truthaboutgastricbypass.com

Bariatric surgery is weight loss surgercical procedures. These surgeries are major gastrointestinal operations that a) seal off most of the stomach to reduce the amount of food one can eat, and b) rearrange the small intestine to reduce the calories the bodies can absorb. There are several different types of bariatric weight loss surgical procedures, but they are known collectively as ‘bariatric surgery’.

Bariatric Surgery is not a magical solution for weight loss. Bariatric surgery is not an easy option for obesity sufferers. It is a drastic step, and carries the usual pain and risks of any major gastrointestinal surgical operation.

Bariatric Surgery involves new eating habits. Bariatric surgery compels patients to change their eating habits radically, and makes them very ill if they overeat. After Bariatric surgery is performed, patients remain at a lifelong risk of nutritional deficiencies.

Bariatric Surgery typically leads to major weight loss. Some patients who undergo Bariatric gastrointestinal surgery lose more than 100 pounds in weight – some individuals lose as much as 200 pounds weight. Some reach a normal weight, while others remain overweight, although less overweight than before.

Candidates for Bariatric weight loss surgery, have tried all other weight loss options. Some Bariatric surgeons accept patients in their 60’s, and some even operate on teenagers. But because Bariatric surgery is a last-gasp solution to weight loss, to be used when other more conventional weight loss programs have been tried and failed, candidates must generally have severe obesity-related health problems.

In general, in order to qualify for Bariatric surgery you must be ‘morbidly obese’, which usually means being overweight by 100 pounds (man) or 80 pounds (woman) with a Body Mass Index (BMI) of 40+.

Alternatively, Bariatric surgery may be appropriate if you are 80 pounds overweight and have a serious obesity-related condition like type 2 diabetes or life-threatening cardio-pulmonary problems such as severe sleep apnea or obesity-related heart disease.

Some people who are suffering from extremely severe obesity (End Stage obesity syndrome) may have to be hospitalized before undergoing Bariatric surgery in order to lower the risks of surgery.

The higher the motivation of patients to lose weight, and manage the post-operative requirements of dietary modification and behavioral therapy, the more successful Bariatric surgery is likely to be, in solving their obesity and weight problems. This may influence the selection of candidates for Bariatric surgery.

Bariatric Gastrointestinal Surgical operations cost about $25,000 or more, although insurers are slowly beginning to accept that this kind of weight loss surgery can deliver powerful medical benefits that will save them money in the long run, especially where convention weight loss remedies have consistently failed to reduce obesity.

Do not believe everything you read about Bariatric surgery. Talk with patients who have undergone this form of weight loss surgery. Find out about Bariatric surgery yourself. Find out about the risks and what’s involved.

What do you take into consideration when choosing an operation?
In general, the more weight loss someone wants, the more risk they have to be willing to accept, so the right surgery depends on what their goals are for weight loss. For example, Gastric Bypass Surgery is associated with a 1 in 50 risk of death. Adjustable gastric banding is a safer operation. That operation probably has a less than 1 in a 1000 risk of death.

In patients who are older or sicker, physicians generally tend toward either the banding or sleeve procedure. Those operations are good for people who are unwilling to accept the risk of the Gastric Bypass Surgery, as well as volume eaters.

How can people choose a good Bariatric surgeon?
The surgeon should have extensive experience in Bariatric Procedures. There is a learning curve with these operations, especially if done laparoscopically. Choose a surgeon who has performed an excess of 200 operations. Also make sure he/she answers your questions honestly and takes the time to evaluate and educate you carefully on the procedure.

Patients habe a tendancy to rush into surgery. They make a decision in their head and then it’s wherever they can have the surgery performed at the earliest time. However, the goal should always be for long-term health and quality of life in addition to weight loss.

