The Roux-en-Y gastric bypass has generally been considered
the gold standard surgical procedure to treat 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 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 than 20 lbs after surgery, no driving for five days after surgery and can usually 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 basis. 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.