The Surgical Procedure

How is gastric bypass (bariatric) surgery performed?

There are two types of operations. In open gastric bypass surgery an incision is made in the abdomen. In laparoscopic gastric bypass surgery, a smaller incision is made and a surgeon uses small instruments and a camera to guide the surgical process.

In both procedures, surgical staples (or sometimes a plastic band) are used to create a small pouch at the top of the stomach, hence the colloquial term "stomach stapling" used to refer to the surgery. The smaller stomach is then connected directly to the middle of the small intestine, bypassing much of the upper stomach and intestines.

How It Works

How does gastric bypass surgery work to reduce weight?

Most simply, gastric bypass surgery is surgery that makes the stomach smaller and allows food to bypass a portion of the small intestine. Patients who undergo successful surgery generally lose weight afterward for two reasons: they feel full sooner and bypassing the small intestine causes fewer calories to be absorbed by the body.

The Risks

What are the risks of gastric bypass (bariatric) surgery?

While gastric bypass surgery has benefited many people, saving them from health problems associated with obesity, the risks of bariatric surgery are many. According to the Virginia Commonwealth University Health System, which has an internationally respected gastric bypass program, these problems range from the commonplace and remediable to the serious and fatal.

Perhaps the most common problem is a leak from a staple or staples that have pulled loose from the stomach (or the spot where the new, smaller stomach is attached to the small intestine) into the abdominal cavity. This can produce peritonitis (an inflammation of the membrane that lines the abdomen wall) or a pulmonary embolism, a blockage of blood flow into the lungs. If left untreated too long, either can prove fatal.

The following are the risk rates seen at the Virginia Commonwealth University program for open gastric bypass surgery:

  • Major wound infection – 2 percent
  • Incisional hernia – 20 percent
  • Ulcer – 9 percent
  • Blood clots in the lungs – 0.5 percent
  • Peritonitis, or leak from hook-up – 1.5 percent
  • Death – 1 percent

Some programs have put the risk ratios at higher levels, some lower. The fatality rate was reported at 2 percent in the study of 3,328 gastric bypass patients reported in the Journal of the American College of Surgeons. The American Gastroenterological Association reported in 2002 that fewer than three in 200 (or 1.5 percent) of patients die after the weight-loss surgery. Other studies have put the fatality risk at 1 percent or lower.

Still with 170,000 gastric bypasses expected to be performed in the United States in 2005, even a 1 percent fatality rate represents 1,700 deaths following bariatric surgery.

A Major Cause Of Problems

What is a major cause of bariatric-related injuries?

The proliferation of patients seeking bariatric surgery (which typically costs $25,000 to $30,000) has meant that more and more doctors are jumping into the field to perform the operations. Some reports place physician inexperience as the most significant factor in gastric bypass patient deaths. According to one study, the risk of death within 30 days of the surgery was far greater – 4.7 times greater – in cases in which a surgeon had performed fewer than 20 gastric bypass procedures. Many may lack not only the experience for the surgery but many also lack proper training. (Reports also have surfaced over defective surgical staplers.)

Obesity Defined

What is obesity?

More than 64 percent of adults in the United States are considered overweight or obese, according to the 1999-2000 National Health and Nutrition Examination Survey. Among those are people considered to be “morbidly obese,” defined as 100 pounds overweight, a condition associated with severe physical problems. The most serious, of course, is an increased mortality rate due to a number of health-related factors.

According to the American Society for Bariatric Surgery, for men and women 50 percent above average weight the mortality rate increased twofold, and by far greater rates for people with diabetes or digestive tract disease. Most of the deaths are associated with conditions stemming from obesity, including hypertension, hypertrophic cardiomyopathy, hyperlipidemia, diabetes, cholelithiasis, obstructive sleep apnea, hypoventilation, degenerative arthritis and psychosocial impairments.

Click here if you or someone you know has suffered a severe injury or death as the result of gastric bypass/bariatric surgery