How much weight loss can people expect to see with surgery and how quickly does that happen?
With Lap-Bands, people can expect to lose approximately 50 percent of excess weight. So if they are 100 pounds overweight, they can expect to lose 50 pounds. That weight loss takes approximately two years. With the Gastric Bypass Surgery, patients with a BMI under 50 seem to lose 70 percent of their excess weight or more. Patients who have a BMI over 50 tend to lose about 50 percent of their excess weight with a Gastric Bypass procedure. Approximately, three-quarters of the weight loss happens in the first six months and almost all of it by a year to 18 months.

Is there a risk of becoming undernourished?
Nobody should go to a surgeon who does Bariatric surgery without a program that delivers pre-operative and post-operative nutritional support. With Lap-Bands, there’s almost no risk of becoming undernourished as long as chronic vomiting doesn’t become a problem. With Gastric Bypass, there are certain vitamins and minerals (iron, calcium, vitamins B12 and D) that can be poorly absorbed after the surgery, so we recommend supplements.

With Biliopancreatic Diversion, 2 to 10 percent of patients can end up with protein malnutrition that requires intravenous nutrition and then further surgery to allow the patient to absorb more of their proteins. Up to a third of patients can end up with vitamin or mineral deficiencies. These patients have to be even more carefully followed and even stricter about their diet.

What are other surgical options?
A new surgical option is a Gastrectomy. This is when only the first portion of the Biliopancreatic Diversion is performed. Three-quarters of the stomach is removed, leaving a sleeve of stomach. Some surgeons are using that as a first stage to get higher-risk patients to lose weight and then come back and do the rest of the operation at a second stage so they can lose more weight.

The Gastric Bypass Surgery is the most commonly performed operation for weight loss in the United States. In the U.S, approximately 140,000 Gastric Bypass procedures were performed in 2005, an amount dwarfing the number of Lap-Band, Duodenal Switch and Vertical Banded Gastroplasty procedures performed. Furthermore, since Gastric Bypass has been performed for almost 50 years, surgeons have become more comfortable with the understanding of its risks and benefits. By sheer volume of cases combined with the volume of scientific research, the Gastric Bypass Surgery has become the “gold standard” operation for weight loss in the U.S.

One of biggest advancements in the Gastric Bypass operation has been the technique used to enter into the abdomen – the laparoscopic approach. Although the laparoscopic approach has a number of potential advantages over the traditional open operation, the training and expertise necessary to perform the laparoscopic approach safely is considerable.

The laparoscopic approach has a number of advantages.

1. Generally 5 tiny incisions are necessary. Four are about ½” long and one is 1″ long. These incisions are too small for any significant infection to occur and the risk of developing a hernia is less than one percent. The risks of infection, wound problems and hernias are close to 30 percent with the traditional open procedure.
2. The operation, in expert hands, can be performed quicker than an open operation. In fact, average operating room times are close to one hour. Less time in the operating room means less anesthesia and anesthesia-related complications.
3. Less pain. Patients, although sore in the first few hours, need only Tylenol with Codeine the day after surgery. Many patients do not require any medications for pain by the time they go home.
4. Quicker return to work. Patient can often return to work in one week. However, it is generally recommended to take two weeks off work to be on the safe side.
5. Better operation. The operation is performed under magnification. Doctors are able to see details that are difficult in the open approach.
6. As patients are walking the day of surgery and discomfort is easily controlled, patients are at lower risk to develop blood clots, pneumonia, bed sores or other complications resulting from prolonged immobility.

The Gastric Bypass Procedure (GBP) has been proven in numerous studies to have good long-term weight loss. The average weight loss often peaks at 18-24 months after surgery – but half of all the weight loss often occurs in the first six months. The Gastric Bypass Procedure, through multiple studies, has been shown to improve or cure diabetes, hypertension, arthritis, venous stasis disease, certain types of headaches, heartburn, sleep apnea and many other disorders. Most importantly, the Gastric Bypass Procedure has demonstrated significant improvements in the quality of the patient’s life.

