This procedure is the most commonly performed bariatric procedure in the United States, and is often referred to as the “gold standard” in weight loss surgery. This surgery combines a restrictive component, along with nutrient malabsorption. This procedure utilizes staples to transect the stomach and create a small pouch. The small bowel is then directly connected to the pouch and a gastrojejunostomy is created. The surgeon may choose to create a “long-limb” and this procedure is then called a Long-Limbed Roux-en-Y. The rearrangement of the normal anatomy allows food to bypass portions of the small bowel, thus limiting the body’s ability to digest food, and allowing undigested food to pass out of the body. Several studies have indicated that weight loss is most effective with Roux-en-Y as compared to vertical-banded gastroplasty or other forms of gastric bypass.
When properly performed, and with adequate post-operative care, gastric bypass can save lives. Research has shown that those patients who underwent successful surgery had as much as a 40% lower risk of dying over seven to ten years compared to those who did not have the operation.
A caveat: The risks of surgery may be greater than was once thought. Data suggest that 20% of weight-loss surgery patients suffer some type of competition, with 5% suffering serious problems such as heart attacks and stroke. The death rate in the first 30 days after surgery may be higher than for some types of heart interventions.
A warning for post-op patients: Take Your Vitamins. Brain damage, which in some cases is permanent, can occur in the weeks following surgery if there is a thiamine deficiency. Timing is an essential B. vitamin which must be taken as a post operative supplement. Advise your doctor immediately if you have vomiting, confusion, lack of coordination or vision changes.
While gastric bypass surgery can moderate or even cure diabetes, in some rare cases the pancreas may go into hyper-drive, resulting in increased insulin production and dangerously low levels of blood sugar (hypoglycemia). Patients with this condition typically have a hypoglycemic attack a few hours after eating. If you have unexplained symptoms after eating, contact your doctor immediately.
Leak is a potentially fatal complication after surgery. If a leak is not timely and properly dealt with the kidneys may shut down, infection may develop, and death may result from multi-organ failure.
Leaks occur in as many as five of one hundred surgeries. Is believed that the great majority of leaks occur through no fault on the part of the surgeon. While many techniques have been tried intraoperatively to prevent leaks, there is no actual proof that they are effective. The surgeon must have a very high degree of suspicion and act quickly. A heart rate elevated to 120 bpm or more, a condition known as tachycardia, is very concerning and should be thought of as a red flag for leak.
The hospital in which gastric bypass is being performed should absolutely have the capability to perform computed tomography (CT scan). While there are inherent limitations in clinically severe obese patients, and false negative results are possible, CT scanning is the primary imaging study when there is clinical suspicion of leak. A CT scan may show an active leak, but the surgeon must be aware that a leak can be occurring even with a negative or equivocal result. If the patient is exhibiting signs or symptoms of a leak, exploratory surgery should be done on an emergency basis. A number of studies have shown that surgical read exploration is safe when compared to the consequences of inaction. Given that inflammation, sepsis, organ failure or death may occur when diagnosis and treatment of a leak is delayed surgery is the safest option. It is dangerous to try to manage a leak without surgery, and unless symptoms resolve quickly and completely, surgery must be done. If surgical re-exploration is performed and reveals no leak, that is not a basis for claim that the surgery was inappropriate.
While some leaks occur while the patient is still in the hospital, others become symptomatic shortly after discharge. The post operative bariatric patient must never hesitate to come back to the hospital when symptoms develop. If time is wasted the body’s defenses can be overwhelmed and very significant illness or death can occur.
The American Society for Metabolic and Bariatric Surgery has established guidelines for the emergency care of patients with complications relating to weight-loss surgery. They have gone so far to say that “ethical standards” require that the operating surgeon provide appropriate postoperative care including emergency care after discharge from hospital. In addition the guidelines place significant responsibility on the shoulders of surgeons in a very specific way. For instance:
• Bariatric surgeons have an obligation to maintain their familiarity with various surgical procedures as a part of their “obligation” to provide care to all patients requiring emergency treatment of bariatric surgery related complications.
• Bariatric surgeons have an “obligation” to provide emergency care .
• Be on the staff of a hospital that performs bariatric surgery and provides 24-hour per day emergency services.
