Gastric Bypass Surgery
Gastric bypass surgery is the most commonly practiced obesity surgery in the United States.
Do I Qualify for Gastric Bypass Surgery?
Dr. Jorge Rincon is proud of the tremendous success in weight loss among his gastric bypass surgery patients.
Dr. Rincon usually recommends gastric bypass surgery for those patients who have a high BMI and multiple co morbidities. Because it restricts appetite and limits absorption of nutrients, fat, and calories, Roux-en-Y gastric bypass surgery allows patients to achieve rapid and lasting weight loss.
To be a candidate for Roux-en-Y gastric bypass surgery at our Rincon Surgery, you must have a body mass index (BMI) of at least 40, or BMI of 35 if you also suffer from certain significant co-morbid physical conditions.
Gastric Bypass Surgery via the Roux-en-Y procedure is generally considered to be the best surgical procedure for the treatment of morbid obesity in the United States. Weight loss is achieved by reducing the functional portion of the stomach (the size of a football) to a pouch one ounce or less in size (the size of a golf ball), and by creating a stoma, a small opening between the new pouch and the intestine. This operation can be done laparoscopic (6 small incision between ½ to 2 inches) or as a one open mini incision (one small incision between 3 1/2 to 5 inches long).
The hospital stay is usually 2 days after surgery.
After the gastric bypass procedure, a small size of the stomach pouch causes the patient to have a sensation of fullness after eating only a small portion of food. The small stoma delays stomach emptying, making the sensation of fullness last longer. These are called the restrictive components of the procedure.
The limb of intestine coming down from the small pouch is called the Roux-Y limb. The limb of intestine coming down from the bypassed portion of the stomach can be called the Biliary or Bypassed limb. The remaining portion of the intestine is called the Common Channel.
Food does not pass down the Bypassed limb, only the Roux-Y limb and the Common Channel. The longer the Bypassed limb, the less the length of intestine actively working to absorb nutrients from the food that is eaten. Digestive juices that normally help absorb nutrients and fat from the food enter the Bypassed limb from the larger portion of the stomach, the liver, and the pancreas, and pass down the Bypassed limb to the Common Channel. These juices do not mix with the food while it is passing down the Roux limb. The longer the Roux limb, the longer the portion of intestine trying to absorb nutrients without the benefit of these digestive juices. Both of these changes result in less absorption of nutrients and fat and contribute to weight loss, and are called the Malabsorptive components of the procedure.
Exactly how the Gastric Bypass surgery is done, (laparoscopic or open), for an individual patient depends on their individual anatomy, their general health status, their BMI, whatever changes they may have from prior surgeries, and what they hope to be achieving from the operation. The stomach compartments can be completely divided from each other or simply partitioned, the small stomach pouch and the intestinal limbs may be connected to each other with either staples or sutures, and the two intestinal limbs may be made longer or shorter.
Patients will be on a liquid diet and protein shakes for the first few days immediately following gastric bypass surgery, and then advance to a pureed diet. These foods will be very soft, so as to pass through the small, newly formed pouch and stoma. One of the main issues during this period will be adequate fluid intake, and dehydration can be a problem for patients recovering from this surgery. We will ask patients to take in at least 32 to 48 ounces of liquid a day after the surgery.
Approximately over one month after the gastric bypass surgery the patients can expect to be advance in four stages to a normal diet. They begin to take more regular table foods, but will often still go back to eating the pureed foods that they have tolerated well. They will still be learning how to eat right, including chewing food carefully, learning to drink most of their liquids between rather than with meals, and learning that eating the wrong foods, such as sweets or fatty foods, may make them ill.
Patients experience the most rapid weight loss during this period. They are often thrilled to see the weight coming off, sometimes at the rate of 20 pounds a month, but it is not an easy time. Patients feel the loss of calories taken in, and are sometimes low in energy. Their small pouch will make them uncomfortable when they eat too much or too fast. They may have loose stools, which can usually be controlled by avoiding certain foods or by taking medication. They may experience some hair loss at 3 to 6 months after their gastric bypass surgery, though the hair usually begins to grow back within a few months. This is usually because of protein and/or vitamins deficiency. Most of the time is corrected with diet supplements and an increase your protein intake.
