GASTRIC BYPASS RISKS RESULTS

Risks
Gastric bypass surgery has many of the same risks associated with any other major abdominal operation. Life-threatening complications or death are rare, occurring in fewer than 1% of patients. Such significant side effects as wound problems, difficulty in swallowing food, infections, and extreme nausea can occur in 10–20% of patients. Blood clots after major surgery are rare but extremely dangerous, and if they occur may require re-hospitalization and anticoagulants (blood thinning medication). Some risks, however, are specific to gastric bypass surgery:
• Dumping syndrome. Usually occurs when sweet foods are eaten or when food is eaten too quickly. When the food enters the small intestine, it causes cramping, sweating, and nausea.

• Abdominal hernias. These are the most common complications requiring follow-up surgery. Incisional hernias occur in 10–20% of patients and require follow-up surgery.

• Narrowing of the stoma. The stoma, or opening between the stomach and intestines, can sometimes become too narrow, causing vomiting. The stoma can be repaired by an outpatient procedure that uses a small endoscopic balloon to stretch it.

• Gallstones. They develop in more than a third of obese patients undergoing gastric surgery. Gallstones are clumps of cholesterol and other matter that accumulate in the gallbladder. Rapid or major weight loss increases a person’s risk of developing gallstones.

• Leakage of stomach and intestinal contents. Leakage of stomach and intestinal contents from the staple and suture lines into the abdomen can occur. This is a rare occurrence and sometimes seals itself. If not, another operation is required.

Because of the changes in digestion after gastric bypass surgery, patients may develop such nutritional deficiencies as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be prevented by taking iron, calcium, Vitamin B12, and folate supplements. It is also important to maintain hydration and intake of high-quality protein and essential fat to ensure healthy weight loss.

Normal results
In the years following surgery, patients often regain some of the lost weight. But few patients regain it all. Of course, diet and activity level after surgery also play a role in how much weight a patient may ultimately lose.

Results from long-term follow-up data of gastric bypass surgery show that over a five-year period, patients lost 58% of their excess weight. Over 10 years, the loss was 55%, and after 14 years, excess weight loss was 49%. While there is a tendency to slowly regain some of the lost weight, there is still a significant permanent weight loss over a long period of time.

Morbidity and mortality rates
Obesity by itself does not cause death. However, for those with a body mass index (BMI) above 44 lb/m2 (20 kg/m2), morbidity for a number of health conditions will increase as the BMI increases. (M2 refers to the percent of body fat divided by height). Higher morbidity, in association with overweight and obesity, has been reported for hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and some types of cancer (endometrial, breast, prostate, and colon). Obesity is also associated with complications of pregnancy, menstrual irregularities, hirsutism, stress incontinence, and psychological disorders (depression).

Alternatives
Surgical alternatives
The Lap-Band gastric restrictive procedure represents an alternative to gastric bypass surgery. The Lap- Band offers another approach to weight loss surgery for patients who feel that a gastric bypass is not suitable for them. It causes weight loss by lowering the capacity of the stomach, thus restricting the amount of food that can be eaten at one time. The band is fastened around the upper stomach to create a new tiny stomach pouch. As a result, patients experience a sensation of fullness and eat less. Since there is no cutting, stapling, or stomach rerouting involved, the procedure is considered the least invasive of all weight loss surgeries. The surgeon makes several tiny incisions and uses long slender instruments to implant the band. By avoiding the large incision of open surgery, patients generally experience less pain and scarring.

In addition, the hospital stay is shortened to less than 24 hours, including overnight hospitalization. Vertical banded gastroplasty (VBG), another commonly used surgical technique also known as stomach stapling, is today considered inferior to RNY gastric bypass in inducing weight loss. It is also associated with several undesirable complications.

Non-surgical alternatives
Dietary therapy is the fundamental non-surgical alternative. It involves instruction on how to adjust a diet to reduce the number of calories eaten. Reducing calories moderately is known to be essential to achieve gradual and steady weight loss and also to be important for maintenance of weight loss. Strategies of dietary therapy include teaching patients about the calorie content of different foods, food composition (fats, carbohydrates, and proteins), reading nutrition labels, types of foods to buy, and how to prepare foods. Some diets recommended for weight loss include low-calorie, very low-calorie, and low-fat regimes.

Another nonsurgical alternative is physical activity. Moderate physical activity, progressing to 30 minutes or more on most or preferably all days of the week, is recommended for weight loss. Physical activity has also been reported to be a key part of maintaining weight loss. Abdominal fat and, in some cases, waist circumference can be modestly reduced through physical activity. Strategies of physical activity include the use of such aerobic forms of exercise as aerobic dancing, brisk walking, jogging, cycling, and swimming and selecting enjoyable physical activities that can be scheduled into a regular routine.

Behavior therapy aims to improve diet and physical activity patterns and habits to new behaviors that promote weight loss. Behavioral therapy strategies for weight loss and maintenance include recording diet and exercise patterns in a diary; identifying such high-risk situations as having high-calorie foods in the house and consciously avoiding them; rewarding such specific actions as exercising for a longer time or eating less of a certain type of food; modifying unrealistic goals and false beliefs about weight loss and body image to realistic and positive ones; developing a social support network (family, friends, orcolleagues); or joining a support group that can encourage weight loss in a positive and motivating manner.

Drug therapy is another nonsurgical alternative recommended as a treatment option for obesity. Three weight loss drugs been approved by the U.S. Food and Drug Administration (FDA) for treating obesity: orlistat (Xenical), phentermine, and sibutramine (Meridia).