Gastric bypass is the favored bariatric surgery in the United States. Surgeons prefer this surgery because it’s safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes.
Additionally, it can help reduce the following:
Heart Disease and Stroke
Heart disease and stroke are the leading causes of death and disability for both men and women in the United States. Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, than people who are not overweight. Very high blood levels of cholesterol and triglycerides (blood fats) can also lead to heart disease and often are linked to being overweight. Being overweight also contributes to angina (chest pain caused by decreased oxygen to the heart) and sudden death from heart disease or stroke without any signs or symptoms. The good news is that losing a small amount of weight can reduce your chances of developing heart disease or a stroke. Reducing your weight by 10 percent can decrease your chance of developing heart disease by improving how your heart works, blood pressure, and levels of blood cholesterol and triglycerides.
Several types of cancer are associated with being overweight. In women, these include cancer of the uterus, gallbladder, cervix, ovary, breast, and colon. Overweight men are at greater risk for developing cancer of the colon, rectum, and prostate.
Type II diabetes reduces your body’s ability to control your blood sugar. It is a major cause of early death, heart disease, peripheral vascular disease, kidney disease, stroke and blindness. People who are overweight are twice as likely to develop type 2 diabetes as people who are not overweight. You can reduce your risk of developing this type of diabetes by losing weight and by increasing your physical activity control your blood sugar levels. If you use medicine to control your blood sugar, weight loss and physical activity may make it possible for your doctor to decrease the amount of medication you need.
Sleep Apnea is a serious condition that is closely associated with being overweight. Sleep apnea can cause a person to stop breathing for short periods during sleep and to snore heavily. Sleep apnea may cause daytime sleepiness and even heart failure. The risk for sleep apnea increases with higher body weights. Weight loss usually improves sleep apnea.
Osteoarthritis is a common joint disorder that most often affects the joints in your knees, hips and lowers back. Extra weight appears to increase the risk of osteoarthritis by placing extra pressure on these joints and wearing away the cartilage (tissue that cushions the joints) that normally protects them. Weight loss can decrease stress on the joints to improve the symptoms of osteoarthritis and prevent further damage to the joints.
Gout is a joint disease caused by high levels of uric acid in the blood. Uric acid sometimes forms into solid stone or crystal masses that become deposited in the joints. Gout is more common in overweight people and the risk of developing the disorder increases with higher body weights.
Note: Over the short term, some diets may lead to an attack of gout in people who have high levels of uric acid or who have had gout before. If you have a history of gout, check with your doctor or other health professional before trying to lose weight.
Gallbladder disease and gallstones are more common if you are overweight. Your risk of disease increases as your weight increases, though it is not clear how being overweight causes gallbladder disease.
Chronic Venous Insufficiency
This is a condition where blood pools in the veins of your legs instead of traveling back to the heart. This can lead to varicose veins and leg ulcers.
Degenerative Joint Disease
In addition, obesity is associated with increased arthritis pain, low back pain, chronic joint pain, and joint deterioration. It has been shown that many of these conditions will improve or resolve with weight loss.
SHORT TERM COMPLICATIONS
Early complications with gastric bypass and Lap Band operations have been low. The most frequent early complication is infection of the surgical incision, especially in the larger “open” surgery. However, infections can happen anywhere in your body. Examples of infection are pneumonia, bladder infection, and abdominal abscess. All infections must be treated. Prior to your surgery and after the procedure, antibiotics are administered. The antibiotics will decrease the risk of developing a wound infection. Also, a breath exercise machine (Incentive Spiro meter) is used to keep your lungs expanded to help prevent pneumonia.
Morbidly obese people are at a high risk of developing “clots”. Clots are known as “DVT’s”, Deep Venous Thrombosis, and can form in the veins of the legs. If clots migrate from the legs and go to the lungs, then they are known as “PE’s”, Pulmonary Embolus. PE’s are the most frequent cause of acute death following a gastric bypass surgery. The risk of DVT formation can be decreased by using pneumatic compression boots for the legs, and walking (nurses on 9 East Jones will strongly encourage after surgery.)
A serious complication after gastric bypass is a leak. Leaks can happen anywhere in the stomach or intestines. Your GI Tract (mouth, esophagus, stomach, intestines, and colon) is one continuous tube. During gastric bypass surgery, the tube is cut and sewn to re-arrange the bowel. A leak can develop at any of the cut areas. A leak can cause you to become very sick and will usually require another operation to repair the leak. There is a 5% chance of developing a leak.
In some patients the Lap Band may be too tight around the stomach tissue, causing nausea and vomiting with any oral intake. This will require further time in the hospital to receive intravenous fluid while waiting for the tissue swelling to resolve.
LONG TERM COMPLICATIONS
General – Gastric Bypass and Lap Band
Wound herniation, or the pulling apart of small sections of the abdominal wound, is a complication caused by the tremendous amount of pressure on that wound closure in a very obese abdomen.
