The Roux-Y Gastric Bypass
Surgical procedures for weight loss can be
classified as restrictive or mal-absorptive. The restrictive procedures
create a small stomach pouch, limiting food intake, while the
mal-absorptive procedures bypass a portion of the intestinal tract,
limiting the absorption of ingested food.
The original "gastric stapling" operation was a purely restrictive
procedure, limiting the amount of food one could eat at a time.
The results of this early procedure were quite discouraging, in that only 30% of patients were able to lose 50% of their excess body weight. The operation could easily be defeated by poor food choices, and a very strict diet was required following surgery to allow a satisfactory result. A patient could actually gain weight after this operation by drinking milkshakes and eating fast food. For this reason, it was not adopted by mainstream surgeons, since the risks could not justify jumping on the bandwagon of an operation that had a 30% chance of being 50% successful.
The "Lap-Band" is another purely restrictive procedure whose results are almost identical to the initial gastric stapling procedure. An attractive advertising campaign cannot change the fact that "those who do not learn from history are doomed to repeat it." We utilize the Roux-Y Gastric Bypass, which has become the "gold-standard" against which all other procedures must be judged, as the procedure of choice. Note that the stomach is actually divided to create the pouch.
This operation creates a small stomach pouch, which is connected to the mid-portion of the small intestine, combining the best features of both types of procedures.
Surgical Results
The actual weight a patient will lose after the procedure is dependent on several factors. These include:
- Patient's age
- Weight before surgery
- Overall condition of patient's health
- Surgical procedure
- Ability to exercise
- Commitment to maintaining dietary guidelines and
other follow-up care
- Motivation of patient and cooperation of their
family, friends and associates
In general, weight loss
surgery success is defined as achieving loss of 50% or more of excess
body weight and maintaining that level for at least five years.
Clinical data will vary for each of the different procedures mentioned
on this site. Results may also vary by surgeon. Ask your doctor for the
clinical data stating their results of the procedure they are
recommending.
The results of this procedure are well documented. In one study, a
14-year follow-up of 608 morbidly obese patients undergoing this
procedure, the mean weight loss was 100 pounds. Clinical studies show
that, following surgery, most patients lose weight rapidly and continue
to do so until 18 to 24 months after the procedure. Patients may lose
30 to 50% of their excess weight in the first six months and 77% of
excess weight as early as 12 months after surgery. Another study showed
that patients can maintain a 50-60% loss of excess weight 10-14 years
after surgery. Patients with higher initial BMIs tend to lose more
total weight. Patients with
lower
initial BMIs will lose a greater percentage of their excess weight and
will more likely come closer to their ideal body weight. Patients with
Type 2 Diabetes tend to show less overall excess weight loss than
patients without Type 2 Diabetes. The surgery has been found to be
effective in improving and controlling many obesity-related health
conditions. A 2000 study of 500 patients showed that 96% of certain
associated health conditions studied (back pain, sleep apnea, high
blood pressure, diabetes and depression) were improved or resolved. For
example, many patients with Type 2 Diabetes, while showing less overall
excess weight loss, have demonstrated excellent resolution of their
diabetic condition, to the point of having little or no need for
continuing medication. Of this group, 298 had Type II adult onset
diabetes. 91% of these patients returned to normal fasting glucose
levels. 353 of these patients were hypertensive before the operation.
Following the surgery, only 85 (14%) remained hypertensive. Other
studies confirm these results.
In summary, this is a superior operation for weight loss and has become
the gold standard in the United States against which other procedures
are judged.
What Would It Mean For Me?
It is reasonable to undergo a bariatric surgical procedure to achieve improved health, or improved ability to be active for health. Patients should not enter into this surgical commitment to become more attractive, to mend a distressed marriage, or for other social factors.
Prospective patients must consider the fact that if the surgery creates the effects it is intended to, it will cause dramatic and irrevocable changes in their lifestyle, in all of their personal relationships (not always good changes) and in their relationship with food.
Consider how deeply intertwined food is with many American social functions ranging from weddings to funerals to just "going out."
People who undergo bariatric surgery do not function "normally" in these food-oriented situations, they are not able to occupy themselves with food and must learn new ways to occupy themselves socially.
Weight loss and the subsequent improvement in medical problems are the core issues in outcomes of bariatric surgery.
But, in the long run, these factors are a small price to pay for the improved quality and, ultimately, the quantity of your lifetime.
Choosing Surgery
Weight loss surgery is major surgery. Although most patients enjoy an improvement in obesity-related health conditions (such as mobility, self-image and self-esteem) after the successful results of weight loss surgery, these results should not be the overriding motivation for having the procedure.
The goal is to live better, healthier and longer.
That is why you should make the decision to have weight loss surgery only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician. A qualified surgeon should answer your questions clearly and explain the exact details of the procedure, the extent of the recovery period and the reality of the follow-up care that will be required. They may, as part of routine evaluation for weight loss surgery, require that you consult with a dietician/nutritionist and a psychiatrist/therapist. This is to help establish a clear understanding of the post-operative changes in behavior that are essential for long-term success
It is important to remember that there are no ironclad guarantees in any kind of medicine or surgery. There can be unexpected outcomes in even the simplest procedures. What can be said, however, is that weight loss surgery will only succeed when the patient makes a lifelong commitment. Some of the challenges facing a person after weight loss surgery can be unexpected. Lifestyle changes can strain relationships within families and between married couples. To help patients achieve their goals and deal with the changes surgery and weight loss can bring, most bariatric surgeons offer follow-up care that includes support groups, dieticians and other forms of continuing education.
Baltimore Bariatrics (Unpublished data)
591 Patients RYGBP (Jan 2001 - Dec 2006)
- Females: 499 Males: 92 (5:1)
- Average age: 42 years (range 19 - 67 yrs)
- Mean weight: 314 lbs (range 193-569 lbs)
- Mean BMI: 49.8 (range 35.1 - 91.8)
- Mean Weight Loss: 109 lbs (Total 63,6000 lbs, 31.5
TONS)
- Mean % Excess Body Weight: 61% (range 30 - 102%)
Ultimately, the decision to have the procedure is entirely up to you. After having heard all the information, you must decide if the benefits outweigh the side effects and potential complications. This surgery is only a tool. Your ultimate success depends on strict adherence to the recommended dietary, exercise and lifestyle changes.
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