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The last sentence of the first paragraph appears to contain incorrect information that does not reflect the reference cited. The article currently reads "complications are common and surgery-related death occurs within one month in 2% of patients." citing reference 3.
Reference 3, to the Swedish Obese Subjects study published in NEJM, states in its "Adverse Events" section: "Within 90 days after surgery, five subjects in the surgery group (0.25%) and two subjects in the control group (0.10%) died."
-- 71.228.220.189 ( talk) 02:24, 23 January 2011 (UTC)
I have revised the stated meal frequency to the original, of 2 to 3 meals per day. I base this statement on experience of several thousand patients, and on living with my own gastric bypass. Patients who eat 2 to 3 meals a day, the normal eating pattern for slender persons, seldom can gain weight again, following the gastric bypass. After gastric bypass, eating a normal small meal will produce physiological satiety which lasts for several hours. When I eat my breakfast, I seldom have any real sense of hunger till mid-afternoon. or later -- but I do have several impulses to snack, and usually not on healthy foods; more often on pecan pralines or dark chocolate. Patients will misinterpret these snack impulses for hunger, act upon them by having a "meal", and lose control of their weight.
Eating 5 to 6 meals a day is not a normal or natural pattern, probably even for our hunter-gatherer ancestors. It subverts the physiology of satiety, and encourages grazing, which is the worst possible behavior for weight control. A new patient will need to eat 5-6 very small meals daily but as time passes and food offerings change the patient must convert to the w to 3 daily meals.
Bottom line: A patient should always follow the specific recommendations of the surgeon they trusted to perform their operation.
Topnife ( talk) 19:01, 8 April 2008 (UTC)
It is difficult to globalize a topic with less than uniform global implications. Gastric Bypass is most commonly performed in the USA. Fundamental methods of doing surgery do not vary by country, nor does basic physiology, but choice of procedure is influenced by many factors.
By way of background, the USA has been a leader in this area of surgery, since its inception:
Bariatric surgery has now developed in many countries, as an increasing need has been recognized, although most of the techniques continue to draw on the methods originated in the USA. The Bilio Pancreatic Diversion, developed by Nicola Scopinaro of Genoa, Italy is a notable exception, and has strongly influenced the latest methods of bariatric surgery.
Different countries and areas of the world differ markedly with respect to the favored operative procedures, while other areas offer little or no such surgery (mainland China and most of Africa, at last report). The banding procedures are favored in most of Europe, and in Australia. South America tends toward the Scopinaro procedure, with some Gastric Bypass. At this time, the International Federation for the Surgery of Obesity (IFSO) remains loosely organized, without a developed website. Estimates of the usage of the various procedures can mainly be gleaned by observing reported series from various countries, and by attending surgical meetings, which is well beyond the scope of this article.
Those non-US surgeons who perform the Gastric Bypass typically employ one of the two technical methods, both originally developed in the USA. The physiological principles apply to all peoples, although some ethnic variables have been recognized, and cultural variability in diet influences choice of procedure and outcomes. Regional economic factors also influence availability, and choice of procedure.
I believe that the information provided in the article applies to the procedure regardless of where performed. I would welcome alternative input from my non-US colleagues.
Topnife 20:00, 14 January 2007 (UTC)
There are a lot of very misleading and inaccurate statements in this article. The first one I can find is the explanation that gastric bypass divides the stomach into two pouches which "remain connected." They are actually NOT connected. Gastric acid and other substances from the "old stomach" or the portion your food no longer travels through do join the digestive process farther on in the intestines. But there is no connection between the new "pouch" and the rest of the stomach which it's been divided from. Actually, that's exactly WHY the operation is called a BYPASS: because most of the stomach and a section of the large intestine are bypassed.
This article still needs a lot of work.
—The preceding
unsigned comment was added by
198.180.131.16 (
talk) 16:12, 11 January 2007 (UTC).
Topnife 19:12, 14 January 2007 (UTC)
I too am concerned about accuracy of facts in this article. The quoted death rate for example, is 2%. Most reports now put the mortality rate at 0.5% for an experienced surgeon. Aifb ( talk) 21:54, 12 January 2010 (UTC)
The 30-60 mL measure sounds small, but doesn't give any idea of scale. Is there anyone who can add in the parenthesis a measurement in terms of the size of the original stomach? I feel it will be more useful to the laity. -- 66.207.89.14 06:31, 16 Jun 2004 (UTC)
This reads like a copy and paste job, it even says " Please see the written consent form for a more detailed written listing of complications." what is that?
