Temecula Obesity Surgery, Gastric Bypass - Southwest Healthcare System

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Surgery for Obesity

Who would be a potential candidate for surgical procedures to reduce weight?

A patient who is 100 pounds above his/her ideal weight (as calculated by height and bone frame).

What medical considerations are taken to decide who should undergo an operation to reduce weight?

The patient should be of a reasonable surgical and anesthetic risk for such a major operation. Risk Factors include age, hypertension, coronary artery disease, diabetes, obstructive pulmonary disease, airway challenges, strokes, blood clots, arthritis, gallstones, gastroesophageal reflux, liver disease, and sex-hormone dysfunction. Although these are all factors that may complicate any surgical procedure for obesity, they are also problems that may possibly be improved or prevented by a successful operation that results in significant and permanent weight loss.

What other considerations are taken to decide who would be a good candidate for surgery?

The patient must have shown previous serious effort to lose weight. The patient must have sufficient will-power and intention to successfully comply with the post-operative dietary restrictions. The patient should have a routine psychiatric evaluation to rule out significant eating disorders that may persist post-operatively. Patients with depression that may be inadequately treated are not good surgical candidates. Alcohol and drug use are also contraindications to surgery. The patient must not have unrealistic expectations of the outcome of surgery.

What kind of operation is done for weight loss?

Most likely, a gastric bypass procedure will be recommended. There are two components to this operation - a gastric (stomach) stapling, and a small intestine bypass. First, this procedure would entail stapling across the top portion of the stomach to create a new, very small, stomach pouch. This small pouch thus restricts the amount of food that may be tolerated in any given meal. The new stomach pouch is then connected to the small intestine, thus bypassing some of the absorptive part of the small intestine. The net effect of such an operation is that the amount of food eaten should be greatly reduced by having a much smaller stomach pouch and whatever food that is eaten should be absorbed into the system to a lesser degree because of the small intestine bypass. No part of the stomach or small intestine is actually removed - they are bypassed. There are variations to this procedure, depending on the degree of obesity and the presence of any previous operation. One additional point - if there are gallstones, the gallbladder may be removed. Also, because of a high incidence of gallstone formation upon weight loss, the gallbladder is often removed prophylactically at the time of the gastric bypass.

What kind of recovery period may be expected?

The patient should expect a 6-8 day hospital stay. The patient may be in the intensive care unit during the initial post-operative period. There will be a nasogastric tube (from the nose to the stomach pouch) that will be removed 2-3 days after the operation. Patients will typically begin taking liquid diet on the 3rd post-operative day and may remain on a liquid diet for 4 weeks after they go home. Patients should be up and walking by the second post-operative day. Pain management will include patient-controlled analgesia machines until the patient is able to tolerate oral medications.

What kind of complications may happen after such an operation for weight loss?

The mortality rate (risk of death) is about 2% overall. This depends, of course, on a given patient's individual risk factors. Other complications include anastomotic leak, infections in the abdomen or in the skin wound, pneumonia, blood clots, heart attack, stroke, stomach ulcer, anastomotic narrowing, adhesions, and bowel obstruction. Long-term complications include vitamin deficiencies (specifically B12 and iron), vomiting, and malnutrition. There is a 5-20% chance of a need for revision of the original operation due to failure to lose weight, anastomotic leak, anastomotic stenosis, or staple line disruption. The most common complications include wound/skin breakdown (25%) and incisional hernia (25%).

What kind of results might be expected from a gastric bypass procedure?

Patients should hope to lose 50-70% of their excess weight in an 18-month period. Most patients can maintain this weight loss if they are compliant with the dietary changes. By the third post-operative year, patients should aim to maintain a weight no more than 30-40% above their ideal weight (for example, if the patient's ideal weight is 150 pounds, the patient should maintain a weight of no more than 195-210 pounds). Most patients will find some difficulty eating and tolerating red meat and chicken as well as sweet foods. Also, patients may experience symptoms of the dumping syndrome - feeling of fullness, dizziness, and desire to lie down after eating. These "unpleasant" sensations and difficulties are, to a certain degree, intended designs of the operation to help patients learn to eat less. The amount of weight loss may be determined, to a large extent, by the patient's compliance with these negative signals of ingestion.

Other positive results of gastric bypass procedures are that many patients will find their hypertension and diabetes to improve significantly. If patients have not developed hypertension and diabetes at the time of surgery, their risks for developing these problems in the future may be significantly reduced by a maintained weight loss. Other disorders such as arthritis and gastroesophageal reflux may improve as well.

Many patients will eventually have some excess skin that does not contract sufficiently upon weight loss. These patients may choose to have plastic surgery to remove the excess folds.

Notes Of Caution

For the supermorbidly obese (BMI > 50), the bypass part of the operation may need to be more aggressive to allow long-term weight loss. However, there is a small chance that the mesentery may be too short to reach the top of the stomach making the bypass part of the operation impossible. If this is the case, then only a gastric stapling can be done and the weight loss may not be as good. If a more aggressive bypass is performed, there is a higher chance of metabolic, digestive, and liver disorders associated with the surgery. Overall, results for the supermorbidly obese are not as good or predictable as for the morbidly obese, while the complication rates are higher.

In some instances, there is too much scar tissue from previous surgery that may prohibit the gastric bypass operation to be performed safely.

For information on physicians who perform weight loss surgery at Southwest Healthcare System, call 800-879-1020.