by Sue Widemark
Gastric Bypass is not only a 'stomach stapling' as the
media is fond of calling it. It's also an intestinal
bypass. In a proximal bypass (like Carnie
Wilson had), only about 20 inches of small intestine is
bypassed but that includes the part in which most of
the digestion of vitamins and minerals takes place. This
means that even with a small amount of intestine
bypassed, the post op might develop vitamin and mineral
patients will develop malnutrition and complications REGARDLESS of what
vitamins they take or what diet they do or whom their surgeon was -
different bodies are --- different. If
your surgery "goes wrong" it is NOT your fault and don't let anyone tell you
The following attorneys handle gastric bypass cases: http://www.gastricbypassmalpractice.com
If you are over 50, the gastric bypass may not be a good idea. Older bodies are not quick healing nor forgiving of drastic surgical changes as are younger bodies. If you are over 50, and feel you need Weight Loss Surgery, consider getting the adjustable lap band which is a lower risk surgery than the gastric bypass.
gastric bypass and DS/BPD patients may be high risk for osteoporosis.
This is because the part of the intestine where most calcium is absorbed
is bypassed. No one knows how much calcium the Weight Loss Surgery
patient can absorb but it may be a lot less than the daily needs.
Osteoporosis is a silent illness and difficult to measure even with bone
scans - typically the patient is not aware they have it until it causes
the back bone to crumble or some other catastrophic event occurs.
Therefore, even if you have 'normal' bone scans and blood level calcium
tests, your body may still be sapping what it needs from your bones if you
are not getting enough calcium from what you eat.
Having Weight Loss Surgery does NOT mean you will never have to diet again. It is intended as a tool to HELP you diet. Like all tools, it doesn't work for everyone.
gastric bypass patients have complications which require repeat surgeries.
Complications like bowel obstruction, narrowing
of the stoma (opening between pouch and intestines), kidney stones, or
hernia may require you to go back to the hospital for more surgery.
A percentage of gastric bypass patients develop leaks right after surgery. This is often caused by a stapler misfire and can show up a day or two post op. If you don't feel well or are extremely nauseated, be very pro active about having your surgeon check for leaks. Quick action on this can be the difference between life and death, literally.
Weight loss surgery can be extremely painful and some patients are given a morphine pump for pain. Most go home with several drains to allow the patient to watch for internal bleeding and infection. The diet immediately after surgery is liquids only for several weeks. Some patients feel well right away but others feel poorly for months after surgery as the body slowly heals from the surgical rearrangement made inside the abdomen. The DS/BPD patients seem to heal a bit more slowly than gastric bypass patients. Expect to be uncomfortable for at least a month or two after surgery.
Gastric bypass or duodenal switch surgery will cause a very quick weight loss in the first year or so, by a drastic reduction of nutrient intake. But after the first year or two, you will heal and if you don't diet and exercise, you may re-gain the weight.
The results of the Hebrew University study in 1993 showed that only 7 percent of gastric bypass patients kept all their weight off, another 25 percent gained back to clinical obesity and the rest kept off 'some weight'. Surgeons will call your surgery a success if you keep off 40 percent of your initial weight loss. So if you lose 100 lbs and keep off 40 lbs, you are considered a 'success'.
Dept. of Surgery C, Soroka Medical Center, Beer Sheba (Israel study)
Harefuah 1993 Feb 15;124(4):185-7, 248 (article is in Hebrew)
Some patients experience a certain amount of puking or loose bowel movements as a result of Weight Loss Surgery. Dr Fobi calls the gastric bypass "Induced bulimia". Be sure to eat very slowly, take small bites and chew to liquefy food, to avoid problems. Vomiting can rip out the new assembly in a gastric bypass patient. Avoid it at all costs. Having Weight Loss surgery does not mean you don't have to measure food, it means you have to measure it MORE CAREFULLY. Dr Simpson suggests "measure twice, eat once, vomit NEVER".
Weight Loss surgery will
basically render very obese people, less obese, writes Dr Louis Flancbaum.
Do not hold unrealistic hopes as far as how "thin" you will be after this
surgery - it is done for health rather than looks.
Some patients have a lot of loose skin
after a quick weight loss and may feel that for comfort, they need plastic
surgery. Plastic surgery is sometimes covered by insurance and
stapled stomach produces very little acid (this
is on purpose to avoid esophageal reflux) which means that protein is not
well digested (the enzyme which digests protein needs to work in stomach
acid) and also, bacteria may not be killed before the food is absorbed in
the blood stream. Large amounts of bacteria entering the blood
stream from the intestines can cause a lot of problems in the body
including auto immune illness like joint disease, and rheumatoid
bypassed stomach can still produce acid but it is not neutralized
by the duodenum since the action of the duodenum to neutralize requires the
presence of food. Thus the acid may go into the small bowel. Ulcers in
the small bowel especially in longer term gastric bypass patients are
common. These can be hard to find, hard to fix and cause leaks, and
Some post ops who are four and five years
out from surgery, do stay fairly thin without dieting and exercise but only because
they have a lot of physical problems. Be careful that you
aren't exchanging one set of problems for another.
