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Gastric bypass surgery has been around for about 40 years, but it's still a dangerous technique. A procedure may make it possible to "bypass bypass": for easier weight loss.

Gastric bypass is a group of surgical procedures that shrinks the stomach so that food "bypasses" most of the stomach as it goes to the small intestine. The bypass procedure drastically reduces the amount of food the stomach can digest at any one time, so that it is impossible to overeat. Weight loss after the surgery is both "easy," at least in the sense of controlling appetite, and inevitable, but the procedure is not without risk.

The Journal of Gastrointestinal Surgery published a study of 1,000 patients of the same, skilled gastric bypass surgeon, 854 women and 146 men. These patients all received a proximal Roux-en-Y gastric bypass procedure, in which the small intestine is divided into two parts, and one part is attached to the upper stomach, the lower part still attached to the lower stomach. After the graft heals, the patient feels full very quickly after eating. Protein foods are digested and flow quickly to the small intestine, but fats and starches settle in the stomach are sent to the other side of the "Y" made in the intestine. On their side of the Y, fats and starches ferment and produce noxious gases that may result in burping or flatulence. The procedure essential punishes the consumption of unhealthy foods with belches and farts.

As mutilating as the Roux-en-Y procedure may be, it works. But even a skilled surgeon like the one in the study has to deal with post-operative problems:

  • 1.2% of the 1000 patients died within the first 30 days.
  • 1.5% of the 1000 patients died of surgery-related complications after the first 30 days.
  • 1.6% of the 1000 patients experienced intestinal "leaks" into surrounding tissue.
  • 1.9% of the 1000 patients developed intestinal obstructions.
  • 3.1% of the 1000 patients had to be operated on a second time within the first 30 days

To be fair to this excellent surgeon, over 90% of his bypass procedures produced no complications. But when traditional gastric bypass surgery goes wrong, it goes very wrong.

Newer Gastric Bypass Methods Are an Improvement, But Aren't Problem-Free

In the late 1990's, an American surgeon named Dr. Robert Rutledge developed a "mini-bypass" procedure in which a portion of the stomach is rolled into the shape of a long tube, and the small intestine is reconnected to this "tube" near the top of the new stomach. Some of the early results of the procedure were disastrous, especially when the stomach "tube" was attached to close to the esophagus. In recent years, however, the procedure has become much safer. When the records of 1000 patients of another skilled surgeon were examined in another study:

  • None died in the first 30 days.
  • 0.5% had to be treated for leakage from the stomach tube but none had to be treated for leakage from the intestine or the surgical connection site,
  • 2.7% had some kind of complication during the first 30 days.

Those are better odds of recovery than can be obtained with Roux-en-Y surgery. But the newer lapband gastric bypass is even better. In yet another study of 1,186 lap band patients:

  • 0.5% had to have the lapband removed.
  • 0.6% had the lapband slip.
  • 1.1% experienced "pouch dilation," that is, their available stomach size increased.
  • 1.8% experienced other complications.

But wouldn't be a great thing if somehow it would be possible to get the benefits of gastric bypass with no surgery at all?

Continue reading after recommendations

  • Cobourn C, Degboe A, Super PA, Torre M, Robinson J, Jin J, Furbetta F, Bhoyrul S. Safety and effectiveness of LAP-BAND AP System: results of Helping Evaluate Reduction in Obesity (HERO) prospective registry study at 1 year.J Am Coll Surg. 2013 Nov. 217(5):907-18. doi: 10.1016/j.jamcollsurg.2013.06.010. Epub 2013 Sep 10.
  • Flancbaum L, Belsley S. Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon. J Gastrointest Surg. 2007 Apr. 11(4):500-7.
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