exercise habits, vitamin supplementation, and regular follow-up care. Less invasive treatment options that have less risk of complications are available to you to help you lose weight, so you should consider getting a second opinion about your treatment options before having gastric bypass.

Types of gastric bypass

Gastric bypass is a malabsorptive procedure. This means that it can help you lose weight by changing the normal process of digestion. Specific gastric bypass procedures include:

• Biliopancreatic diversion with a duodenal switch (BPD-DS, duodenal switch) involves removing part of the stomach and using staples to create a smaller tube-shaped stomach (vertical sleeve gastrectomy). In another surgery, the stomach is attached to the middle of the small intestine, bypassing a large part of the small intestine and reducing the amount of calories and nutrients that are absorbed into the body.
• Roux-en-Y gastric bypass (RYGB) involves stapling the stomach to create a small pouch and attaching it directly to the middle of the small intestine. This allows food to bypass much of the stomach and the first section of the small intestine, reducing the amount of calories and nutrients that are absorbed into the body.

Why is gastric bypass performed?

Gastric bypass is a major surgery that may be recommended to treat obesity and reduce the risk of life-threatening complications of obesity. These include diabetes, heart disease, and severe sleep apnea. Gastric bypass is not a treatment option for people who are mildly overweight. It is generally considered for adults with a body mass index (BMI) of 40 or more. This means being approximately 100 pounds overweight for men and 80 pounds overweight for women. Certain people who are less obese with a BMI of about 35 to 39.9 with serious weight-related health problems may also be considered for gastric bypass.

Gastric bypass may be an option if other treatment options that involve less risk and fewer complications have been ineffective in helping you achieve and maintain a healthy weight. These include diet, exercise, behavioral and nutritional counseling, and medication. Talk with your doctor about all of your treatment options and consider getting a second opinion before deciding on gastric bypass.

How is gastric bypass performed?     

Your gastric bypass will be performed in a hospital by a surgical team led by a bariatric surgeon. A bariatric surgeon is specialized in bariatrics. Bariatrics is the field of medicine that deals with the causes, prevention, and treatment of obesity.

Surgical approaches to gastric bypass

A gastric bypass may be performed using one of the following approaches:

• Minimally invasive surgery is performed by inserting special instruments and a laparoscope through small incisions in the abdomen. The laparoscope is a long thin camera that transmits pictures of the inside of your body to a video screen viewed by the doctor as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your doctor will make small incisions instead of larger one used in open surgery. He or she can then thread surgical tools around structures and organs instead of cutting through or displacing them as in open surgery.
• Open surgery is performed by making a long incision in your abdomen. Open surgery allows your doctor to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because open surgery requires more cutting and displacement of muscle and other tissues and organs than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients, such as those who are very obese or have adhesions (scarring from previous surgeries).