Regardless of the entry technique (laparoscopic or open), most surgeons perform the operation in a very similar manner. The stomach is cut to form a small pouch (usually one ounce in size) and the remaining stomach and first 1-2 feet of small intestine are bypassed. In the standard Gastric Bypass Procedure, the amount of intestine bypassed is not enough to create malabsorption of proteins and other macronutrients. However, the bypassed portion of intestine is especially adept at absorbing calcium and iron – thus, anemia and osteoporosis are the most common long-term complications of the gastric bypass and must be prevented with lifelong mineral supplementation. Other clinically significant deficiencies have been identified such as thiamine and Vitamin B12. Lifelong follow-up with a bariatric program is mandatory to monitor and prevent nutritional complications. Most surgeons recommend specific supplements to prevent these long-term complications.

Unlike the Duodenal Switch, the Gastric Bypass Procedure does not require the removal of any part of the stomach. The unused stomach survives well with no demonstrable long-term problems. In fact, the unused stomach produces important enzymes. Intrinsic Factor, for instance, is crucial in the absorption of Vitamin B12 and is only made in the stomach.

Although the most commonly performed GBP (sometimes called the proximal bypass) involves little or no malabsorption, some surgeons modify the gastric bypass to incorporate a significant amount of malabsorption for the purpose of augmenting weight loss. This modification, called a distal gastric bypass, has significantly more nutritional complications than the proximal gastric bypass. Whether long-term weight loss is superior to the proximal GBP or whether the malabsorptive complications are worth the possible improvements in weight loss have not been well studied. Many surgeons reserve the distal GBP for very select circumstances.

The mechanism in which the gastric bypass works is complex. After surgery, patients often experience significant changes in their behavior. Most state that they do not get hungry frequently and that their hunger is fleeting. Patients often state that they enjoy healthy foods and lose many of their food cravings. Rarely do people feel deprived of foods. These complex behavioral changes are partially due to poorly understood alterations in the hormones and neural signals produced in the GI track that communicates with the hunger centers in the brain. One interesting hormone that has recently been studied is ghrelin. Certainly the small size of the stomach pouch restricts the volume of food people eat as well. Thus, the decrease in hunger and the rapid feeling of fullness accounts for most of the weight loss after a gastric bypass.

Another mechanism of weight loss after the Gastric Bypass Procedure is called dumping syndrome. Dumping syndrome causes the intolerance to sweets after surgery. Dumping may result in lightheadedness, flushing, heart palpitations, diarrhea and other symptoms immediately after eating desserts. Some people are extremely sensitive to sweets for the rest of their lives; other patients lose some or all of their sweet sensitivity over time. The exact mechanism of dumping syndrome is not entirely understood.

Step 1

During the gastric bypass procedure, the upper stomach is divided with a stapler and reinforced with stitches to create the new upper (proximal) stomach pouch.  The new pouch is the size of a golf ball, holding about 20 cc. The pouch is made so small for two reasons.  First, it will eventually stretch somewhat. By making it very small at first, the final size will still be quite restrictive. Second, the upper pouch continues to make stomach acid. The pouch is kept small to minimize the amount of acid that enters the upper jejunum and thus minimize the chance of developing an ulcer at the stomach jejunum anastamosis.

The lower (distal) larger part of the stomach is left in place for three reasons.  First, it still produces acid and pepsin to help digest food.  These juices travel down the duodenum and into the jejunum to mix with food. Second, if for any reason a patient needs to have the operation reversed, the stomach is still there and can be hooked up again. Please note that this is very rarely necessary.  Third, removing the lower part of the stomach would greatly prolong the surgery and make it more dangerous.

The upper jejunum is also divided in preparation for bringing it up to connect to the upper stomach pouch.

