Treatments

Obesity lowers quality of life, which can result in poor overall health and contribute to a higher risk of depression. Surgery may be indicated if there is a body mass index (BMI) of 40 or more or a BMI of 35 associated with serious obesity-related health problems such as diabetes, coronary heart disease, sleep apnea, high blood pressure or severe arthritis.

Doctors generally recommend weight-loss surgery only if the patient is severely obese. They also usually don’t recommend it unless you haven’t been able to lose a large amount of weight and keep it off through diet, exercise and changes in lifestyle.

Studies on Gastric Bypass have found that it can often reverse type 2 diabetes and lower the risk of high blood pressure, sleep apnea and certain heart problems.

RISKS

Gastric bypass is a major surgery and it has many risks, some of which are very serious. You should discuss these with your surgeon.

Risks for any surgery or anesthesia include:

• Allergic reactions to medicines
• Blood clots in the legs that may travel to your lungs
• Blood loss
• Breathing problems
• Heart attack or stroke during or after surgery
• Infection, including in the cut, lungs (pneumonia), bladder, or kidney

There are a number of risks for any weight-loss surgery. Long-term complications related to Gastric Bypass surgery may include:

• Malnutrition, especially if you don’t take your prescribed vitamins and minerals daily for the rest of your life
• Iron and calcium deficiencies
• Left untreated, severe and potentially fatal vitamin and protein deficiencies due to poor absorption of certain nutrients
• Gastric “dumping,” which can cause nausea, rapid heartbeat, flushing, fainting, and other unpleasant symptoms such as diarrhea after eating
• Narrowing of the sites where intestines are joined (stricture)
• Staple-line failure, where the pouch was created
• Dangerous internal hernias in which the intestine can be trapped and blocked – intestinal obstruction
• Need for additional operations because of problems such as a stretched pouch or separated stitches
• Failure to lose enough weight if you snack on high-calorie foods and don’t exercise
• Abdominal infection

BEFORE SURGERY

Your surgeon will ask you to have tests and visits with other health care providers before you have this surgery.

If you are a smoker, you should stop smoking several weeks before surgery and should not start smoking again after surgery. Smoking slows recovery and increases the risk of problems. Tell your doctor or nurse if you need help quitting.

Always inform your doctor or nurse:

• If you are or might be pregnant
• What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that affect your blood’s ability to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.
• Prepare your home for post-surgery recovery.

SURGERY

The surgery will be performed under general anesthesia. You will be asleep and pain-free.

There are two steps during gastric bypass surgery:

• The first step makes your stomach smaller. Your surgeon will use staples to divide your stomach into a small upper section and a larger bottom section. The top section of your stomach (called the pouch) is where the food you eat will go. The pouch is about the size of a walnut. It holds only about 1 ounce of food. Because of this you will eat less and lose weight.
• The second step is the bypass. Your surgeon will connect a small part of your small intestine (the jejunum) to a small hole in your pouch. The food you eat will now travel from the pouch into this new opening and into your small intestine. As a result, your body will absorb fewer calories.

Gastric bypass can be executed in two ways. With open surgery, your surgeon will make a large surgical cut to open up your belly. Your surgeon will do the bypass by working on your stomach and small intestine.

Another way to perform this surgery is to use a tiny camera, called a laparoscope and the process is called laparoscopy.

In this surgery:

• First, your surgeon will make small cuts in your belly.
• Then the surgeon will pass the laparoscope through one of these cuts. It will be connected to a video monitor in the operating room. Your surgeon will look at the monitor to see inside your belly.
• Your surgeon will use thin surgical instruments to complete your bypass. These instruments will be inserted through the other cuts.

Gastric Bypass is the same whether you have open or laparoscopic surgery.

Advantages of laparoscopy over open surgery include:

• Shorter hospital stay and quicker recovery
• Less pain
• Smaller scars and a lower risk of getting a hernia or infection

This surgery takes about 2 to 4 hours.

AFTER THE PROCEDURE

Most people stay in the hospital for 3 to 5 days after their surgery.

In the hospital:

• You will be asked to sit on the side of the bed and walk a little on the same day you have surgery.
• You may have a (tube) catheter that goes through your nose into your stomach for 1 or 2 days. This tube helps drain fluids from your stomach.
• You may have a catheter in your bladder to remove urine.
• You will not be able to eat for the first 1 to 3 days. After that, you can have liquids and then pureed or soft foods.
• You may have a catheter connected to the larger part of your stomach that was bypassed. The catheter will come out of your side and drain fluids.
• You will wear special stockings on your legs to help prevent blood clots from forming.
• You will receive shots of medicine to prevent blood clots.
• You will receive pain medicine. You will take pills for pain or receive pain medicine through an IV (a catheter that goes into your vein).

You will be able to go home when:

• You can eat liquid or pureed food without vomiting.
• You can move around without a lot of pain.
• You do not need pain medicine through an IV or given by shot.

The following supplements are recommended to prevent nutritional deficiencies after recovery from the surgery. However they need to be taken as per your consultant’s advice:

• Daily vitamin D and calcium supplements: Vitamin D deficiency is common in people who have had this kind of gastric bypass. Additional daily calcium supplementation is also suggested.
• Multivitamins: You should take a daily multivitamin that contains 200 percent of the daily values. Wait two hours to take a calcium supplement after your multivitamin.
• Vitamin B12 supplements: Doctors recommend vitamin B12 supplementation for all weight-loss surgery patients to help prevent bone fractures. You may need to give yourself B12 injections for the rest of your life.
• Oral vitamin D supplementation if a deficiency is detected: Your doctor may prescribe vitamin D2 taken orally once a week for eight weeks; some people require lifelong vitamin D supplementation.
• Iron supplements: Research suggests that after gastric bypass surgery, the amount of iron contained in a standard multivitamin may not be enough to prevent anemia. Teens and menstruating women may require the amount of iron found in two multivitamins, along with 50 to 100 mg of elemental iron a day.

PROGNOSIS

Most people lose about 10 to 20 pounds/4.5-9 KGs a month in the first year after surgery. Weight loss will decrease over time. Sticking to your diet and exercise plan will help you lose more weight.

You may lose half or more of your extra weight in the first 2 years. You will lose weight quickly after surgery if you are still on a liquid diet.

Losing enough weight after surgery can improve many medical conditions, including:

• ASTHMA
• GASTROESOPHAGEAL REFLUX DISEASE (GERD)
• HYPERTENSION
• DYSLIPIDEMIA
• OBSTRUCTIVE SLEEP APNEA
• TYPE 2 DIABETES

Weighing less should also make it much easier for you to move around and do your everyday activities.

To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your doctor and dietitian have given you.