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What is gastric
bypass surgery?
Gastric bypass is a surgical method used to help people
with morbid obesity lose weight and reverse other health
problems associated with being overweight, such as high
blood pressure and Type II diabetes. The Roux-en-Y gastric
bypass, creates a small pouch in the top of the stomach
to which the small intestine is connected. With a smaller
stomach, the patient feels "full" sooner and
is less likely to overeat. Depending upon what is best
for each individual patient, the bypass is performed
as an "open" procedure, or with a minimally
invasive technique using laparoscopes.
Can
anyone who is overweight have gastric bypass surgery?
The surgery is not a cosmetic procedure, but rather,
a course of last resort for people who are at least
100 pounds over their ideal weight and have a body mass
index (BMI) of over 40. Patients with a slightly lower
BMI may be considered for the procedure if they have
other obesity-related problems such as Type II diabetes,
cardiovascular disease, or sleep apnea. Gastric bypass
is also generally reserved for patients who have been
unable to lose weight through weight reduction programs
and exercise.
What
is "stomach stapling", and is it the same
thing as gastric bypass?
"Stomach stapling" is a catch-all term commonly
used to describe a variety of obesity reduction surgeries.
It can mean gastric bypass or an entirely different
procedure. However, when gastric bypass surgery is performed,
part of the stomach is stapled.
What
are the risks of gastric bypass surgery?
As is true with any operation, there are complications
associated with gastric bypass surgery. One of the most
serious is leakage where the stomach pouch meets the
small intestine.
With no treatment, approximately one in four gastric
bypass patients will develop gallstones following surgery.
That is why a bile thinning medication is prescribed
after surgery.
Some other complications include abdominal hernia,
wound infection, and bowel obstruction. There is also
the possibility of lung-related conditions, such as
pulmonary embolism, and additional stress on the cardiac
system; for these reasons, the patients are closely
monitored during the post-surgical hospital stay. In
very rare situations, a patient may even die as a result
of the surgery or one of its complications.
Gastric
bypass surgery reduces stomach capacity quite significantly.
Does the stomach ever stretch back to a larger size?
Surgery reduces the stomach capacity by about 90 percent.
Immediately after surgery, the pouch can hold approximately
two ounces. Gradually, the stomach pouch does stretch
somewhat and the capacity increases, but not to its
original size.
How
effective a procedure is the Roux-en-Y gastric bypass?
The results are very encouraging. But the surgery is
not a magic "cure all" in itself: Eating healthy
foods and exercising regularly are the other parts of
the equation for success.
How
long does recovery from gastric bypass surgery take?
Patients can expect to be out of bed by evening of
the same day of the surgery, with a total hospitalization
stay of about 3-4 days. The surgical recovery period
averages between 3-5 weeks.
How
many pounds can someone expect to lose after surgery,
and how long does it take to achieve the desired weight
loss?
A. Every person's weight loss experience is different.
As a rule of thumb, the heavier the patient, the more
weight they are likely to lose. Most patients can expect
to lose two-thirds of their excess weight. Most of that
weight loss will occur within the first 18 months. That
loss is almost always followed by a slight weight gain
while the body is stabilizing, and is followed by another
period of weight loss.
Losing the weight is only part of the picture, however.
The difficulty can be in keeping it off. That is where
gastric bypass surgery has proven to be so effective.
Five years after surgery, 95% of all patients have maintained
a loss of more than 50% of their excess weight. Keep
in mind that on average, with a traditional diet-based
weight loss program, only about 1% of morbidly obese
persons maintain their weight loss at that level.
Do
patients ever have to "diet" again following
gastric bypass surgery?
The patient will have to adopt a healthy eating plan
and an exercise program for the rest of his or her life.
What
is "dumping syndrome"?
When large amounts of high-calorie foods (especially
those containing sugar) pass quickly from the stomach
pouch into the intestine, fluid rushes into the small
intestine to dilute the high concentration of sugar.
The patient may feel faint, break out in a cold sweat,
and have intestinal cramps followed by diarrhea. Fortunately,
"dumping syndrome" can be averted simply by
the patient avoiding high intakes of sweets.
What
happens if someone "cheats" on the recommended
post-surgical diet?
Usually, "cheating" cures itself, as the
consequences can be quite uncomfortable for the patient.
Eating high-calorie foods can bring on "dumping
syndrome," which results in cold sweats, a feeling
of faintness, intestinal cramps, and diarrhea. It is
such an unpleasant experience that most people do not
keep on "cheating."
How
does gastric bypass surgery affect which medications
a patient is able to take?
Patients should avoid aspirin or aspirin-containing
medications and anti-inflammatory drugs; they can irritate
the intestinal tract’s inner lining and sometimes cause
ulcers. For the same reason, alcohol and tobacco products
should be avoided, as well.
Is
pregnancy possible following gastric bypass surgery?
A. Many obese women of childbearing age do not have
menstrual periods, a condition known as amenorrhea,
and thus, are unable to become pregnant. After the surgery
and subsequent weight loss, regular menstrual cycles
typically resume. Barring other fertility-related problems,
these women are able to become pregnant. However, it
is not advisable to attempt a pregnancy until 18 months
after the surgery. Before then, the rapid weight loss
and nutritional deficiencies can harm a developing fetus.
When the waiting period is over, these women–with
proper pre-natal care and monitoring by their obstetrician
and bariatric team–can go on to have uneventful pregnancies
and healthy babies. Despite the reduced size of her
stomach, the mother-to-be can still intake sufficient
calories for both the fetus and herself.
Is
the gastric bypass covered by insurance?
Because gastric bypass surgery is not a cosmetic procedure
and is performed only when medically necessary, many
insurance companies cover all or part of the costs involved
for the laparoscopic and/or open version of the surgery.
As every insurance plan is different, it is your responsibility
to call your insurance company and inquire about your
plan's coverage and pre-certification or authorization
requirements. Refer to CPT Code #43846, which identifies
the type of surgery, when talking with your insurer.
You should confirm that UMDNJ-University Hospital and
Dr. Asha Bale are participating providers in your insurance
plan.
If
I want to pay for the surgery myself, in the event my
insurance won't cover it, how much can I expect to pay?
If you are interested in paying out-of-pocket for the
procedure, the fees at the Obesity Treatment Center
are in the $20,000 range (depending upon the services
needed) and are payable in full prior to the surgery.
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The
Surgical Option
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