Gastric Bypass Surgery Support Group

Gastric bypass (GBP) is any of a group of similar operative procedures used to treat morbid obesity, a condition which arises from severe accumulation of excess weight as fatty tissue, and the resultant health problems ("co-morbidities") which occur. Bariatric surgery is the surgical treatment of morbid obesity, and includes the gastric bypass procedures as one of several classes of operations.

A gastric bypass consists of a division of the stomach into a small upper pouch and a much larger, lower "remnant" pouch, accompanied by re-arrangement of the small intestines to permit both pouches to remain connected to the intestines. The manner in which the intestines are reconnected gives rise to several variations of the procedure. The operation leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food. Weight loss is typically dramatic, and co-morbidities are markedly reduced.

Gastric Bypass is indicated for the surgical treatment of morbid obesity, a diagnosis which is made when the patient is seriously obese, has been unable to achieve satisfactory and sustained weight loss by dietary efforts, and is suffering from co-morbid conditions which are either life-threatening or a serious impairment to the quality of life.

In the past, serious obesity was interpreted to mean weighing at least 100 pounds (45 kg) more than the "ideal body weight", an actuarially determined body weight at which one was estimated to be likely to live the longest, as determined by the life insurance industry. This criterion failed for persons of short stature.

In 1991, a Consensus Panel of physicians was sponsored by the National Institutes of Health, and its recommendations have set the current standard for consideration of surgical treatment, the Body Mass Index (BMI). The BMI is defined as the body weight (in kilograms), divided by the square of the height (in meters). The result is expressed as a number usually between 20 and 70, in units of kilograms per square meter.

The Consensus Panel of the National Institutes of Health (NIH) recommended the following criteria for consideration of bariatric surgery, including gastric bypass procedures: People who have a body mass index (BMI) of 40 or higher, or people with a BMI of 35 or higher with one or more related comorbid conditions.

The Consensus Panel also emphasized the necessity of multidisciplinary care of the bariatric surgical patient, by a team of physicians and therapists, to manage associated co-morbidities, nutrition, physical activity, behavior and psychological needs. The surgical procedure is best regarded as a tool which enables the patient to alter lifestyle and eating habits, and to achieve effective and permanent management of their obesity and eating behavior.

Since 1991, major developments in the field of bariatric surgery, particularly laparoscopy, have outdated some of the conclusions of the NIH panel. In 2004, a Consensus Conference was sponsored by the American Society for Bariatric Surgery (ASBS), which updated the evidence and the conclusions of the NIH panel. This Conference, composed of physicians and scientists of many disciplines, both surgical and non-surgical, reached several conclusions, amongst which were:

* Bariatric surgery is the most effective treatment for morbid obesity

* Gastric bypass is one of four types of operations for morbid obesity.

* Laparoscopic surgery is equally effective and as safe as open surgery.

* Patients should undergo comprehensive pre-operative evaluation, and have multi-disciplinary support, for optimum outcome.

The gastric bypass reduces the size of the stomach by well over 90%. A normal stomach can stretch, sometimes to over 1000 ml, while the pouch of the gastric bypass may be 15 ml in size. The Gastric Bypass pouch is usually formed from the part of the stomach which is least susceptible to stretching. That, and its small original size, prevents any significant long-term change in pouch volume. What does change, over time, is the size of the connection between stomach and bowel, and the ability of the small bowel to hold a greater volume of food. Over time, the functional capacity of the pouch increases; by that time, weight loss has occurred, and the increased capacity serves to allow maintenance of a lower body weight.

When the patient ingests just a small amount of food, the first response is stretching of the wall of the stomach pouch stimulates nerves which tell the brain that the stomach is full. The patient feels a sensation of fullness, as if he/she had just eaten a large meal -- but with just a thumbful of food. Most persons do not stop eating, simply in response to a feeling of fullness, but one rapidly learns that subsequent bites must be eaten very slowly and carefully, to avoid increasing discomfort, or even vomiting.

Normally when we eat, food passes out of the stomach into the duodenum, after about 30 minutes. When it reaches the lower end of the duodenum, a new hormonal message is generated, telling the brain that enough food has been eaten. The person with a normal GI tract experiences this hormone release as a sense of satisfaction or "satiety" — a feeling of indifference toward eating any more. Recently, a hormone called ghrelin has been discovered, which may have something to do with this effect.

The gastric bypass, when the bowel is re-arranged, moves this portion of the bowel to connect it with the small gastric pouch. The Gastric Bypass patient, within just a few minutes, and before more than a small amount can be eaten, begins to get a feeling like "who cares", and comfortably decides not to eat any more.

To gain the maximum benefit from this physiology, it is important that the patient eat only at mealtime, 2 to 3 meals daily, and avoid snacks and grazing between meals, which can effectively "bypass the bypass". This requires a change in eating behavior, and alteration of long-acquired habits for finding food. The Gastric Bypass is a powerful tool for enabling change in eating behavior to a healthy form.

In almost every case where weight gain occurs late after surgery, capacity for a meal has not greatly increased. The real cause of regaining weight is eating between meals, usually high-caloric snack foods. There is no known operation which can completely counteract the adverse effects of destructive eating behavior.

Weight loss of 65 to 80% of excess body weight (the amount by which actual body weight exceeds actuarial ideal body weight) is typical of most large series of Gastric Bypass operations reported. The medically more significant effects are a dramatic reduction in co-morbid conditions: — Hypercholesterolemia is corrected in over 70% of patients. — Essential Hypertension is relieved in over 70% of patients, and medication requirements are usually reduced in the remainder. — Obstructive Sleep Apnea is markedly improved with weight loss, so that most patients are asymptomatic, and often do not even snore, within one year. — Diabetes Mellitus, Type 2, is reversed in up to 90% of patients, usually leading to a normal blood sugar without medication, sometimes within days of surgery. — Gastroesophageal Reflux Disease is relieved from the time of surgery in almost all patients. — Venous thromboembolic disease signs such as leg swelling are typically much improved. — Low back pain and joint pain are typically relieved or improved in nearly all patients.

A recent study (2005) in a large comparative series of patients showed a 89% reduction in mortality over the 5 years following surgery, compared to a non-surgically treated group of patients. There were accompanying decreases in the incidence of cardiovascular disease, infections, and cancer.

Concurrently, most patients are able to alter their lifestyle, to consume "healthier" foods, exercise more regularly, and to enjoy greater participation in family and social activities. Bariatric surgery is the most effective treatment for morbid obesity, and can markedly improve health and lifestyle.