The stomach is divided into two pieces, one small (about the volume two teaspoons) and the remainder. The intestine is also divided about 1-2 feet from where it starts, and everything is reconnected so that food goes through the small stomach pouch directly into the small intestine, and the secretions from the remainder of the stomach and the first portion of the small intestine join the food about four feet downstream.
How it works
While eating through a small stomach pouch may restrict the amount of food one can eat initially, there is nothing mechanically keeping the food from going into the small intestine, which means that the size of the stomach pouch has little to do with long term portion control. In addition, not many calories are lost from only bypassing 1-2 feet of small intestine. In fact, the surgery works by delivering undiluted food directly into the small intestine. The small intestine then sends a stronger and quicker fullness signal to the rest of the body, signaling that food has arrived and no more is needed. See: How weight loss surgery works.
Gastric bypass has been shown to produce a weight loss of around 70% of excess weight (current weight minus ideal body weight), and a 90% rate of resolution of diabetes and other medical problems. It has also been in existence since the 1960s and as a result, has a large amount of research behind it showing durable weight loss and improvement of many associated medical problems.
As with all surgery there is a short term risk of bleeding, infection, damage to surrounding structures, and risks of anesthesia. There is also the more long-term risk of ulcers at the connections between the stomach pouch and small intestine, called marginal ulcers, which occur almost exclusively in people who smoke, drink alcohol regularly, and use non-steroidal anti inflammatory drugs (NSAIDs) regularly for pain control. In addition, because the intestine is divided and rerouted, spaces are created behind the intestine which other intestine can go through and twist around on itself. This very rare complication (less than 1%) is called an internal hernia, and would require another surgery to fix. All these risks are very rare, ranging anywhere from less than 1% to 2% in national studies.
You may be a candidate…
If you are a body mass index of 35 or more with one qualifying medical condition, or if you are a body mass index of 40 or more with no medical problems. These criteria are subject to variation depending on your insurance. This operation may also be better choice for you also if you have moderate to severe heartburn.
This may not be the best choice for you…
If you are highly dependent on NSAIDs (nonsteroidal anti-inflammatory drugs) for treatment of pain, secondary to the risk of ulcers.
What is the required work-up prior to having surgery?
We are proud to offer full service at our center and will assist you with ordering any testing and further evaluation that you need. We require that everyone considering surgery with us undergo preoperative testing and work-up including:
Labs, X-rays and EKGS
Evidence of up –to –date health maintenance (pap-smears, mammograms, and colonoscopies)
Evaluation by a dietician
Evaluation by a psychologist or psychiatrist
Completion of a medical weight management period, if required by insurance
Further testing and educational and counseling sessions may be required depending on the results of initial testing and evaluation
Many insurance companies will also require a medical weight management period, consisting of monthly visits with a program dietician for 3-6 months. We currently offer these weight management appointments as well as psychological and dietician evaluations at our Lodi location.
I am interested in learning more. Where do I start?
We will be happy to provide you with more details on our informational forum, which you may attend free of obligation. Please fill out the form on this website if you would like more information on dates and times for the forum. We will contact you with further information.