Jan 30, 2010
Weight-loss (bariatric) surgery changes the anatomy of your digestive system to limit the amount of food you can eat and digest. The surgery aids in weight loss and lowers your risk of medical problems associated with obesity.
Gastric bypass is the favored bariatric surgery in the United States. Surgeons prefer this surgery because it's safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes.
Gastric bypass isn't for everyone with obesity, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle. Before deciding to go forward with the surgery, it's important to understand what's involved and what lifestyle changes you must make. In large part, the success of the surgery is up to you.
How is gastric bypass surgery done?
In gastric bypass (Roux-en-Y gastric bypass) the surgeon creates a small pouch at the top of your stomach and adds a bypass around a segment of your stomach and small intestine.
The surgeon staples your stomach across the top, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. The pouch is physically separated from the rest of the stomach. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch.
This connection redirects the food, bypassing most of your stomach and the first section of your small intestine, the duodenum (doo-o-DEE-num). Food enters directly into the second section of your small intestine, the jejunum (jay-JOO-num), limiting your ability to absorb calories. Even though food never enters the lower part of your stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in your small intestine.
Some surgeons perform this operation by using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen (laparoscopic gastric bypass). The tiny camera on the tip of the scope allows the surgeon to see inside your abdomen.
Compared with traditional "open" gastric bypass, the laparoscopic technique usually shortens your hospital stay and leads to a quicker recovery. Fewer wound-related problems also occur. Not everyone is a candidate for laparoscopic gastric bypass, however. Talk to your doctor about whether this approach is appropriate for you.
Before gastric bypass, food (see arrows) enters your stomach and passes into the small intestine. After surgery, food is redirected so that it bypasses (see shaded areas) most of your stomach and the ...Enlarge Image
What can you expect during the surgery?
Gastric bypass surgery is performed under general anesthesia. This means you inhale analgesics as a gas or receive the anesthetic agent through an intravenous (IV) line so that you're asleep during the surgery.
During surgery, a tube is passed through your nose into the upper stomach pouch. Occasionally, this tube stays in overnight. The tube is connected to a suction machine after surgery to keep the small stomach pouch empty so that the staple line can heal.
You may have another tube in the bypassed stomach. This tube comes out the side of your abdomen and is removed four to six weeks after surgery. Some skin irritation may develop around this tube.
Gastric bypass surgery takes about four hours. After surgery, you wake up in a recovery room, where medical staff will monitor you for any complications. Your hospital stay may last from three to five days.
What can you expect after gastric bypass surgery?
You won't be allowed to eat for one to three days after the surgery so that your stomach can heal. Then, you'll follow a specific progression of your diet for about 12 weeks. The progression begins with liquids only, proceeds to pureed and soft foods, and finally to regular foods.
With your stomach pouch reduced to the size of a walnut, you'll need to eat very small meals during the day. In the first six months after surgery, eating too much or too fast may cause vomiting or an intense pain under your breastbone. The amount you can eat gradually increases, but you won't be able to return to your old eating habits.
You may experience one or more of the following changes as your body reacts to the rapid weight loss in the first three to six months:
What are the benefits of gastric bypass surgery?
Within the first two years of surgery, you can expect to lose 50 percent to 60 percent of your excess weight. If you closely follow dietary and exercise recommendations, you can keep most of that weight off long term.
In addition to dramatic weight loss, gastric bypass surgery may improve or resolve the following conditions associated with obesity:
The improvements observed in type 2 diabetes, high blood pressure and high blood triglycerides may significantly decrease the risk of cardiovascular events in people who have undergone gastric bypass surgery compared with those people who did not have surgery. Also, gastric bypass surgery may reduce the risk of dying of diabetes, heart disease and cancer. The surgery has also shown to improve mobility and quality of life for people who are severely overweight.
What are the risks of gastric bypass surgery?
