Gastric Bypass Surgery New Jersey
Roux-en-Y gastric bypass is both a restrictive and malabsorptive procedure which means that calories are restricted both by physically limiting the food a patient can eat (restrictive) and by reducing the number of calories absorbed through the small intestine (malabsorption).
How The Gastric Bypass Works
Most gastric bypass procedures today are performed in a minimally invasive manner. The surgeon inserts medical devices through four or five very small incisions in the abdomen. Using a high definition camera called a laparoscope, the surgeon can clearly see the surgical field and perform the procedure using specially made long-handled tools.
During the gastric bypass procedure, the bariatric surgeon creates a small (15-30cc) stomach pouch. This represents between 10 and 20 percent of the original size of the stomach. What’s left is about the size of a golf ball. The remainder of the stomach is not removed, but is completely shut off and divided from the stomach pouch.
The surgeon then creates an outlet from this newly formed pouch (a “bypass” for food) that empties directly into the lower portion of the duodenum or small intestine, thus significantly reducing caloric absorption. This bypass allows food to skip parts of the small intestine, and therefore, the body cannot absorb as many calories or nutrients.
Gastric Bypass Results
The gastric bypass offers the greatest weight loss potential of any of the three major weight loss surgery procedures we offer. Patients can expect to lose up to 80% of their excess body weight over the course of a year or two after surgery. As with every bariatric procedure however, a patient’s dedication to bettering their lifestyle will go a long way to achieving these goals.
Gastric bypass surgery also offers significant improvement or resolution of many of the diseases associated with morbid obesity. Interestingly, many patients will see a complete remission of type-2 diabetes within a few weeks, even days, after surgery. We believe that after a gastric bypass, the bacterial composition of the gut changes, promoting balanced secretion of insulin and in turn regulating blood sugar.
Recovery after Gastric Bypass
Recovery after a laparoscopic gastric bypass procedure is usually much shorter and less painful than traditional open surgery. However it is still major surgery and proper recovery protocols should be followed closely as per the post-surgical packet patients will receive from our office.
Patients will usually spend two nights in the hospital for observation and to ensure there are no leaks in the staple line. Any complications may extend this hospital stay. Patients should be able to return to work within four weeks and should be able to resume normal activity within 6 weeks. Patients should be mindful however, that lifting heavy objects or performing strenuous exercise activity should not be done until cleared by our office.
Benefits of Gastric Bypass:
- The average excess weight loss after the gastric bypass (Roux-en-Y) procedure is generally greater than with purely restrictive procedures such as the gastric sleeve and gastric band
- Because the gastric bypass is performed laparoscopically, patients tend to recovery more quickly with less pain and blood loss
- One year after surgery, weight loss can average 77% of excess body weight
- Studies show that after 20 to 14 years, 50-60% of excess body weight loss has been maintained by some patients
- A 2000 study of 500 patients showed that 96% of certain associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved
- The gastric bypass can be revised by placing a gastric band over the bypass if patients are not losing sufficient weight
- The bypass requires fewer follow-ups than the typical gastric band surgery
- Patient will not need to live with an implanted medical device like the gastric band
Risks of Gastric Bypass:
- Because the duodenum is bypassed, poor absorption of iron and calcium can result in low total body iron and a predisposition to iron-deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis, should be aware of the potential for heightened bone calcium loss. This can be managed and mitigated with vitamin and mineral supplementation
- Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements
- Chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections
- A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious health risk, the results can be unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery. This can be avoided by minimizing the consumption of high fat, high sugar foods
- In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc. This may require a revisional procedure to reduce the size of the stomach
- The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur
Gastric Bypass FAQs
Q: Who Is The Ideal Gastric Bypass Patient?
A: The gastric bypass is suitable for many patients with a BMI of 40 or over, or those with a BMI of 35 or over that have one or more obesity related diseases. Patients with certain weight related issues may find that gastric bypass is preferable to other bariatric surgeries. Those with severe or uncontrolled acid reflux or GERD as well as those with severe type-2 diabetes may be particularly suited to a bypass.
