GASTRIC BYPASS - Formally called Roux-en-Y-Gastric Bypass

Description -This procedure involves cutting the stomach with a stapler device leaving only a very small stomach pouch. This pouch can hold approximately 15 to 30 ml. This portion of the procedure ensures that you can only eat small portions of food. Next, the small intestine is cut, rearranged, and reconnected to the new stomach pouch. This portion of the procedure causes less of the food that is eaten to be absorbed by the body. This procedure may be done laparoscopically (minimally invasive) or through the traditional “open” (large incision) technique. Dr. Deol is trained in the laparoscopic technique.

Risks- Following are some, but not all, of the things that may occur during or after surgery. Precautions are taken to prevent these things; however, despite preventive measures, these things will occur in a certain percentage of patients undergoing this procedure. An approximate percentage is listed after the complication.

1. Leak of staple line- (1.5% to 5.8 %) Wherever the stomach or intestine is cut and reconnected, there is a chance that the new connection may leak. The contents inside the intestine then leak out into the abdomen causing pain and infection. Treatment may require simple placement of a drainage tube with the help of CT scan; or, it may require re-operation. In the worst case, it may lead to overwhelming infection and death.

2. Pulmonary Embolus - (0.9% to 1.5% ) This potentially fatal complication occurs when a blood clot, usually from the leg, travels to the lung. It may cause severe chest pain and shortness of breath. Treatment involves hospitalization with intravenous blood thinners. Eventually, you may be sent home with blood thinner pills that are taken for up to six months.

3. DVT - ( 1% to 1.5% ) Deep venous thrombosis is the condition where a blood clot forms in a large vein in the body (usually in the leg). It may cause leg pain and swelling. Treatment involves hospitalization with intravenous blood thinners. Eventually, you may be sent home with blood thinner pills that are taken for up to three months.

4. Heart Attack- The percentage of heart attacks is dependant on patient's pre-existing heart condition) This may occur due to the stresses placed on the heart by anesthesia and/or surgery. You may also have some degree of heart disease secondary to your  obesity. This would give an additional risk of heart attack. Heart tests are done before surgery; however, these may not identify all cases of heart disease.

5. Wound Infection- (1% to 8%) In the process of cutting and reconnecting the intestine, some bacteria from inside the intestine may escape. This can lead to infection of the incision sites. Intestine cleansing medications are given to you the day before the surgery. Additionally, intravenous antibiotics are given during and after surgery to minimize this risk. In spite of this, wound infections may occur in a certain percentage of patients. This may cause pain, bleeding, redness, or discharge at the site of the incision. Treatment involves opening the skin at the incision to allow the infection to drain. You may also be given a course of antibiotics.

6. Abdominal Hernia - (0.7% to 3.8%) The abdominal wall will be naturally weaker at the site of a prior incision. Hernias may develop at these points of weakness. These usually require an operation to be repaired. Some may be repaired with the laparoscopic technique; however, some may require a larger incision.

7. Intestinal Obstruction- (0.6% to 3.5% ) Any surgical procedure can cause the development of “scar tissue” inside the abdomen. This scar tissue is called adhesions . Sometimes these adhesions may cause a twisting or blockage of the intestines. You may experience: vomiting, abdominal pain, abdominal bloating, decrease in bowel movements or diarrhea. Treatment may involve hospitalization with intravenous fluids and the placement of a tube through the nose, into the stomach to decompress the intestine and stop the vomiting. If this is not successful, a surgical procedure may be required to cut the scar tissue.

8. Lung Failure- Several things may lead to lung failure. You may develop pneumonia . You is given instructions on lung exercises to help prevent this condition. Infection in the abdomen can travel to the lung and lead to lung failure. If lung failure develops, you may be placed on a breathing machine in order to help treat this condition. Rarely, lung failure can lead to death.

9. Death- ( 0.5%) The most serious risk. The potential for death exists with any surgery. Causes can be anything from anesthesia to one of the above listed complications.

Side Effects

1. Vomiting- This will occur if: food is eaten to quickly, food is not well chewed, too much food is eaten, or foods high in sugar are eaten.

2. Dumping Syndrome - This will occur if high caloric food or beverages are eaten. The combined symptoms of: nausea, vomiting, diarrhea, abdominal pain sweating, flushing, and fast heart rate usually cause you to visit the emergency room.

3. Constipation-Usually this will occur if you are not taking adequate quantities of water or fiber. In the immediate post-operative period, it may be related to the use of pain medications.

4. Diarrhea- Usually this occurs with dumping syndrome.

5. Dehydration - Due to inadequate intake of water. You must drink plenty of water.

6. Peptic Ulceration - (2 to 11%) An ulcer may develop in the area where the stomach pouch is connected to the intestine. This may cause abdominal pain, nausea, and vomiting of blood. This is usually diagnosed with an EGD (lighted camera placed down throat into stomach). Most cases can be treated with medication. However, some more severe cases may require an operation involving revising the connection between the stomach pouch and the intestine.

7. Stricture - (1.6% to 6.3%) This is a narrowing that may form in the connection between the stomach pouch and the intestine. This may cause you excessive vomiting and the inability to swallow solids, and eventually, liquids. Treatment for this may involve EGD with attempted dilation of the narrowed area with a special device. Rarely, dilation is unsuccessful and an operation is required.

8. Anemia -(30 to 39%) The portion of the intestine that is bypassed is the main site where iron is absorbed. You must be sure to take prescribed vitamin and mineral supplements.

9. Malnutrition- Due to the rearrangement of the intestine, you must be sure to follow the guidelines of the nutritionist. It is very important for you to get adequate amounts of: protein, water, vitamins, and minerals.

Weight Loss - You may expect to loose from 60% to 80% of your  excess body weight over a two-year period. Over the first few months, weight loss will be rapid. However, you will then experience a slowing of your weight loss with periods of “plateaus” where there is no weight loss. It is important not to get discouraged during these periods. There is a pamphlet of helpful tips created by a bypass patient to help you through these periods. Please ask Dr. Deol's office staff for your copy. Approximately 50% of patients will experience some degree of weight gain after the two-year period. This weight gain may range anywhere from 5% to 25%.

Advantages - This procedure has been performed for many years and it is the most commonly performed procedure for morbid obesity in the United States. The results are excellent and have stood the test of time. Its success in the long term with weight loss and the resolution of comorbidities has been proven.

Congratulations on taking the first step towards a healthier life!
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