As with any major surgery, gastric bypass carries risks such as bleeding, infection and an adverse reaction to the anesthesia. Possible risks specific to this surgery include:
Other potential complications of gastric bypass surgery include:
What are other weight-loss surgery options?
Though it's the most commonly used, gastric bypass is just one kind of weight-loss surgery. Other types include:
What you eat, how you eat and how much you eat changes after gastric bypass surgery — surgery that alters the anatomy of your digestive system to promote weight loss.
With your stomach pouch reduced to the size of a walnut or small egg and portions of your small intestine bypassed, you'll need to follow a specific diet after gastric bypass surgery. A registered dietitian can assist you in creating this gastric bypass diet, which includes what type and how much food to eat with each meal and the required consistency and texture of the food. Closely following your gastric bypass diet promotes healthier weight loss and better nutrition.
After surgery: The first three months
You won't be allowed to eat for one to two days after the surgery. Then you consume specific foods according to a diet progression. The purpose of the gastric bypass diet progression is to help in the healing process, minimize stress on surgical sites and allow time for your body to adapt to the new eating patterns.
The following are common phases in the gastric bypass diet progression:
During the diet progression, you eat many small meals a day and sip liquids slowly throughout the day (not with meals). You might first start with six small meals a day, then progress to four meals and finally, when following a regular diet, decrease to three meals a day. Typically, each meal includes protein-rich foods, such as lean meat, low-fat dairy products (yogurt, cheese) or eggs. Protein is important for maintaining and repairing your body after surgery.
How quickly you move from one step to the next depends on how fast your body adjusts to the change in eating patterns and the texture and consistency of food. People usually start eating regular foods with a firmer texture three months after surgery, but it can occur sooner.
Lifelong changes: New eating habits
The changes in your digestive system restrict how much you can eat and drink with each meal. To avoid problems and to ensure you're getting nutrients you need, closely follow these guidelines:
Weight loss and weight gain
Within the first two years following surgery, you can expect to lose 50 percent to 60 percent of your excess weight, if you follow the dietary and exercise recommendations. If you continue to follow these recommendations, you can keep most of that weight off long term.
People who regain weight after gastric bypass surgery usually are consuming too many high-calorie foods and beverages and don't exercise enough. And rather than eating three meals a day and perhaps a planned healthy snack, some people engage in a grazing-type eating pattern — eating food all day long. Grazing often leads to consuming too many calories, which causes weight gain.
Successful weight management requires the following healthy habits:
If you aren't losing weight or are regaining weight after surgery, see your doctor. He or she can help assess your eating behaviors and exercise habits and help you confront and overcome any weight-loss obstacles.
Though weight-loss surgery helps you shed the pounds, its success depends on your willingness to adopt lifelong healthy-eating and exercise habits. What you eat and how you eat changes after surgery, but the benefits of weight loss and your improved health are well worth these efforts.content by:
It's always best to lose weight through a healthy diet and regular physical activity. But if you're among those who have tried and can't lose the excess weight that's causing your health problems, weight-loss (bariatric) surgery may be an option.
Gastric bypass surgery — one type of bariatric surgery — changes the anatomy of your digestive system to limit the amount of food you can eat and digest. Weight loss is achieved by restricting the amount of food that your stomach can hold and by reducing the amount of calories that are absorbed.
Gastric bypass surgery isn't for everyone, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle. An extensive and careful screening process determines whether you're a candidate for this surgery.
Gastric bypass surgery criteria
Generally, gastric bypass surgery is reserved for people who are unable to achieve or maintain a healthy weight through diet and exercise, are severely overweight, and who have health problems as a result. Gastric bypass surgery may be considered if:
Gastric bypass surgery doesn't replace the need for following a healthy diet and regular physical activity program. In fact, the success of the surgery depends in part on your commitment to following the guidelines given to you about diet and exercise. As you consider weight-loss surgery, make sure that you make every effort to exercise more, change your eating habits and adjust any other lifestyle factors that have contributed to your excess weight.