Step 2

The part of the jejunum that is brought up behind the colon and lower stomach pouch is called the “Roux limb”.  (Roux was a Swiss surgeon who developed the general technique.)  The Roux limb is joined or “anastamosed” to the upper stomach pouch using a circular stapler or with a hand sewn technique.  The staple line is reinforced where necessary with hand sewn stitches. The opening between the pouch and the intestine is 1.1cm (less than 1/2 inch) in diameter.

Step 3

The end of the jejunum is attached to the side of the Roux limb.  Thus, food goes down the esophagus into the upper pouch. It then goes through the anastamosis into the Roux limb.  Digestive juices from the stomach, the liver, and the pancreas travel down the duodenum and jejunum and are added to the food that has come down the Roux limb where the two parts of the small intestine are attached.   The food and the juices then travel down the small intestine mixed together and further digestion takes place.

Step 4

A gastrostomy tube is inserted through the left upper abdominal wall into the lower stomach in about 10% of patients.  The tube is a safety device that allows stomach juices to escape if the juices can’t drain easily into the small intestine.  Most patients don’t need the tube, and the decision to place the tube is made at the time of surgery based on how loose or tight the tissues are where the small bowel is attached to the Roux limb.  The gastrostomy can cause complications, and it is inconvenient and uncomfortable, so we do not use it routinely.  If a gastrostomy tube is inserted, it can easily be removed in the office 2 weeks or so after surgery.

The operation,”Roux en Y Gastric Bypass” is labeled as such because the idea of bringing up the length of small intestine was developed by the Swiss surgeon Roux, the reconstruction in “Y” shaped, and most of the stomach is bypassed!

“The battle of obesity has been my personal war from my day of birth – 12 lbs, 8 ozs. In all seriousness, my battle with the control of my weight has been very difficult. Food was always plentiful in my home. My fat – was USDA Grade A – meat and potatoes – and not McDonald’s French Fries and Big Macs. Throughout my elementary school years, I was always the last picked on any team and I always had to have a designated runner. Buying clothes, was a dreadful experience. I always ended up in the Men’s portly department.

By college, I had already experienced Weight Watchers – with no success. I entertained all of the weight loss fads of the sixties and the early seventies. On graduation day, I received my BA in my cap and gown wearing a 58 waist pants. My next venture was to seek employment as a schoolteacher. While no formal statute existed pertaining to weight discrimination in the work place, when I went for my interview, I was received in a less than favorable light. I would have never received my first teaching position without a well-placed political phone from my father’s attorney to the Board of Education.

I now embarked on my first teaching position. I spent the next 33 years in the classroom and yo-yoing with my weight gains and weight losses – Weight Watchers, Overeaters Anonymous, Diet Watchers were all visited by me. In each program, I gained and lost the weight. While I would experience minimal success, I would always gain back what I had lost and even more. I even succeed at the miracle weight-loss program of the 1980’s – OPTI-FAST liquid diet program. I went from an obese 428 pounds to a svelte 271 in 18 months. I became a poster boy for the program, appeared in the local newspaper, and became a weight-loss celebrity. My fame was fleeting. Just liked all the rest of the weight-loss programs – “I failed this test.” As soon as I came off the liquids, my abnormal behaviors resumed and I once again started my upward scale of weight gain. My second marriage went down in flames as well. I was, I thought, at my maximum weight ever and was presented with a major medical malady, Type II diabetes. Typically, I thought pills and insulin needles would control the sugar. However, while taking five needles of 150 units of insulin and every diabetes control pill a day, my weight loss was nonexistent and my sugar levels were still high. I figured it was time to do something because I was now in serious medical trouble.

Bariatric surgery seemed a definite possibility and I started to look into having the procedure. Of course, living near New York City, I opted to go to one of the biggest and best known bariatric programs in the area. I learned that bigger is not always better. I was very disappointed and remember overcoming my disappointment, after leaving the doctor’s office in the city, by stopping at a Nathan’s and having four hot dogs and a double order of fries with cheese!!!! I rewarded my hurt and disappointment by eating. A good friend, and teaching colleague, then suggested that I consider having the operation done locally in White Plains.