In patients over 300 pounds, this complication may occur in nearly 20% of cases. In patients with lesser intra-abdominal pressure, the incidence is about 5%. A laparoscopic operation greatly reduces the risk of a wound hernia, as the size of the incision is much smaller. Hernias can be effectively repaired with surgery when the weight is lost.
The development of gallstones is related to the rapid and significant amount of weight loss, and therefore, is highest in the first six months after surgery. Gallstones are not a complication of surgery as such, but rather a complication of rapid weight loss. Obese persons have a very high rate of gallstone formation compared to normal weight persons, mainly because of the many weight loss/gain episodes that obese persons undergo. By age 50, nearly 50% of morbidly obese women have developed gallstones. If you have a gallbladder following gastric bypass surgery you will be placed on a medication for six months post-operatively to prevent the formation of gallstones. This reduces your risk of developing gallstones from about 30% to almost 3%.
Late complications with gastric bypass operations have been low. The most frequent long term complication is weight gain due enlargement of the pouch, enlargement of the outlet, patient non-compliance.
Bowel obstruction due to a blockage from adhesions (scar tissue) can occur as it can after any abdominal operation, trauma, or intra-abdominal infection. Usually this presents with nausea and vomiting and frequently requires another operation to correct.
Stomal ulcer is an acid/peptic ulcer that occurs on or near the anastomosis (connection) between the stomach pouch and the bowel. An ulcer may also rarely occur in the usual duodenal ulcer position. The acid-peptic ulcer occurs in approximately 2-4% of patients which is not unlike the incidence in the general population, except that the stomal ulcer is much more likely to occur in smokers or patients who must continue to use non-steroid anti-inflammatory drugs (NSAID) such as ibuprofen, Aleve, etc. You will be placed on a medication to help prevent the formation of ulcers post-operatively for 6 months following surgery. Some patients may need to take this medication longer.
Stomal stenosis or stricture is narrowing of the outlet of the stomach pouch. This problem often requires outpatient endoscopic dilation for correction. Sometimes this procedure may need to be repeated 2-3 times to correct the problem.
Iron deficiency anemia is a complication of significance in the long term. It usually occurs in menstruating women who do not take extra iron supplements. It is almost always preventable. It is not difficult to treat, but must be recognized in order for it to be treated. This is one of the important reasons for long-term follow-up and blood tests.
Additional vitamin deficiencies can be a long-term complication following a Roux-en-y gastric bypass. These deficiencies may include protein, calcium, Vitamin B12, magnesium, and folate. It is extremely important to continue with your follow up after surgery and have your blood work monitored at the specified intervals: 3 months, 6 months, 1 year and annually thereafter (more frequently if necessary). After surgery you must take a multivitamin and calcium (1200 mg) for the rest of your life.
Dumping syndrome under normal physiologic conditions, the stomach and pylorus (the opening of the stomach into the small intestine) control the rate at which the gastric contents leave the stomach. That is, the stomach, pancreas and liver work together to prepare nutrients (or sugar) before they reach the small intestine for absorption. The stomach serves as a reservoir that releases food downstream only at a controlled rate, avoiding sudden large influxes of sugar. The released food is also mixed with stomach acid, bile, and pancreatic juice to control the chemical makeup of the stuff that goes downstream and avoid the “dumping syndrome”.
Dumping syndrome is usually divided into early and late phases. The two phases have separate physiologic causes and will be described separately. In fact, a patient usually experiences a combination of these events and there is no clear-cut division between them.
Rapid gastric emptying, or early dumping syndrome, happens when the lower end of the small intestine fills too quickly with undigested food from the stomach. After the RNY gastric bypass, patients can develop abdominal bloating, pain, vomiting, and vasomotor symptoms (flushing, sweating, rapid heart rate, light headedness). Finally, some patients have diarrhea. Since with the RNY Gastric bypass the stomach is not being used and a new, small pouch that directly connects to the small intestine is created, there may be dumping. Early dumping syndrome is due to the now rapid gastric emptying causing bowel distension plus movement of fluid from the blood to the intestine to dilute the intestinal contents. These symptoms usually occur 30 to 60 minutes after eating and are called the early dumping syndrome.
Late dumping has to do with the blood sugar level. The small bowel is very effective in absorbing sugar, so that the rapid absorption of a relatively small amount of sugar can cause the glucose level in the blood to rise rapidly. The pancreas responds to this glucose challenge by increasing the insulin output. Unfortunately, the sugar that started the whole cycle was such a small amount that it does not sustain the increase in blood glucose, which tends to fall back down at about the time the insulin surge really gets going. These factors combine to produce hypoglycemia (low blood sugar), which causes the individual to feel weak, sleepy and profoundly fatigued.