Gastric bypass is a surgical procedure used to treat morbid obesity. The clinical definition of morbid obesity is a body mass index (BMI) of more than 40 or an individual more than 100 pounds overweight. The procedure may also be used to treat those with a BMI of more than 35 if the individual has a serious medical condition such as diabetes or high blood pressure that might be improved as a result of the surgery.
Who Should Consider Gastric Bypass?
Gastric bypass is never the first option for weight loss. Bariatric physicians require candidates to demonstrate they have tried other options unsuccessfully before considering a surgical option to resolve their weight issues.
In order to satisfy increasingly strict insurance requirements, many doctors will require additional testing prior to surgery to document concurrent conditions that will benefit from the surgery. The more solid the case, the more likely insurance will approve the surgery, an important criteria for most patients investigating the procedure.
Significant benefits have been documented for those with high blood pressure, high cholesterol, high triglycerides, Type 2 diabetes, asthma, obstructive sleep apnea, gastroesophageal reflux disease (GERD) and mobility difficulties. Limited studies have shown some potential for Type 1 diabetes where the patient is concurrently overweight, a situation which occurs less than with Type 2 diabetes.
Gastric bypass candidates should be well informed, well motivated and committed to following their doctor's instructions to ensure a positive outcome from the surgery.
Risks and Complications
Mortality risks from gastric bypass surgery are far less than those from the weight-related health issues, if left untreated. A July 2009 study in the New England Journal of Medicine found the mortality risk to be no more than 0.3%, or similar to the risk from a hip replacement surgery.
The most common complications are pneumonia, blood clots in the legs which move to the lung, heart or brain, or leaks along the staple/suture line requiring additional surgery to repair and leading to infection or abscess if undetected.
An increase in gallstones requiring gallbladder surgery has been noted for many years. A June 2009 study by Johns Hopkins in the Journal of Urology has also documented an increased risk of kidney stones. Although the risk remains small at 8%, it is double the rate for those who did not have the surgery.
Approximately one in five patients experiences some form of minor complication immediately after surgery, including drainage from the incision, nausea or vomiting.
Longer term side effects are more common with malabsorptive procedures such as the Roux-en-Y gastric bypass. These side effects include mineral deficiencies and dumping syndrome, caused by the body's inability to process sugars and fats readily, leading them to be "dumped" into the bloodstream, resulting in rapid pulse, sweating, nausea, light-headedness and, in some cases, diarrhea. This effect can be minimized by judicious food choices.
