Yara Zakharia, Esq.
Nearly 60 million Americans or slightly more than 60% of the U.S. adult population suffers from obesity, which is responsible for nearly 300,000 deaths per year. Approximately 22 million Americans struggle with morbid obesity, which poses life-threatening illnesses or 'comorbidities'. These lead to an impaired quality of life and shorter life expectancy.
Studies have shown that obesity increases the risk of death for a multitude of health conditions including the following:
- Certain forms of cancer
- Coronary heart disease
- Degenerative disc disease
- Diabetes type 2
- Gallbladder disease
- Gastroesophageal reflux disease
- Liver disease
- Sleep apnea
- Venous thromboembolic disease
The American Obesity Association defines obesity as having a body mass index (BMI) that is higher than 25; this is the point at which excess weight augments the likelihood of disease. One of the four leading medical procedures for treating severely obese individuals is gastric bypass surgery.
Once deemed an extreme measure, this weight loss surgery is growing in popularity, with nearly 150,000 Americans opting for the procedure each year. It brings about not only dramatic weight loss and a decrease in mortality, but also reduction or elimination of various health conditions linked to obesity such as joint pain, lower back pain, diabetes type 2, hyperlipidemia, and gastroesophageal reflux disease. Gastric bypass surgery also lowers the incidence of cancer, cardiovascular disease, and infections.
Gastric bypass surgery should only be undertaken if all other weight loss options have been exhausted and proven to be unsatisfactory (i.e. unsuccessful dietary regimen) and the individual is living with a life-threatening or serious health condition.
Pre-requisites for the surgery, as set forth by the National Institutes of Health (NIH) are that the patient must have an excess weight of 100 pounds and a BMI of at least 40 or have a minimum BMI of 35 along with at least one very serious health condition.
Gastric bypass surgery shrinks the volume of the stomach by more than 90% and leads to a marked reduction in food intake. In this type of weight loss surgery, a small stomach is created, with the remainder of the stomach bypassed with the small intestine attached instead to the new stomach. A smaller stomach is supposed to enable the patient to experience less hunger and feel satiated or full quicker. This operation is performed in a hospital by a general surgeon who is board-certified and is a specialist in treating overweight patients. Gastric bypass surgery is referred to as a malabsorptive procedure since it aims at reducing caloric intake. Variations of this surgery include the following:
- Roux-en-Y gastric bypass
- Laparoscopic Roux-en-Y bypass
- Transected Roux-en-Y bypass
- Gastric bypass with long gastrojejunostomy
- Mini Gastric Bypass (Billroth II gastrojejunostomy)
While the approach utilized for creation of a smaller stomach differs among these various procedures, their objective is the same- restriction of food intake. The leading bariatric surgery in the U.S. and the most commonly-utilized technique in hospitals and clinics is the Roux-en-Y gastric bypass, which proceeds as follows:
- A small pouch is created from the patient's upper stomach, with the original stomach separated into two parts.
- The surgeon re-arranges the small bowel in the shape of a Y to allow the food to transit from the esophagus to the small pouch and into the portion of the small bowel called the Roux limb. The food is thus diverted from the larger part of the stomach.
- To prevent leaks, the two portions of the stomach are sealed by sewing and stapling.
A surgeon may perform the Roux-en-Y either through an open surgery or laparoscopically. In the latter route, a small incision is made and a small video camera with a surgical telescope attached to it is inserted in the stomach. This enables the surgeon to see the operation on a television monitor. Some of the advantages to a laparoscopic gastric bypass surgery include a significantly-reduced risk of hernia, fewer scars, a quicker recovery period, less discomfort, and a shorter hospital stay. Typically, the obesity surgery procedure consumes approximately two hours, and patients can expect to remain at the hospital for about three days.
Complications and Risks
Complications of gastric bypass surgery mirror those resulting from other major operations of the abdomen. The risk of complications is present in 14.5% of gastric bypass procedures performed with a laparoscope and 7% of those involving open incisions. Some of the risks associated with this type of weight loss surgery include the following:
- Abdominal hernia
- Bowel obstruction
- Cardiovascular problems
- Chronic anemia
- Difficulty in swallowing
- Dumping syndrome
- Leakage of intestinal contents
- Leaking from staples
- Narrowing of blood vessels
- Narrowing of stoma
- Nutritional deficiency
- Spleen injury
The average cost of gastric bypass surgery ranges from $10,000 to $15,000. It is becoming increasingly affordable since Medicare and more insurance providers are covering the cost. Some clinics also extend payment plans to help individuals finance the operation. Prospective patients should choose a gastric bypass surgeon who is qualified and experienced and find out whether the hospital facility offers long term follow-up care (psychological, nutritional, and medical).
[page updated December 2008]