Most people feel that thin and ill is not preferable to being
fat and healthy.
Weight Loss Surgery will not fix
depression. As a matter of fact, prolonged starvation
(which you will experience, eating 500-1000 calories a
day and not absorbing much in the way of nutrients) has
been observed to cause depression. A high percentage of
marriages break up after Weight Loss Surgery. Also, the chronic pain which
some Weight Loss surgery patients suffer can contribute to depression.
Any quick weight loss is
considered "extreme dieting" which means a very low nutritional intake.
This type of weight loss, while very attractive to members of an "instant"
society who wish things RIGHT NOW, does have its side effects. For one, your body sets your
metabolism way down making it harder to keep the weight off after the
first year. Your body does this by cannibalizing it's
own muscles and even parts of organs. There is a growing
body of evidence that starvation can cause brain damage
and a lessening of mental abilities as well. This would
make sense as the cognitive areas of the brain are not necessary to maintain
life. (See the studies of the Institute of Food Research, UK -
studies are not on line but they will send these if you request)
media tells us that the gastric bypass is a new surgery and that's why
they don't have statistics on longevity and other issues - but, it is NOT
new. Gastric bypasses have
been done for 40 years yet we have access to little to no statistics on
long term results.
The inventor of the gastric
bypass, Dr Edward Mason, has expressed concerns about the gastric bypass
because of vitamin deficiency and advocated a surgery called the VBG which
did not include any shortening of the small gut.
Many Gastric bypass patients do
not digest Vitamin B12 and need to take B12 shots, at least once a month.
If you don't take these, you may get symptoms like numbness of the hands,
feet and legs ("peripheral neuropathy"). A long term deficient in Vitamin
B12 can cause auto immune disease and pernicious anemia. Make sure you are
careful about watching for symptoms which can show up before your blood work
shows a shortage.
The gastric bypass is, for all
practical purposes, not reversible. The digestive system
is permanently changed in weight Loss surgery. Some of it can be
fixed (called a 'take down') but the patient will suffer repercussions for
the rest of his/her life and the takedown surgery is as dangerous or more
so than the original surgery. So be very
sure of what you are doing before you make this decision.
(Note: The Adjustable Band is reasonably reversible although, in time -
2-5 years, some damage
to the stomach may be done by the band.)
will not die in five years if you don't have Weight Loss Surgery!
No research to date shows that obesity alone, is a risk factor. The
risk factor on having a BMI over 40 is generally thought to be like being a
light smoker. (reduce life span by 5 years so that means you may only
live to 73 instead of 78)
Living a sedentary lifestyle is a risk factor but no matter how large a
person is, they can begin to exercise (water aerobics, cycling and walking
are good exercises for larger people). Many large people have said
"no" to Weight Loss surgery and have long outlived their friends
that did have the surgery.
It may be true that as they say, that Weight loss surgery is the only
way to permanently lose weight as the ads tell us.
However, it is a tool which doesn't work for everyone and there are no
guarantees that the risks you are taking with having surgery are going to
result in a permanent weight loss. More importantly, there is a
growing body of evidence to suggest that we can only vary our bodyweight 10
percent below our setpoint (20-40 lbs) without fighting total daily wars
with our bodies. This is because the body is a complex and automated
system and will produce hormones and change in other ways to stop weight
loss or cause a gain WITHOUT US DOING ANYTHING if it senses it's at -what it
considers- an unhealthy weight. This is even true with patients who
have HAD bariatric surgery. So when you consider surgery, keep in mind you
may only be looking at keeping off 30-50 lbs in the long run which you can
do without surgery also. Weight Watchers states that losing 10
percent of your present bodyweight is enough to reduce health risks by 95
percent and you can do that without surgery.
The Duodenal Switch is a newer surgery than the gastric bypass and the stomach stapling part has some advantages over the gastric bypass: (1) DS patients may have less intestinal ulcers because the stomach is made into a pouch and retains the natural arrangement with a few inches of the first part of the small bowel still connected (i.e. no 'bypassed stomach' to dump raw acid into the small bowel). However, it should be noted that 70-90 percent of the stomach is REMOVED OUT OF THE BODY in this surgery so if the 10-20 percent of stomach you have left develops ulcers or necrosis, you can totally lose your stomach. (I have met two such patients who have lost their stomachs after this surgery went wrong). (2) You have more leeway about what you can eat - most DS patients don't dump after eating sugar and most can eat more veggies than can gastric bypass patients. But this surgery can have its darker side. It is done with a BPD which was a variation of the old intestinal bypass. The BPD shortens the small gut considerably and as such, can cause kidney stones, liver failure and "bacterial overgrowth" (part of the small gut gets obstructed and starts to rot). Bottom line, when a DS "goes bad" it's not pretty! :)
Evidence exists that the absence of bile and pancreatic juice, the shortness of the gut, the protein malnutrition, and possibly the presence of undigested food in the colon are all factors predisposing to bacterial overgrowth.
