Gastric Bypass

Stomach bypass surgery

Gastric bypass surgery is a type of weight loss surgery that forces the patient to eat less food by making the stomach physically smaller. The operation also involves a bypass of part of the intestine, resulting in fewer calories absorbed by the body. While often grouped under the category of cosmetic surgery, this procedure is conducted on patients with a body mass index of 40 or higher who face moderate to severe health risks due to their weight.

Cost of Gastric Bypass

The average cost of a gastric bypass operation ranges from $20,000 to $25,000 and is eligible to be covered by some health insurance plans. Typically, gastric bypass insurance coverage requires approval from your primary care provider prior to being referred to a specialist. Many insurance companies request that a letter of medical necessity be submitted by both your personal physician and the specialist during the pre-authorization process. If you are denied, you can appeal the decision within 30 to 60 days.

Self-pay patients are those who pay all the expenses out of their own pocket. Options to make the surgery more financially feasible include obtaining a loan from a private lender or choosing a hospital that offers payment plans rather than billing in one lump sum.

Patient Evaluation

Prior to being approved for gastric bypass surgery, patients must undergo a battery of tests and evaluations. A prospective patient needs to have been obese for at least five years and must have made other attempts to lose weight that were unsuccessful. Candidates for the surgery must not be suffering from depression or any other major psychiatric disorder, and cannot have dependency issues on drugs or alcohol. Successful patients must also be within the ages of 18 and 65.

The Gastric Bypass Procedure

There are three versions of gastric bypass surgery; Roux-en-Y gastric bypass (RGB), the mini gastric bypass (MGB) and the extensive gastric bypass (biliopancreatic diversion).

  • Roux-en-Y gastric bypass surgery is the most popular form of bypass surgery. A small stomach sack is created by stapling a portion of the stomach together or through the use of vertical banding to limit the amount of food the stomach can hold. A Y-shaped section of the small intestine is attached to the newly-formed stomach pouch that allows food to bypass the duodenum and the first portion of the jejunum intestine. The result of this procedure ensures less food intake and a large caloric reduction in the food that is processed by bypassing a significant amount of the first and second intestines. This procedure is usually performed as a laparoscopic gastric bypass surgery using small incisions and a thin telescope-like instrument (for viewing purposes) for a quicker recovery time.
  • Mini gastric bypass surgery is very similar to the Roux-en-Y procedure, but uses a loop of small intestine rather than a Y-shaped segment to attach to the stomach pouch. This procedure is quicker and simpler to perform, typically requiring 30 minutes in surgery and only 24 hours of hospitalization. It is a newer technique, however, and there are some questions as to whether there may be long-term complications.
  • Extensive gastric bypass is a more complicated form of bypass surgery. Rather than form a small pouch and bypass the rest of the stomach, the gastric bypass surgeon actually removes the lower section of the stomach and attaches the remaining small pouch to directly to the final portion of the small intestine. While this results in significant weight loss, this procedure is not widely used due to the high risk of nutritional deficiencies from bypassing both the duodenum and jejunum sections of the intestine.

Upon completion of the surgery, patients tend to quickly lose weight for up to 12 months. Up to one-third of the excess weight may be lost within 1 to 4 years.

Risks of Gastric Bypass Surgery

As in any form of body surgery, gastric bypass surgery carries numerous risks. Risks specific to gastric bypass surgery include:

  • Nutritional deficiencies resulting in anemia or osteoporosis
  • Stomach leakage into the abdomen
  • The stomach pouch stretching and reverting to original size
  • Weakness, faintness, nausea, sweating and possibly diarrhea from food passing too quickly through to the small intestine
  • Gallstones, ulcers or hernia

In order to reduce the odds of nutritional or vitamin deficiencies, patients undergoing a gastric bypass are required to ingest nutritional supplements such as vitamin B12, calcium and iron. Risks common to other surgeries including infection of the incision or negative reactions to anesthesia also apply to weight loss surgery.

One unpleasant aspect of significant weight loss involves the excessive amounts of skin on various parts of the body. Not does the excess skin look unsightly, it may lead to hygiene problems along with skin irritation and infections. Younger patients are more likely to have the skin tighten up eventually, while older people may need to seek successive cosmetic surgeries such as a tummy tuck, liposuction or panniculectomy to address the problem.

Recovering from the Operation

A typical hospital stay after a gastric bypass operation ranges from two to six days depending on the success of the surgery and the how fast the patient's body heals.

Once at home, you should gradually increase your activity level and gently ease yourself back into a regular routine. It may take some time to figure out the food portion size that is right for you; overeating or eating too fast can cause almost instant gastric dumping syndrome reactions. Joining a gastric bypass support group and following a gastric bypass diet are great ways to help adjust to your life after the operation.

Alternative Procedures

While gastric bypass surgery is a radical means of losing weight, there are few, if any true alternatives out there. Lap band surgery is an alternative, but also involves invasive surgery to reduce stomach capacity. Since the procedure is only considered when all other means have shown no results, bypass surgery often represents the last hope that many patients have to return to a normal life and reduce potentially life-threatening health risks.