I met with the Bariatric surgeon in July, 2000 and discussed very openly and honestly, the weight loss surgery procedure. When I left his office, I knew this was the doctor for me. The wheels were set in motion and the date was set for August 17, 2000; a Thursday. To “celebrate” my impending surgery, my teaching colleagues took me out to dinner August 15, 2000. This is now known as the “Night of the Last Supper.” I went to an all-you-can-eat Mexican restaurant, had eleven main dishes and four desserts, including “Fried Ice Cream.” I washed it all down with 4 or 5 frozen margaritas. Twenty -four hours later came the surgery. My weight was 447.5 pounds on the hospital scale, the only scale, to this day, I will weigh myself on.

As of this writing, August 2002,1 have lost 235.5 pounds and now weigh 212 pounds naked. My waist is a 36-38.1 have dropped about 30 to 32 inches in my waist and I have gone from a 6X-7X to a large-extra large. Needless to say, my whole life is changed. I am still a diabetic, but I now have normal sugar levels and I no longer take any needles or pills for my diabetes. This is the key to post-bariatric surgery life.

There are no guarantees in life. The Bariatric Surgery Team, and the support team s available to you. It is up to you to follow the guidelines given and attend support group meetings. The Bariatric Support Group is an outstanding asset to the post-op bariatric patient. Few programs, even the “big city” hospitals, have the network that provides the support one needs after this type of surgery.

In conclusion, I would like to take a moment to thank all the individuals who have helped me “gain” a goal — a goal I thought was not possible: losing weight and keeping it off!!!”

Prior to all procedures, a consultation should occur between the prospective patient and the providing surgeon. During this consultation, the surgeon and patient will discuss the treatment plan like the desired outcome, various options that are available to achieve it, the procedure itself as well as various risks and limitations. The surgeon will also provide information regarding anesthesia options, the location and description of where the procedure will be performed (i.e., hospital vs. office surgical suite) and associated costs. A discussion regarding the patient’s medical history and reasons for wanting the surgery, will also take place during the consultation.

To learn more about gastric bypass and have realistic expectations, the patient about, it is recommended that the patient look at before and after photographs, speak with previous bypass patients, (you are always welcome to ask your doctor for referrals to previous patients and where to contact them) and get answers to the following questions:

1. Are the desired results I described realistic?
2. Where is the bypass performed and how long will it take?
3. In my case, what technique and which bypass is most appropriate?
4. What kind of anesthesia will the surgeon use during the surgery?
5. How much does bypass cost and what other elements factor into that cost (i.e., hospital fee, anesthesia, etc)?
6. What is the surgeon’s level of experience in performing gastric bypass?
7. What percentage of patients experience complications with the bypass?
8. What is the surgeon’s policy in regards to correcting or repeating the procedure if the bypass does not meet agreed upon goals?
9. What should I expect, post-operatively, in terms of soreness, scaring, activity level and so on?
10. Have you ever had your malpractice insurance coverage denied, revoked or suspended?

In addition to the previously mentioned questions, it is important that gastric bypass patients relay to their surgeon information regarding any allergies and serious medical conditions they may have. Furthermore, patients should inform the surgeon of any medications they are taking.

Do not get sticker shock. Because the operation involves substantial time of highly trained surgeons, anesthesiologists, psychologists and other medical subspecialties, plus a great deal of hospital time and numerous follow up visits, gastric bypass can range between $20,000 and $55,000. The average cost is the following:

Bariatric Weight Loss Surgeries Cash Price List

Hospitals, throughout the country, are now considering Bariatric surgery of GBP for teenagers, when it is seen as the only way to help them lose weight.

Severely obese adults have been turning to Bariatric surgery for over a decade. When the traditional weight loss plan of diet and exercise doesn’t work, Bariatric surgery is often the only way to reverse the life-changing medical complications of obesity. However, most surgeons have been reluctant to offer this surgery to teenagers.

