Illinois Bariatric Center
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Treatment Options
Non-Surgical Treatment
Dieting, exercise, and medication have long been regarded as the conventional methods to achieve weight loss. Sometimes, these efforts are successful in the short term. However, for people who are morbidly obese, the results rarely last. For many, this can translate into what's called the "yo-yo syndrome," where patients continually gain and lose weight with the possibility of serious psychological and health consequences.
Recent research reveals that conventional methods of weight loss generally fail to produce permanent weight loss. Several studies have shown that patients on diets, exercise programs, or medication are able to lose approximately 10% of their body weight but tend to regain two-thirds of it within one year, and almost all of it within five years.(1) Another study found that less than 5% of patients in weight loss programs were able to maintain their reduced weight after five years.(2)
1. American Association of Clinical Endocrinologists (AACE) / American College of Endocrinology (ACE) Statement on the Prevention, Diagnosis, and Treatment of Obesity (1998 Revision). AACE/ACE Obesity Task Force. Endocr Pract. 1998; Vol. 4 No. 5: 297-330.
2. Kramer FM et al. Long-term follow-up of behavioral treatment for obesity: patterms of weight regain among men and women. Int J Obes 1989; 13:123-136.
Gastric Bypass
In Roux-en-Y Gastric Bypass (RYGB), a small stomach pouch of one half to one ounce, is created, and connected to the rest of the GI tract, through an opening about one-half inch in diameter.
RYGB is completely different, and should not be confused with, Intestinal Bypass or Jejuno-ileal (J-I) Bypass, an operation used during the 1960s for the treatment of obesity. With J-I Bypass, weight loss was based on non-absorption (malabsorption) of what was eaten rather than restriction of intake. J-I Bypass procedures frequently caused severe diarrhea, protein deficiency and kidney and liver problems, which at times resulted in patient death. Because of these severe side effects, this operation has been abandoned.
RYGB is also not to be confused with the “stomach staplings” that had such dismal results 25 years ago.
Weight loss after RYGB is gradual and occurs at the greatest rate during the first several months after surgery. The consistency rather than the rate of weight loss is most important in the long run. After the first few months the rate of weight loss will decrease, this is related to the decrease in the amount of body fat. After RYGB, you will be discharged on a liquid and pureed food diet. You will be on this diet for at least four weeks after surgery. This gives your stomach ample opportunity to heal prior to the stress of solid foods. The dietitians will review this diet in great detail and supply you with a written description and some recipe suggestions. At your six week postoperative check, you have advanced to a phase of the diet that begins to add solid foods. The dietitians review this very carefully, giving you written instructions and answering all of your questions.
Nausea following this surgery is very common. If vomiting occurs, stop drinking or eating until the feeling of nausea passes. After the nausea resolves, resume drinking liquids before attempting to eat solid foods, if you are in that phase of the diet. Repetitive vomiting to the point that liquids cannot be retained is potentially dangerous, and if this occurs, you should immediately contact the Illinois Bariatric Center.
Following hospital discharge, you should not drive for at least two weeks and perform no strenuous activity, especially heavy lifting, for at least six weeks. You may walk as much as you wish and climb stairs as needed. You may bathe or shower. Some people with sedentary jobs have returned to work as early as three weeks following surgery, however if the job is physically demanding it may be six to eight weeks before preoperative activities can be resumed. It is fairly common to feel weak and tired immediately after discharge from the hospital. The body is recovering from the stress of a major operation and because weight loss is occurring during this time the feeling of weakness may be somewhat prolonged.
Follow-up after surgery is extremely important. The operation is only one part of the course to a good result. Success is not determined at the time of discharge. Weight loss will occur for the next 12-18 months following the operation. Participation in the program is vital to the long-term maintenance of the weight loss achieved. Counseling by the dietician is important in making the transition from liquids to soft foods. This will help emphasize the importance of appropriate food choices to maintain a balanced diet and avoid high calorie liquids and soft foods, which can defeat the purpose of the operation. All gastric reduction operations can be defeated by consuming too many calories.
RYGB Follow-Up Schedule
Follow-up visits at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and yearly for life.
You will also see a dietician at every appointment
You will see a physical therapist at your 3 month visit
Lab work done at 3 months, 6 months and yearly.
These visits are required and are essential in order to detect nutritional complications.
Possible Complications
All abdominal operations carry the risks of bleeding, infection in the incision, heart and/or lung problems, intestinal obstruction (blockage) due to adhesions, and the risks associated to general anesthesia. Some of these risks are greater in patients with clinically severe obesity.
Risks specifically related to RYGB can be divided into early and late complications. The most serious early complication is death, which occurs in about one patient per two hundred. This is usually due to a heart attack or sudden irregularity in the heart rhythm, or a blood clot to the lungs (pulmonary embolus). Other technical early complications include leakage through the staples or sutures, which hold the stomach and intestine together, or injury to the spleen. Leakage is a serious complication and usually requires additional operations to drain the infection and repair the site of leakage. Injury to the spleen during surgery is uncommon, but should it occur it might require removal of the spleen if the bleeding cannot be controlled. These complications occur in about one patient per hundred.
Later risks of RYGB include the formation of ulcers in the stomach or small intestine. This is rare, occurring in less than two patients out of 100, and can usually be successfully treated with medications. Obstruction (blockage) of the opening or stoma can occur when a piece of food becomes lodged in the outlet. This is a rare occurrence and generally can be remedied by removing the food using an endoscope passed from the mouth into the stomach. Conversely, there may be pouch or esophageal dilation (stretching) or, rarely, staple disruption. With this the feeling of fullness disappears and the operation loses its effectiveness. Vitamin and/or Iron deficiency may occur in a mild form in as many as 34-40 percent of patients after gastric bypass. Such deficiencies can generally be restored with oral supplements or injections and are among the reasons that close, life-long follow up is very important. Like any weight loss method, these procedures appear to be associated with an increase incidence of gallstone formation. Therefore, there is an increase in complications secondary to gallbladder disease. Failure to lose weight or maintain lost weight is another long-term complication. In some patients the reasons for this failure can be identified and corrected, but in a small number of patients there is no apparent explanation.
Advantages
Rapid initial weight loss
Most commonly performed procedure
Minimally invasive approach is possible
Longer experience in USA
Disadvantages
Cutting and stapling of stomach and bowel is required
More operative complications than with LAP-BAND
Portion of digestive track is bypassed, reducing absorption of essential nutrients
Complications due to malabsorption reported
Nonadjustable
1 in 200 mortality rate