(DS/BPD - Marceau, Surg Clin North Am - 01-Oct-2001; 81(5): 1113-27)
Some feel that long term protein malnutrition is also a danger with the BPD:
The BPD and the duodenal switch involve permanent removal of part of the stomach and bypassing of a large amount of intestine. It is more radical than the original intestinal bypass operation that was abandoned many years ago. BPD is associated with horrific side effects including kwashiorkor. It takes several years for the body to be fully depleted of stored nutrients so most likely recent post ops have not been affected yet. DS patients should be followed by a gastroenterologist.
Paul Ernsberger, PhD, Department of Nutrition, Case Western Reserve School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4906 Web address: http://www.cwru.edu/med/nutrition/ernsberger.htm Email: firstname.lastname@example.org ; FAX: (216) 368-6644
Some patients get loose bowels with the BPD (several soft bowel movements a day)
According to the ASBS website: "Any procedure involving malabsorption must be considered at risk to develop at least some of the malabsorptive complications exemplified by JIB (jejuno-ileal bypass). " All gastric bypasses work through malabsorption and the Duodenal Switch is an EXTREMELY malabsorptive procedure so these patients are in danger of the following complications:
Listing of jejuno-ileal bypass complications:
Mineral and Electrolyte Imbalance:
- Decreased serum sodium, potassium, magnesium and bicarbonate.
- Osteoporosis and osteomalacia secondary to protein depletion, calcium and vitamin D loss, and acidosis,
Protein Calorie Malnutrition:
- Hair loss, anemia, edema, and vitamin depletion
- Abdominal distension, irregular diarrhea, increased flatus, pneumatosis intestinalis, colonic pseudo-obstruction, bypass enteropathy, volvulus with mechanical small bowel obstruction.
- Acute liver failure may occur in the postoperative period, and may lead to death acutely following surgery.
- Liver disease, occurs in at least 30%
- Steatosis, "alcoholic" type hepatitis, cirrhosis, occurs in 5%, progresses to cirrhosis and death in 1-2%
- Erythema Nodosum, non-specific pustular dermatosis
- Weber-Christian Syndrome
Renal Disease: (in other words, kidney disease and kidney failure)
- Hyperoxaluria, with oxalate stones or interstitial oxalate deposits, immune complex nephritis, "functional" renal failure.
- Peripheral neuropathy, pericarditis. pleuritis, hemolytic anemia, neutropenia, and thrombocytopenia.
If you join one of the post operative support groups, you will indeed see several people with the above complications. The longer ago they had the surgery, the more complications seen. You will also see some of those people say that their complications are not because of the Weight Loss Surgery, even though what they are describing is listed as one of the side effects of WLS. Some people are in denial about the cause of their physical problems, perhaps because it would be too painful to wonder whether they made the right decision to have the surgery.
As with all things, take time with your decision. You can always have the surgery at a later date when you have a greater comfort level about it. It is entirely possible that in the near future there may be a medication obese individuals can take which will work directly on the appetite centers. The billroth II, the surgery from which the gastric bypass was invented, is not done anymore because the condition of duodenal ulcers is now treated with medications.
Weight Loss surgery is a miracle for some, for others, the tradeoffs are worth the results and for still others, it can be a disaster. It is serious invasive surgery and all factors should be considered. The idea behind weight loss surgery is that although it IS a painful risky solution, it can be LESS painful or risky than remaining clinically obese. Each person must decide for themselves if they feel they would benefit from this solution.
These books are helpful:
Weight Loss Surgery a Lighter Look at a Heavy Subject
by Terry Simpson, MD
Dr Simpson, a Bariatric Surgeon who has done thousands of WLS procedures has written what is probably the most authoritative book on the subject. The book is illustrated and written in a readable style with Dr Terry's own brand of humor throughout. More information or order book
I Want To Live - Gastric Bypass Reversal by Dani Hart
Dani Hart takes you on her journey through Weight Loss Surgery (RNY gastric bypass) and the reversal.
See more information or order book
Doctor's Guide To Weight Loss Surgery by Dr Louis Flancbaum et al
Very pro surgery but pretty honest about the risks etc
See more info or order book
For more information about Weight Loss surgery, click here.