Teenagers with morbid obesity, some who weigh 500 or even 600 pounds, are faced with medical complications such as diabetes, high blood pressure, joint problems and high cholesterol. Their social development and self-image are also profoundly affected by their obesity, as many of them are unable to attend school or participate in many of the normal activities of teenagers.

Initially, the medical community was opposed to the idea of Bariatric surgery in teenagers; however, they began to realize that for many of them this might be the only way to reverse these serious medical problems.

As a result, a task force was created by the American Pediatric Surgical Association. This group developed recommendations about who should be a candidate for this surgery.

Surgery is only done if everything else has failed. In order to be considered, a patient must have failed to lose weight after six months of organized attempts and have a disease related to obesity. The important concept here is to not make the teens thin, rather to treat their life-threatening diseases.

The most effective procedure is the Roux-en-Y gastric bypass. The two-hour laparoscopic surgery makes the stomach smaller by creating a small pouch at the top of the stomach using surgical staples. This small pouch is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. Not only is the stomach pouch too small to hold large amounts of food, but by skipping the small intestine, absorption of calories is reduced as well.

One of the risks of the surgery for teens is the possibility of losing something other than extra pounds – important vitamins and minerals. Since adolescents are still growing, physicians don’t know if there might be side effects that they can’t predict. For example, much of the calcium in bone is put into the bone at the end of adolescence.

One of the recommendations of the APSA taskforce was that Bariatric surgery should only be performed in teenagers in the setting of a long-term study. It is very important for physicians to learn how to avoid these possible complications by following these patients closely.

In spite of the possible risks, the potential benefits are great. In adults, most of the diseases associated with obesity vastly improve or disappear after the surgery.

By performing the surgery early, it is very likely that these diseases will be even easier to cure. In addition, these teens will have a better quality of life, as they will be able to participate in the normal activities teenagers enjoy.

Once patients are chosen, they participate in a support group and begin to practice the rules they will have to follow after surgery. Once the team is sure that patients and their families understand all the pros and cons of the surgery, and are able to follow the rules, they are scheduled for surgery.

The surgery is saving obese teens lives.

Today, there are several surgical procedures used for achieving weight loss. The most common are the Roux-en-Y gastric bypass, or simply, the gastric bypass and the Lap-Band, or adjustable gastric banding system.

Gastric Bypass is the most common form of weight loss surgery in the United States because it results in reliable weight loss with acceptable risks and minimal side effects. In gastric bypass surgery, the surgeon staples off a large section of the stomach, leaving a tiny pouch. Patients simply can’t eat as much as they did before surgery, because this small pouch can only accommodate a few ounces of food at a time, and they subsequently lose weight. Additionally, because most of the stomach and some of the small intestine has been bypassed, some of the nutrients and calories in your foods will not be absorbed. Appropriate candidates for this surgery are those who are 100 pounds or more overweight.

It is important that patients who have had a gastric bypass procedure make a lifelong commitment to making the necessary changes in their diet. This includes maintaining an adequate intake of protein, taking vitamin and mineral supplements including a multivitamin, B12, iron and calcium, and avoiding sweets and fatty foods.

Laparoscopic Gastric Bypass Surgery

Since 1997, the Center for Obesity Surgery has been performing a laparoscopic gastric bypass procedure. In laparoscopic surgeries, surgical instruments are inserted through small incisions rather than a large one. Patient’s benefit by having a faster recovery time than with traditional surgery, a lower risk of hernia, and less scarring. Laparoscopic surgery also protects the patient’s immune function, whereas open surgery can compromise the immune system and even promote the growth of any existing tumors. Possible complications of bowel obstruction and leaks should be discussed with your physician.

Success Rates

Weight loss surgery is considered successful when 50% of excess weight is lost and the loss sustained up to five years. For example, a patient who is 100 pounds overweight should lose at least 50 pounds; a patient who is 200 pounds overweight should lose at least 100 pounds. And they should be able to maintain loss successfully for the following five years.