Before surgery: The screening process
Surgical candidates must go through an extensive screening process. Not everyone who meets the criteria for gastric bypass surgery is psychologically or medically ready for the surgical procedure. A team of professionals, including a physician, dietitian, psychologist and surgeon, evaluates whether weight-loss surgery is appropriate for you. This involves identifying which aspects of your health might improve after surgery and which aspects of your health may increase the risks of surgery. Surgery is recommended when the perceived benefits of surgery outweigh the recognized risks.
Your willingness and ability to follow through with the recommendations made by your health care team and to carry out prescribed changes in your diet and exercise routine help determine your readiness for surgery. The surgery may not be recommended or may be postponed if there's concern that you aren't psychologically or medically ready for such surgery.
It's important to follow your doctor's directions in preparing for gastric bypass surgery. These may include restrictions on eating and drinking, limiting or stopping the use of nicotine products, and starting a physical activity program.
Surgery may be delayed or canceled if:
Once you've completed the screening process and your surgeon determines you're a candidate for gastric bypass surgery, you need to secure financial preapproval from your medical insurance company, Medicare or state assistance. The preapproval process requires documentation from your team of doctors that demonstrates a medical need for the procedure. It usually takes several weeks to receive approval.
Requirements for proving medical necessity for weight-loss surgery vary among insurers. Check to see what related services are covered, for example, pre-evaluation appointments and follow-up appointments after surgery. You may have to pay some of the costs yourself.
The process of securing financial resources and then being scheduled for surgery can take several months. The long approval process allows you time to make a final decision about the surgery. Surgery usually isn't scheduled until insurance or other financial coverage is established.
Surgery for weight reduction isn't a miracle procedure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after gastric bypass surgery depends on your commitment to making lifelong changes in your eating and exercise habits. But the feeling of accomplishment as you lose weight and your improved health are significant benefits and are well worth your efforts.content by:
Sep 22, 2009
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Apr 07, 2009
I am bipolar and I thought this chart would help others with bipolar disorder that are worried about the absorption rate of their psych meds after surgery.
I've had to have several medication changes after RNY surgery because of issues of absorption. If you have questions, please print the chart out and take it with you at your next doctor's appt.
Twelve of the 22 medication preparations were found to dissolve differently across the two environments. Ten of the 12 dissolved more in the control model, and only two dissolved to a greater degree in the RYGB model. Although not reported, variability within each sample of three pills was minimal. In no case did a value stray beyond 10% difference from the median weight change. (Variability data are available from the authors.) We chose not to report standard deviations, as we could not confirm that the data were parametric. Reporting the high and low values in addition to the median seemed unhelpful, considering that there were only three pills in each sample.
Within the antidepressant class, bupropion was the only agent that dissolved to a greater degree in the RYGB model (a median of 450 mg dissolved, compared with 320 mg in the control model, p<0.05). The dissolution of citalopram and venlafaxine did not differ between conditions. The remaining antidepressant medications (amitriptyline, fluoxetine, paroxetine, sertraline) dissolved more in the control model than in the RYGB model (Table 1).
Among the anxiolytic/sedatives, only one of the six medications varied between the conditions. Clonazepam was found to dissolve slightly more in the control model (a median of 100 mg dissolved, compared with 90 mg in the RYGB model, p<0.05). Dissolution of the remaining agents (buspirone, diazepam, lorazepam, trazodone, zolpidem) did not differ between conditions (Table 1).
For the antipsychotic/miscellaneous category, lithium carbonate dissolved significantly more in the RYGB model (median of 280 mg dissolved, compared with 130 mg in the control model, p<0.05). The dissolution of haloperidol, oxcarbazepine, and methylphenidate did not vary between conditions. Five newer antipsychotics (clozapine, olanzapine, quetiapine, risperidone, and ziprasidone) had greater dissolution in the control condition (Table 1).
Apr 07, 2009