Q: What results can I expect?
A: The gastric bypass has excellent weight loss and obesity related disease improvement potential. Every patient experience will be different, however on average, patients may lose up to 80% of their excess body weight and improve or resolve a majority of their obesity related diseases.
Q: Are All Bypasses Performed Laparoscopically?
A: We strive to perform all gastric bypass surgeries laparoscopically. If, however, the patient has too much scar tissue or fat accumulation in the surgical area, we may have to perform an open procedure. There is a small chance that a gastric bypass would need to be converted from laparoscopic to open mid-surgery for patient safety.
Q: How Long Is The Hospital Stay After A Gastric Bypass?
A: A typical, uneventful recovery from a laparoscopic gastric bypass will require a 2-3 night stay in the hospital. An open procedure may require an additional night or two.
Q: Is The Gastric Bypass Reversible?
A: Since no part of the stomach or intestine is removed from the body during surgery, the gastric bypass is technically reversible. However, the procedure to reverse the bypass is not only complicated, but risky. There are many reasons why a patient may not be losing as much weight as expected and only a consultation with our practice can determine the best course of action.
Q: Can You Revise A Gastric Bypass?
A: Yes, gastric bypass revisions are straightforward. The most common bypass revisions including adding a gastric band to the top of the stomach pouch, or endoscopically shrinking the stomach or tightening the stoma if they have stretched over time. Many revisions can be performed in an outpatient setting. Please learn more about gastric bypass revisions.
Q: The Gastric Bypass Seems Complicated, Are There Serious Risks?
A: Much like any surgery, the gastric bypass comes with inherent surgical risks and a few unique to the procedure itself. Thorough pre-operative testing is employed to assess your risk as a bypass patient. Many of the perioperative risks revolve around a patient’s poor general health. You will learn more at your consultation. With that being said, the risks of the bypass must be compared with the risks of living with obesity. The goal of bariatric surgery and lifestyle change is to improve your health for a longer, happier life.
Q: Will I Ever Be Able To Enjoy Food Again?
A: There is no doubt that the gastric bypass comes with the most dietary restrictions of any bariatric procedure we perform. However, we also preach moderation. We don’t expect you to eliminate every indulgence for the rest of your life. Rather, we assist you in developing healthy eating habits that walk the fine line between taste and calories.
Q: What If I Develop A Nutritional Deficiency?
A: Nutritional deficiencies are not common in patients who follow their post-surgical plan. While the risk of deficiency is higher than in the gastric band or sleeve, eating a balanced diet, taking supplements as prescribed and attending all your post op visits should keep nutritional problems at bay.
Q: I Understand That Diabetes Can Go Into Remission Within Weeks of A Gastric Bypass. Does That Mean I Can Consume Sugar Any Time I Want?
A: We have known that patients with Type 2 Diabetes go into remission very early on after surgery and before they lose a significant amount of weight. Recent research has shed light on why. It has been postulated that gut bacteria in your body may rebalance themselves after a bypass, offering better insulin regulation. This is not a free pass, however. Consuming too much sugar will eventually lead to weight regain and a possible return of the diabetic condition. Further, consuming too much sugar can lead to dumping syndrome, a very uncomfortable condition caused by the rapid emptying of stomach contents into the small intestine. Always follow your post-op instructions carefully.
Q: Is It True That I Can’t Drink Soda?
A: Soda, especially for bypass patients, is a no-no. Not only do most sodas contain sugar or sugar substitutes that don’t offer any nutritional value, the carbonation itself can be very uncomfortable and over time, stretch your stomach pouch, causing weight regain.
Q: Is The Gastric Bypass Right For Me?
A: We won’t know until you visit us for your pre-op work-up and consultation with one of our highly skilled surgeons. With that being said, thousands of people have changed their lives with this surgery, so it is worth finding out more by attending a free informational seminar!