Estimated weight loss in the first 1- 2 years after a Roux-en-Y Gastric Bypass is approximately 1/2 to 2/3rd of excess weight. 50% excess weight loss has been documented 10 years and more after Gastric Bypass.

Risks of Gastric Bypass Surgery

Gastric Bypass Surgery achieves weight loss by decreasing intestinal absorption of food; instead of following its usual path, food bypasses a portion of the stomach and small bowel. In addition to surgical complications, some people experience long-term deficiencies of vitamin B12, folate, and iron. “Dumping syndrome,” in which the consumption of sugar causes abdominal cramping and diarrhea, can also occur. Some people will also regain some weight in subsequent years.

faN
pr
iXk return the stomach to its pre-operative size.

Depending on the size of the patient, the Roux-en-Y can be performed through a very small incision with laparoscopic techniques or through a larger incision, in an operation known as open surgery. The stomach pouch is created by stapling or banding part of the stomach together. That limits how much food the patient can hold. Then, a Y-shaped section of the small intestine is attached to the pouch to allow yet more food to bypass that section of the intestines where many nutrients, and calories, are absorbed.

The extensive gastric bypass, a large part of the stomach is surgically removed to create a small food pouch. This operation promotes rapid weight loss but is not widely used because it creates a high risk of nutritional deficiencies and additional problems for the patient.

Patients can expect major swelling, bruising, some pain and post-operative hospitalization. Usually, your doctor gives you prescription medications to control any discomfort. The procedure is usually performed in a hospital operating room.

People who have gastric bypass operations usually lose two-thirds of their excess weight within two years after the operation. The food pouch initially holds about one ounce of food and expands to two to three ounces over time. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness so the patient eats less.

Because the body does not absorb many nutrients after gastric bypass, anemia can be a long-term effect. That, in turn, can lead of osteoporosis and metabolic bone disease. Thus, gastric bypass patients must take nutritional supplements that usually prevent such deficiencies. Many patients require not only close monitoring but also the life-long use of special foods and medications. After gastric bypass surgery, your body will not easily tolerate meals that are high in sugars and fats, foods that may make you physically uncomfortable and are usually avoided. All those changes allow people highly prone to overweight to lose weight and keep it off for the long term. Moreover, recent studies have shown that gastric bypass result in altering the release of hunger-causing hormones so that the patient’s appetite is reduced.

Once their weight has been stabilized at normal levels for at yeast a year, gastric bypass patients usually need yet another operation known as body shaping to remove large amounts of excess skin which has been extremely stretched by the massive overweight.

The operation has about a 1% death rate and is higher than those of other primary operations. Immediately following surgery, possible risks include incision infections, the wound bursting open (dehiscence,) leaks from staple breakdown, marginal ulcers, various pulmonary problems and deep clotting in veins (thrombophlebitis.) About ten percent of patients suffer some post-op complications.

Moreover, the way a patient eats will be forever changed; many patients must eat eight to ten small meals a day to obtain enough nutrients and can drink nothing while eating because the pouch can’t hold both liquid and food. Because the pouch can hold so little food, patients are routinely told to eat protein first because that is the most necessary nutrient.

Additional risks include:

• Pouch stretching. Over time, and because of eating too much, the stomach gets bigger and stretches back to its normal, pre-surgery size.
• Band erosion. The band that closes off part of the stomach disintegrates.
• Breakdown of staple lines. The band or staples fall apart and return the stomach to its pre-operative size.
• Leakage. Stomach contents can leak through the stitches. That’s dangerous because the acid can eat away at other organs.
• ”Dumping” Syndrome. Stomach contents can move too rapidly through the small intestines. Problems caused can include nausea, weakness, sweating, flatulence and, occasionally, diarrhea after eating, as well as the inability to eat sweets without becoming extremely weak.