Gastric Bypass Surgery

During this laparoscopic procedure, six to eight tiny incisions are made to perform the operation. Surgeons insert long instruments through these tiny holes to perform the procedure. A camera is attached to one of these instruments, showing an image of the operation on a television monitor.

A recent advancement is the use of Da Vinci robot to perform Laparoscopic gastric bypass surgery. The robot provides high definition view of laparoscopic filed and allows the performance of complex laparoscopic procedures more precisely.

Since the same operation is performed during open and laparoscopic surgeries, other outcomes, including weight loss, are similar with both approaches. Both open and laparoscopic gastric bypass surgeries are performed at UPMC Hamot. Laparoscopic gastric bypass cannot be performed in every patient. During your consultation, you will be able to find out if you qualify for a laparoscopic gastric bypass surgery. The laparoscopic approach offers the advantages of smaller incisions and, typically, less pain and earlier recovery. There is also a lower incidence of ventral hernias (abdominal hernias) after laparoscopic gastric bypass compared with open gastric bypass.

Since the stomach is smaller, a person feels full after a very small meal. The connection between the gastric pouch and the small intestine is very small, and food tends to stay in the gastric pouch for a long duration, giving the person a feeling of fullness for several hours. Since a part of the small intestine is bypassed, all of the calories in the food are not absorbed. This method helps with weight loss, but still requires a change in lifestyle.

Anemia may result from the non-absorption of the vitamin B12 and iron in menstruating women, while decreased absorption of calcium may bring on osteoporosis and metabolic bone disease. Patients are required to take lifelong nutritional supplements that usually prevent these deficiencies.

Gastric bypass may cause dumping syndrome, whereby stomach contents move too rapidly into the small intestine. A large number of patients will experience dumping syndrome after the operation. Symptoms include nausea, weakness, sweating, faintness, and, occasionally, diarrhea after eating. In addition, eating sweets causes patients to become weak and sweaty, and they must lie down. The symptoms usually pass in less than two hours.

Patients can expect to lose 40 to 75 percent of their excess weight over a period of 18 months after gastric bypass surgery. Over a five year period, patients tend to regain 10 to 20 pounds. However, most people are able to lose a significant amount of weight and keep it off long-term.

Many factors influence weight loss after gastric bypass surgery. Younger patients, men, and patients committed to making permanent lifestyle changes usually lose more weight. Individual weight loss results will vary, and 10 to 15 percent of patients may lose less than 50 percent of their excess weight.

Benefits

• Most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure.
• Significant sustained weight loss. Although many patients regain some of their weight after 24 months, few regain all of their weight.
• Bariatric surgery improves or eliminates most obesity-related conditions, such as high blood pressure, high cholesterol, sleep apnea, and diabetes.
• Blood sugar levels for most patients with adult onset diabetes (Type II) improved almost immediately and become completely normal within a year of surgery.
• Less pain associated with osteoarthritis and improved mobility.
• Improved mood and self-esteem.

Risks

• 10 to 20 percent of patients who have open bariatric surgery may require follow-up operations to correct hernias.
• Other possible post-surgical complications include infection, bleeding, and death.
• During rapid or substantial weight loss, a person’s risk of developing gallstones is increased. More than one-third of gastric bypass patients develop gallstones, which could lead to a laparoscopic procedure known as cholecystectomy to remove the gallbladder. Gallstones can be prevented with supplemental bile salts taken for the first six months after surgery.
• Nearly 30 percent of patients who have bariatric surgery develop nutritional deficiencies, such as anemia, osteoporosis, and metabolic bone disease. These deficiencies can be avoided if lifelong vitamin and mineral intake are maintained.
• Dumping syndrome caused by stomach contents moving too rapidly through the small intestine.

It is important to know that gastric bypass surgery cannot be completely reversed. The decision to have this procedure must be made in consultation with your surgeon, and after a very careful consideration of the potential benefits, risks, and lifelong consequences.