The Roux-en-Y gastric bypass has generally been considered the gold standard surgical procedure for the treatment of morbid obesity. This has been based on the availability of long-term results that achieve an approximate 70% excess body weight loss over seven to 10 years. The correction of comorbid conditions has been reported for diabetes mellitus (83%), hypertension (69%), gastric reflux (100%), urinary stress incontinence, and degenerative joint disease. It has also been shown to provide a significant improvement in survival for those treated with surgery compared with conventional weight-loss treatment. When one considers the improvements in life expectancy, resolution of severe chronic disease, improvements in quality of life, and reduction in risk of cancer, there is hardly a procedure or medication in the history of medicine that can equal bariatric surgery.
The gastric bypass involves a rerouting of the gastrointestinal tract. The normal pathway of food travels from the mouth to the esophagus through the stomach and passes along the small intestine to the colon and then excreted out through the rectum. During this procedure, the upper portion of the stomach is stapled off, leaving a small pouch which is still connected to the esophagus. The lower segment of the small intestine is cut and brought up to be reattached to the pouch, this is considered the roux limb. The stapled off stomach and upper portion of the small intestine is reattached to meet the lower segment of the small intestine (to allow for release of liver, gallbladder and pancreatic enzymes for digestion)- this is considered the billiopancreatic limb. The new pathway of digestion is as follows: food comes in through the mouth, into the small pouch and directly into the lower portion of the small intestine before entering the colon and excreted through the rectum.
The small pouch provides the feeling of fullness or satiety (satisfaction) sooner with smaller amounts of food. This is considered a malabsorptive procedure due to the quicker transit time through the pouch, small intestine and colon. Because the food does not come in contact with the complete stomach and upper portion of the small intestine, essential vitamins and minerals that are absorbed here are not captured; hence, the malabsorptive state. Most common deficiencies are seen with calcium, iron, magnesium, vitamins A, D, E, K and B12.
Two weeks prior to surgery patients will be on a strict protein shake/liquid diet for quick weight loss. This is a normal metabolic process that happens when the body does not have carbohydrates coming in for energy and is forced to get energy from fat storage. The purpose of this is to shrink the size of the liver for a safer and more efficient surgery. Two weeks post-surgery the patient will be on a liquid diet consisting of three small protein shakes a day, and clear liquids in between. This will allow for proper tissue healing and nutrition in preparation for slowly introducing food back into the diet. Week three will start the soft food portion and week 6 will allow for raw fruits, vegetables and harder proteins to be incorporated as well.
Patients are instructed on no heavy lifting greater then 20lbs after surgery, no driving for five days after surgery and are usually able to return to a sedentary type job within 1-2 weeks. Patients that partake in more rigorous work can discuss return to work options with the MD/PA on a one to one bases. Drinking from straws and drinking carbonated beverages are discouraged after surgery. Pregnancy is possible after bariatric surgery and encouraged to hold off until two years post surgery. This will allow ample time for efficient weight loss and adjustment to the new lifestyle. To see if gastric bypass surgery is right for you, please schedule an appointment at our Long Island office by calling (631) 351-2024.