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Morbid obesity is a complex, medical disease, which affects more than nine million people in the United States. It is not a moral problem due to a lack of will power. Studies have shown that diets, medications, behavioral modification or exercise programs have a 95% failure rate in this population, due to underlying physiologic, chemical and genetic factors.
Morbidly obese patients have a very high risk of associated health problems and early death. The National Institutes of Health (NIH) has endorsed Roux-en-Y and Gastric Bypass (RNY) as an acceptable choice for weight loss surgery. Depending on the circumstances, RNY can be accomplished by an open or laparoscopic technique.
Surgery is an aid to dieting and assists individuals alter their eating habits by restricting food intake or limiting absorption of ingested food.
Dr. Thomas offers the Roux-en-Y Gastric Bypass (RYGB) to assist a patient in reducing food and caloric intake. The Roux-en-Y Gastric Bypass, as with all weight loss surgery procedures, is associated with medical risks and in the anticipated chance of success in losing weight.
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Roux-en-Y Gastric Bypass (RYGB)
Roux-en-Y Gastric Bypass (RYGB) is a more complex operation, to provide more consistent and successful weight loss. The small upper pouch is completely separated from the distal stomach which is left in place. A "Y" shaped segment of small bowel is attached to the pouch with a narrow opening. This bypasses the mixing of food and digestive juices from the distal stomach resulting in poorer absorption of calories and nutrients. This both restricts food intake and interferes with absorption resulting in more consistent weight loss, but has a higher risk of complications or side effects. 80% of patients lose at least half their excess weight with the RYGB procedure.
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The laparoscopic approach to obesity surgery
Laparoscopic operations are performed through several small incisions with the aide of a fiber optic video camera and special instruments which can reduce the trauma and discomfort associated with a long open incision. Hospitalization, post-op pain, and recovery time is usually reduced compared to traditional surgery. Laparoscopic obesity operations have only been performed since 1993. Therefore the American Society of Bariatric Surgeons recommends choosing a surgeon who is experienced in both laparoscopic and open bariatric operations, and who understands the complexities of surgical treatment of obesity.
The laparoscopic RYGB averages a 3-4 day hospitalization with a return to full activity in 7-10 days. A liquid and soft diet high in protein is suggested for 4 weeks after surgery, then the patient is placed on a solid diet.
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Possible Complications
If you choose to undergo weight loss surgery, only your surgeon can advise you, individually, of the risks, benefits and potential complications of the procedure you may choose, and he may approve. So that you are aware that complications are associated with any weight loss surgical procedure, the following information is from the International Bariatric Surgery Registry (IBSR), Winter 2000-2001 Pooled Report 15. Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference. March 25-27, 1991, Bethesda, MD. Am J Clin Nutr, 1992. 55(2 Suppl): p. 487S-619S. See also Society of Bariatric Surgeons.
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Complications within 30 days of surgical treatment for obesity of 10, 993 people. Total patients from IBSR 2000-2001 Winter Pooled Report 15(1) |
N |
% |
Minor:* |
Major:* |
| Minor:* |
other: drug skin problems, balloon dilatation, hemorrhoidectomy, gastroenteritis, undefined |
165 |
1.50% |
1.50% |
0.00% |
| Minor:* |
atelectasis (46), hyperventilation (1), respiratory undefined (104) |
151 |
1.37% |
1.37% |
0.00% |
| Minor:* |
wound site Seroma (80), wound infection (48) |
128 |
1.17% |
1.17% |
0.00% |
| Minor:* |
Splenic injury |
27 |
0.25% |
0.25% |
0.00% |
| Minor:* |
pleural effusion (11), pleuritis (2), pneumonitis (9), |
22 |
0.20% |
0.20% |
0.00% |
| Minor:* |
dehydration |
8 |
0.07% |
0.07% |
0.00% |
| Minor:* |
renal, urinary tract infection (4) |
7 |
0.06% |
0.06% |
0.00% |
| Minor:* |
stoma too large (5), stoma too small (1) |
6 |
0.05% |
0.05% |
0.00% |
| Minor:* |
ulcers: duodenal, gastric, stomal (jejunum or anastomoses) |
5 |
0.05% |
0.05% |
0.00% |
| Minor:* |
hepatic, liver hematoma (1) |
4 |
0.04% |
0.04% |
0.00% |
| Minor:* |
esophageal reflux, esophagitis (2) |
3 |
0.03% |
0.03% |
0.00% |
| Minor:* |
hernia: incisional (1), ventral (1) |
2 |
0.02% |
0.02% |
0.00% |
| Minor:* |
dumping syndrome (1), vitamin insufficiency (1) |
2 |
0.02% |
0.02% |
0.00% |
| Major:* |
GI Leak (5 deaths) |
33 |
0.30% |
0.00% |
0.30% |
| Major:* |
stoma obstruction (lumenal - 18); stoma stenosis (15) |
33 |
0.30% |
0.00% |
0.30% |
| Major:* |
GI hemorrhage or GI bleeding; 7 due to ulcers, undefined (19) |
26 |
0.24% |
0.00% |
0.24% |
| Major:* |
cardiac (4 deaths) |
19 |
0.17% |
0.00% |
0.17% |
| Major: |
* pulmonary embolism (11 deaths) |
19 |
0.17% |
0.00% |
0.17% |
| Major: |
* respiratory arrest or failure (4 deaths) |
16 |
0.15% |
0.00% |
0.15% |
| Major:* |
wound dehiscence |
13 |
0.12% |
0.00% |
0.12% |
| Major:* |
small bowel obstruction: Roux-en-y (4), common channel (2), enterostomy (1) undefined (6) |
13 |
0.12% |
0.00% |
0.12% |
| Major:* |
Subphrenic / sub hepatic abscess; abdominal abscess (1) |
11 |
0.10% |
0.00% |
0.10% |
| Major:* |
gastric dilatation (1 death) |
11 |
0.10% |
0.00% |
0.10% |
| Major:* |
deep venous thrombosis (6), thrombophlebitis (2) |
8 |
0.07% |
0.00% |
0.07% |
| Major:* |
staple line breakdown: linear gastric (3), window (1), enterostomy (3 - 2 deaths) |
7 |
0.06% |
0.00% |
0.06% |
| Major:* |
pancreatitis (3); acute cholecystitis (2) |
5 |
0.05% |
0.00% |
0.05% |
| Major:* |
neurologic (1 death) |
4 |
0.04% |
0.00% |
0.04% |
| Major:* |
gastric fistula |
3 |
0.03% |
0.00% |
0.03% |
| Major:* |
peritonitis (2 deaths) |
2 |
0.02% |
0.00% |
0.02% |
| All |
Complications |
|
6.87% |
4.83% |
2.04% |
| |
|
|
Total:* |
Minor:* |
Major:* |
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