The band is removable, if necessary. Studies to date indicate that the intestinal tract returns to normal afterward. Studies, including those done in the elderly, have reported significant weight loss and improved quality of life with the procedure.
Malabsorptive Bypass Procedures
Malabsorptive procedures produce greater weight loss than restrictive procedures. Patients generally achieve about two-thirds of their weight loss within 2 years. Furthermore, in a 2003 study, after standard bypass surgery, 83% of patients with type 2 diabetes had normal blood glucose levels, and the rest had significant weight reductions.
Roux-en-Y Gastric Bypass Procedure. This is the most common and successful malabsorptive surgery in the United States. It involves creating a small stomach pouch that serves as a reservoir and restricts food intake. The pouch eventually holds up to 3 ounces of food and has a small outlet that delays emptying and causes a feeling of fullness. Then the surgeon creates a Y-shaped section in the small intestine that attaches to the pouch. This section allows food to bypass the lower stomach and upper part of the intestine.
Patients on average lose about 60% of their excess weight. Studies have shown improvements in control of type 2 diabetes and reduction in blood pressure. The procedure produces greater and more sustained weight loss than banding procedures, but it is also more complicated. Laparoscopy techniques, which are less invasive, are now preferred over open surgery. They achieve equally good results with fewer complications. Death during or after the surgery occurs in five out of 1,000 patients having this procedure.
By definition, these procedures bypass the first part of the small intestine and carry poorly digested food to a part of the intestine that cannot absorb it as easily. Some patients develop what is called dumping syndrome. Symptoms include nausea, vomiting, bloating, cramping, diarrhea, sweatiness, dizziness, and fatigue. These problems occur anywhere from immediately after eating to 3 hours afterwards. Patients with this problem carry a higher risk of nutritional deficiencies.
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Side Effects and Complications
General Side Effects and Complications. Side effects and complications of bariatric procedures are common, and up to 25% of patients need corrective or repeat procedures. After any of these procedures people must chew all their food carefully, and they cannot eat large amounts of food at one time. If patients do not follow these guidelines, they will experience nausea, abdominal distress, or both.
Complications from any bariatric procedure include:
- Vomiting: This is the most common complication, and it is most common with banding procedures. It is generally a result of eating more than the reduced stomach size can hold. With laparoscopic banding, adjustment of pouch size can be performed relatively easily.
- Heartburn, gastritis, and problems swallowing.
- Nutritional deficiencies: There is a strong risk of nutritional deficiencies, particularly with malabsorptive operations. This complication can lead to anemia, due to either iron or vitamin B12 deficiencies. Nutritional deficiencies can also increase the risk of bone loss and osteoporosis, due to calcium deficiency. Taking enough mineral and vitamin supplements is important after bariatric surgery.
- Deep-vein thrombosis: There is a significant risk for deep-vein thrombosis (blood clots in the veins).
- Abdominal hernia: This is another common complication. Newer, laparoscopic techniques do not carry this risk, but not all individuals are candidates for this less-invasive approach.
- The stomach pouch can break down over time and need repair.
- Rapid weight loss after surgery: This complication puts people at high risk for gallstones.
- Women who wish to be pregnant should wait until their weight has stabilized. Rapid weight loss and nutritional deficiencies can harm the fetus.
Previous Section
Review Date: 04/14/2010
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz.
Previously reviewed by Harvey Simon, MD, Editor-in-Chief, Associate
Professor of Medicine, Harvard Medical School; Physician,
Massachusetts General Hospital (4/14/2010).
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
