Thinking About Gastric Bypass Surgery?

Gastric bypass surgery is a surgical procedure meant to treat morbid obesity. Morbid obesity is legally defined as having a Body Mass Index, or BMI, of 40 or higher. As a person’s weight-to-height ration increases, the risks associated with excess weight are aggravated. There are many life-threatening conditions associated with morbid obesity, called comorbidities, brought about by the mechanical or metabolic effects of excess fatty tissue.

The risks associated with morbid obesity are: atherosclerotic heart disease, diabetes mellitus type II, hypertension, obstructive sleep apnea, gastroesophageal reflux disease, gallbladder disease, liver disease, venuous thromboembolic disease, degenerative disc disease, and osteoarthritis. It is possible to reduce the weight of a morbidly obese person and thus reduce these risks, but often it is not practicable. As an extreme measure to reduce the fatty deposits and weight of the patient, a gastric bypass surgery may be performed.

Gastric bypass surgery is dangerous and irreversible, so there are laws preventing just anyone from undergoing this procedure. To be allowed to have gastric bypass surgery, one must either have a BMI of over 40, or have a BMI of over 35 and one or more comorbidities. These laws are to prevent anorexics and others from abusing this procedure.

The surgical procedure requires opening the abdominal cavity or creating small openings into it, so the patient is put to sleep under heavy anesthesia. After the patient is completely anesthetized, one of two procedures are followed. Stomach acid may need to be reduced prior to the operation, since it may spill out and damage the internal organs during the surgery.

In one procedure, an opening is created to allow the surgeon access to the internal organs in the abdominal cavity. While the opening is made as small as possible, open surgery such as this leaves significantly-sized scars, and can take a long time to heal.

The other procedure is called laparoscopy, or minimally-invasive surgery. In this method, small openings leading into the abdominal cavity are made. Into these holes, hose-like devices that either provides video feeds or specialize surgical instruments. This is a relatively new procedure, first performed in 1993. It has a great advantage in reducing the length of recovery time, discomfort, and pain, but is more difficult to perform.

The next step, regardless of which of the series of steps above was followed, is the reduction of the stomach. The stomach can usually contain over 400 milliliters in volume without stretching, but this surgical operation will reduce it to a mere 15-30 milliliters. The stomach is either partitioned or completely divided with the aid of surgical staples. Total separation is the recommended practice, since the two section may heal back together otherwise. The small intestines are then reconstructed to allow both portions of the stomach to drain. Variations on the portion of the stomach and intestines to be used are available to surgeons, and each variation has advantages and disadvantages.

After the surgery, the capacity of the stomach is reduced by more than 90 percent. Normally, the stomach can stretch to hold up to 1000 milliliters in volume of liquid and solid food. This operation will reduce that capacity to around 30 milliliters. The small pouch of stomach that is left for digestion is also made from the upper part of the stomach, which has muscles that are less likely to stretch. This severely reduces the amount it takes to get that “full” feeling, thus the need to eat is drastically decreased. The reduction in what the patient can eat reduces caloric intake to a very small amount, thus the body will turn to the fat deposits and metabolize them for energy.

When the patient eats as little as a tablespoon or two of food, the gastric bypass pouch is immediately distended, signaling to the brain that it is full, and the patient achieves satiety. It has also been discovered that when food enters the small intestines, hormones are released to prevent further food intake, thus making them satiety factors. These findings are controversial up to today, and the exact means as to how gastric bypass surgery works have yet to be completely explained.

One problem that may arise after the surgery is something called dumping syndrome. This occurs when food moves too quickly along the gastrointestinal tract, a real possibility considering the reduced size of the stomach and shortened intestines. The resulting symptoms are nausea, weakness, fainting, sweating, and diarrhea immediately or soon after eating. These can be bad enough that the patient will need to lie down until the symptoms pass. Patients can return to normal living after 3 to 5 weeks, unless complications arise.

One risk common to all surgeries involving incisions is infection of the cut or cuts. This can lead to prolonged healing, worse scarring, and more, depending on the infecting microbe.

If the staples pull loose, or if the gastric pouch does not heal completely, a leak of gastric juices may occur. This leads to a condition called peritonitis, causing pain, nausea, vomiting, rapid pulse, quickened breathing, chills, and fever. If this happens, another surgery to clean the infection is required, which is followed by antibiotics.

The reduced sizes of the stomach and intestines mean a reduced intake of food and reduced absorption, leading to vitamin deficiencies, so care must be taken to avoid diseases related to such deficiencies. There are several other complications that result from the surgery or changed physiology.

To maximize the effect of the bypass, the patient must make changes to long-term eating habits. The gastric bypass pouch will eventually stretch, and so will a short portion of the attached small intestine, increasing capacity to eat. Thus, the patient must eat only during meal times, and avoid grazing and snacking. When the patient reaches a healthy weight, he or she must also maintain healthy eating habits, to avoid counteracting the surgery.