Gastric Bypass: Q&A

Iím trying to lose a lot of weight. Should I get my mouth wired shut or have my stomach stapled?
Before such drastic measures are performed, there are a few qualifying conditions to be considered eligible for either of these procedures. You must be at least 100 pounds over your recommended weight and have exhausted all efforts to lose weight by reducing food intake, changing your eating habits, planning your meals, and exercising.

Keep in mind that there are no miracle weight loss cures. Any type of weight loss or maintenance regimen requires a lifetime commitment to be successful.

Before you seriously consider either of these procedures, you should investigate the possible risks of the procedures, potential side-effects after the procedures, and whether or not your insurance will cover the procedures.

The stomach stapling procedure you mentioned is called gastric-bypass surgery. It is a permanent procedure and requires a lifetime commitment to eating well and staying fit.

Gastric bypass is traditionally a laparoscopic or minimally invasive procedure. During the operation, which requires general anesthesia (being completely "put under"), a surgeon makes tiny incisions in the abdominal area and, working with a miniature scope, divides the stomach into two sections with two rows of stitch-like staples. Between the rows of staples, the surgeon makes incisions so scar tissue will grow over the staples to secure them in place.

The top section, called the pouch, holds the food (about a tablespoonful, compared to the normal stomach, which holds about a quart). The pouch will eventually expand enough to hold no more than one cup of chewed-up food, so you will feel full quickly. Then, the intestines are detached from the bottom of your stomach, and attached to the pouch. Since the intestines are brought up and not shortened, the food can be fully absorbed, eliminating the chance of vitamin and mineral deficiencies, a problem with previous surgeries of this type. The unused part of the stomach still produces gastric juices, which help the body absorb nutrients.

The surgery might or might not be covered by your insurance. (It generally costs between $15,000 and $20,000.) Many insurance carriers are covering the procedure because it has proved to improve some obesity-related health problems such as diabetes and high blood pressure.

The risks of the surgery include bleeding, infections, and respiratory problems. Generally, the procedure requires a three- to four-day hospital stay. After you go home, you need to follow strict dietary instructions. For the first few weeks after surgery, it might be difficult to eat anything without feeling uncomfortably full, and your stomach will still be very tender. It will take six to eight weeks before you are able to digest complex carbohydrates and protein (such as chicken, pasta, and dairy products) without vomiting. It will be difficult for you to digest large amounts of fat, alcohol, or sugar. Most patients lose an average of 10 pounds per month, and reach a stable weight 18 months after surgery.

Points to remember about laparoscopic bypass surgery:

If you weigh 500 pounds or more, your doctor might recommend a low-protein diet or the mouth-wiring procedure for a few months so that you can lose some weight before a gastric bypass can be performed. While your mouth is wired shut, you will lose weight quickly because your food intake, provided in liquid form, is strictly regulated.

Weight loss before gastric bypass surgery might be necessary because the endoscopy equipment is not long enough to accommodate the girth of a patient weighing 500 or more pounds. In addition, most operating tables can hold up to 400 pounds. Other risks, such as reaction to anesthesia, are also increased in patients who weigh more than 500 pounds, so wiring your mouth shut to promote weight loss might be suggested. However, wiring your mouth shut is only a temporary solution, usually only suggested for a few months. Then, the gastric bypass procedure and reducing and monitoring food intake are needed for long-term success.

© Copyright 1995-2005 The Cleveland Clinic Foundation. All rights reserved

 

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 6/1/2000

index#9671