At 3 months after the gastric bypass surgery the patients will probably be on their long-term maintenance diet, which is more or less what and how they will eat for the rest of their lives. The maintenance diet for the most part consists of regular table foods, but in small portions. Most patients describe their meals as child sized, and they often do not finish what they are served. We recommend to eat no more than ½ a cup or 4 oz. portions. The patients generally become comfortable eating these small meals, and almost always say the loss of the ability to enjoy large meals or certain foods is more than compensated for by being able to successfully control their weight.
Patients may expect to lose approximately 75% to 80% of their excess body weight within the first 2 years following surgery.
Long term success with this operation requires a team effort of both the patients and their doctors.
Gastric Bypass Surgery patients take in less food and absorb less food, fat, vitamins and minerals of what they take in, making them at higher risk for developing nutritional deficiencies. They must also make a life long commitment of taking vitamins, minerals, and possibly protein supplements. We recommend taking these supplements for the rest of their lives.
The exercise program is also as important as the dietary guidelines. You will need to exercise 5 to 6 days a week for at least 45 to 60 min per day, in order for you to obtain and achieve the full benefit and great results of the operation.
Any bariatric surgery (Gastric Bypass or Lap Band) is a tool for you to have, for you to use, and help you achieve a successful weight loss and long term maintenance of your weight loss.
Benefits of Gastric Bypass Surgery
The benefits of the gastric bypass surgery very much outweigh the risks. 75% of patients are expected to lose 75 to 80% of their excess body weight. Well over 80% of patients with hypertension will be off medications and well over 90% of patients with type II non-insulin dependent diabetes mellitus are expected to be off medication. Many times in our experience, patients leave the hospital without taking any high blood pressure or diabetes medication. Drastically improved, if not completely resolved includes sleep apnea, asthma, joint pain, arthritis, reflux, fatigue, shortness of breath and an overall increased sense of well-being.
There is expected to be a significant reduction in risks of heart disease, pulmonary disease and cancers. Morbid obesity can reduce the lifespan as much as 20% and as much as 13 to 20 years of your life, in a given patient, depending on their age and co-morbidities. There is also a significantly improved quality of life and self-esteem in patients who have undergone gastric bypass surgery for weight loss.
It is important to understand that the Gastric Bypass surgery is to be taken serious. In general, the risks to morbidly obese patients are greater for most surgeries and medical interventions than are for patients who are not morbidly obese. The incidence of the risks mentioned above are very low, however, are real and should be considered when making a decision as to your candidacy for a gastric bypass procedure. It is important to understand your role in the gastric bypass surgery. First and foremost, it is a tool for weight loss and for maintenance of weight loss. It is not a magic wand and will not guarantee results without complete dedication by yourself and by your physician. Our practice would expect you to commit yourself to our program and accept long-term follow-up, and recognize that the surgery has its limitations. Following our suggestions made by your surgeon, nurse, and dietician and psychologist will greatly increase your success at this procedure. It is important to remember that protein, vitamin and mineral supplements are a lifelong commitment as is exercise and a sensible diet.
It will require absolute dedication and cooperation from our patients. With this dedication will come unlimited benefits, the most important being the elimination or vast improvement in your obesity related medical problems.
- Right after surgery, most patients lose weight quickly and continue to lose for 18 to 24 months after the procedure. Although some patients may regain some weight they lost, most of our patients maintain a long-term weight loss
- Surgery improves most obesity-related conditions. For example, in one study blood sugar levels of 83 percent of obese patients with diabetes returned to normal after surgery
Many individuals report having developed a new found sense of well being after weight loss surgery. People who undergo gastric bypass surgery can usually expect:
- Improvement in or elimination of conditions associated with morbid obesity, including adult onset diabetes, hypertension, sleep apnea and arthritis and joint problems
- Improved ability to engage in physical activity
- A loss of 50 to 80 percent of that weight above the ideal body weight. This loss usually occurs during the 18 months following surgery
- Long term maintenance of this weight loss