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Why it's done
By Mayo Clinic staffGenerally, gastric bypass surgery is for people who are unable to achieve or maintain a healthy weight through diet and exercise, are severely overweight, and who have health problems as a result. Gastric bypass surgery could be an option for you if:
- Your body mass index (BMI) is 40 or higher (extreme obesity)
- Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as diabetes or high blood pressure
Gastric bypass surgery doesn't replace the need for following a healthy diet and getting exercise. In fact, the success of the surgery depends in part on your commitment to following the guidelines given to you about diet and exercise. As you consider weight-loss surgery, make sure that you exercise, change your eating habits and adjust any other lifestyle factors that have contributed to your excess weight.
Here are some types of gastric bypass surgery:
- Roux-en-Y (roo-en-y). This is the preferred method of performing gastric bypass surgery. In Roux-en-Y, your stomach is stapled to create a small pouch and a passage for food to go around (bypass) a section of your small intestine.
- Biliopancreatic diversion with duodenal switch. In this procedure, the surgeon removes about 80 percent of the stomach, forming a thin sleeve-like stomach. The valve that releases food to the small intestine remains (duodenal switch) along with a limited portion of the small intestine that normally connects to the stomach (duodenum). The surgery bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach (biliopancreatic diversion). This weight-loss surgery is effective but has more risks, such as malnutrition and vitamin deficiencies, and requires close monitoring. It's generally used for people who have a body mass index greater than 50.
Other weight-loss surgery options include:
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Lap-Band adjustable gastric banding (LAGB). The surgeon uses an inflatable band to divide the stomach into two parts by wrapping the band around the upper part of your stomach. Pulling it tight like a belt, the surgeon creates a tiny channel between the two pouches that restricts the amount of food you can eat. The band keeps the opening from expanding and is designed to stay in place indefinitely. It can be adjusted or surgically removed if necessary. LAGB is a simpler procedure and has a lower complication rate when compared with more-involved procedures.
However, LAGB causes less weight loss and a slower rate of weight loss than does the Roux-en-Y gastric bypass. This surgery isn't recommended for people who have certain medical conditions, such as Crohn's disease, large hiatal hernias or a history of gastric ulcers.
- Vertical banded gastroplasty. This operation, also referred to as stomach stapling, divides the stomach into two parts — limiting space for food and forcing you to eat less. There is no bypass. Using a surgical stapler, the surgeon divides your stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch — the rest of your stomach. Partly because it doesn't lead to adequate long-term weight loss, this weight-loss surgery isn't as popular.
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Sleeve gastrectomy. If your body mass index (BMI) is 50 or greater, your doctor may suggest a sleeve gastrectomy as an alternative to gastric bypass. The sleeve gastrectomy is the first part of the biliopancreatic diversion with duodenal switch that has recently been studied as a primary procedure for weight loss.
In this procedure, the structure of your stomach is changed to be shaped like a tube, which restricts the amount of calories your body absorbs. For some people, the sleeve gastrectomy is a "staged procedure" in order to lose some weight initially before the second stage, the biliopancreatic diversion.
- American Gastroenterological Association. American Gastroenterological Association medical position statement on obesity. Gastroenterology. 2002;123:879.
- Bariatric surgery for severe obesity. National Institute on Diabetes and Digestive and Kidney Diseases. http://win.niddk.nih.gov/publications/PDFs/gasurg12.04bw.pdf. Accessed Aug. 10, 2009.
- Mun EC, et al. Surgical management of severe obesity. http://www.uptodate.com/home/index.html. Accessed Aug. 10, 2009.
- Angrisiani L, et al. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surgery for Obesity and Related Diseases. 2007;3:127.
- Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 2009;361:445.
- Suter M, et al. Results of Roux-en-Y gastric bypass in morbidly obese vs superobese patients: Similar body weight loss, correction of comorbidities, and improvement of quality of life. Archives of Surgery. 2009;144:312.
- Cottam D, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surgical Endoscopy. 2006;20:859.
- Mun EC, et al. Complications of bariatric surgery. http://www.uptodate.com/home/index.html. Accessed Aug. 10, 2009.
