Gastric Bypass Surgery

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By: Robert Tanenberg

People with type 2 and obesity who areconsidering gastric bypass surgery first needto learn what exactly is a gastric bypassoperation.

The gastric bypass is a surgical method ofdrastically reducing the size of the stomachand rerouting food around the first partof the small intestine, where much of thecarbohydrate, fat and protein are normallyabsorbed. These mechanical changes,together with changes in the hormonesof the gut, can lead to a loss of 100 to 150pounds within a year or two of a successfulgastric bypass.

However, every prospective candidate mustalso understand what this procedure is not:

  • It is not a quick fix for the majority of obese people.
  • It is not cosmetic surgery.
  • It is not a way to get a movie-star figure.
  • It is not an option for most obese people.

Who Is a Candidate?

Candidates for the surgery are usuallyselected only after a documented long-standinghistory of failure with dietary andmedical weight-loss therapies. The gastricbypass is the best option for those peoplewho are morbidly obese with seriousmedical conditions arising from or greatlyworsened by their obesity.

These conditions include:

  • Type 2 diabetes, and its complications
  • Hypertension
  • Sleep apnea
  • Elevated cholesterol
  • Osteoarthritis, especially of the knees
  • Fatty liver

Does Gastric Bypass Reverse Type 2Diabetes?

In the overwhelming majority of cases, theanswer is yes, as long as the weight loss ismaintained.

A 20-year study of the so-called Greenvillegastric bypass, which was pioneered byWalter Pories, MD, and colleagues at EastCarolina University, found that about 80percent of people with pre-existing type2 (whether on insulin or oral agents) hadnormal blood glucose without any treatmentafter this surgery. Most of the patients wereable to stop insulin within a week of thesurgery, and their blood glucose and A1Csnormalized without any medication by threemonths after surgery and before most of theweight was lost, a finding that supports thebenefit of improving the patient’s insulinresistance with this marked reduction incaloric intake.

The 20 percent of patients whose diabetesdid not resolve were typically those whowere older and who had the longestduration of type 2—usually over 20 years.This suggests that in these patients, theirbeta cells had been “exhausted” by the manyyears of insulin resistance, and even a loss of150 or more pounds was not able to restorethe beta cells to normal. Nonetheless, mostof these patients had a much easier timemanaging their diabetes with insulin thanprior to the surgery.

In addition, patients who underwent thetraditional gastric bypass lost more weightand were more likely to have 100 percentnormalization of their hyperglycemia andinsulin resistance than those who underwentthe lap-band procedure.

Most patients who undergo gastric bypasssurgery no longer need to take medicationsfor high cholesterol or triglycerides andcan reduce most of their antihypertensivemedications. Those with sleep apnea usuallyno longer need their C-pap machine oncethey have lost a significant amount ofweight. Many patients with arthritis are ableto resume walking and may be able to avoidsurgical replacement of their knees if theprocedure is done in time.


GREENVILLE BYPASS (also known as Roux-en-Ygastric bypass or RGB)

This operation is the most common and successfulmalabsorptive surgery. First, a small stomach pouchis created to restrict food intake. Next, a Y-shapedsection of the small intestine is attached to the pouch toallow food to bypass the lower stomach, the duodenum(the first segment of the small intestine) and the firstportion of the jejunum (the second segment of the smallintestine). This bypass reduces the amount of caloriesand nutrients the body absorbs.

ADJUSTABLE GASTRIC or lap-banding procedure

In this procedure, a hollow band made of aspecial material is placed around the stomach nearits upper end, creating a small pouch and a narrowpassage into the larger remainder of the stomach.The band is then inflated with a salt solution. It can be tightened or loosened over time to change the size of the passage.


Typical Meal One Year After Bariatric Surgery

  • One 2-ounce broiled hamburger or chicken breast
  • ¼ cup boiled carrots
  • ¼ cup pasta salad
  • 1 teaspoon soft margarine
  • ½ cup milk
  • Multivitamins

Some of the Downsides of Gastric Bypass Surgery

First of all, you will no longer be able to eat as you did beforehaving the operation (see above). You will have to getaccustomed to eating much smaller portions and savoringeach bite.

Then there is the cost of the surgery, and the preparation, andpossible complications, which can include:

  • Postoperative infections
  • Anemia
  • B12 and other vitamin deficiencies
  • Inadequate weight loss
  • Gallstones

The key to limiting complicationsand getting the best possibleresult is selecting an experiencedsurgeon and surgical team anda top-notch hospital for theprocedure. Different surgeonshave expertise in various surgicalmethods, including the use of thereversible lap-banding procedure.Most surgeons are able to reducecomplications and length of stayby doing the procedure with alaparoscope instead of the moretraditional and invasive “open”procedure that requires a muchlarger abdominal incision.


Resources for More Information

Weight-Control Information Network
1 Win Way
Bethesda, MD 20892-3665
Phone: (877) 946-4627
Web: WIN@info.niddk.nih.gov

American Society for Bariatric Surgery
140 NW 75th Drive, Suite C
Gainesville, FL 32607
Phone: (352) 331-4900
Fax: (352) 331-4975
Web: www.asbs.org

American College of Gastroenterology
Web: www.acg.gi.org/hdhome.html

North American Association for theStudy of Obesity
Web: www.naaso.org

American Obesity Association
Web: www.obesity.org

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