The reason I looked up this article tonight in the first place was because the question came to my mind: "What happens when the patient has lost all the weight they wanted to lose, but they are still unable to take in a normal ammount of food?" Is there surgery to re-expand their stomach, do they just make sure to eat high-calorie foods, or do they just waste away? Is there someone more knowledgable who can add this information? -- 66.207.89.14 06:31, 16 Jun 2004 (UTC)
Topnife 05:20, 14 June 2006 (UTC)
I am a nurse who takes care of Gastric Bypass patients, I work in one of the nation's largest surgical weight loss centers, and I had the surgery myself 14 months ago. I was 345 lbs then and I am 185 pounds now. I wrote the original version of this article.
Answers to questions:
1. It would be useless to estimate "natural" stomach size" because it varies so widely between individuals. It's also very hard to measure. All of the textbooks say between 1 liter and 4 liters. My stomach now holds about 300cc of food.
2. Gastric patients only have one surgery. Their bodies heal, then adapt to their new conditions. We are on a liquid diet for about a month, then reintroduce soft foods. My pouch was about 40cc (about the volume of an egg) when I first introduced soft foods and has expanded to hold more over the last year or so. That said, I will always have problems with maintaining adequate nutrition. I take a vitamin every day (which I cut into tiny pieces or crush - as I do with all pills - so that it will fit through the ring at the opening of my pouch). I have had problems with iron absorption so I added a supplement for that. At each meal I eat protein first, then complex carbs, then whatever else I want. We also have to have B12 injections about once a month (I give my own). I always carry my bottle of water with me to make sure I don't get dehydrated. I have been at this weight (about 185) for the last three months. The only surgery I want now is a tummy-tuck!!
Many gastric patients lose hair after surgery (I did) because of the lower protein intake. Others have other problems associated with malnutrition, but most can be remedied by a vitamin supplement.
Childoferna 03:05, 25 Jun 2004 (UTC)
Wow!!! you lost a lot of weight I bet you feel like a diffrent person? was it hard to cope with your life again. See I was approved to do my surgery but im scared dont know what I should do ive been heavy my whole life but dont know why if i dont eat that much im weighing about 385 and im only 5"5 so i look very big
it is wikipedia policy to use the most common name for an article. in this case gastric bypass surgery would be much more common. I'm stating my intention WP:Be bold and do this soon; although I will wait a day or two to see if someone has an objection. Themindset 01:46, 1 September 2005 (UTC)
This article has been renamed after the result of a move request. Dragons flight 04:38, 14 September 2005 (UTC)
As most research and Childoferna mentioned, there is a significant problem with nutrient absorption after the surgery. Different parts of the intestines absorb specific vitamins & minerals. The surgery specifically bypasses some of these areas, making normal function impossible. I think the article should include information about how most patients will require IV supplements (beyond simply b12) for the rest of their lives, are prone to violent nausea/diarrhea, and complications are VERY common. A recent (2005) study conducted by Medicare shows a 2% morbidity rate for the procedure itself (died during surgery) and 5% mortality in the first year.
My mother and aunt both had this done about 2 years ago and have had no end of problems. For example, the "new" stomach attaches to the small intestines about 12 inches down, the remainder of the stomach drains normally. This new stomach does not have a pyloric valve to prevent material from the intestines from backing up into the stomach. The stomach is acidic, the intestines are alkaline. When material does back up (and it does in the majority of patients at some point), it causes these horrifically painful ulcers.
If nobody has any objection I would like to add the above information (minus personal story) with relevant citations.-- Legomancer 04:07, 3 January 2006 (UTC)
MORTALITY RATE IS NOT CURRENT - 2% is much higher than current figures in large surveys show.
N Engl J Med. 2009 Jul 30;361(5):445-54. Perioperative safety in the longitudinal assessment of bariatric surgery. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ, Thirlby R, Wolfe B. —Preceding unsigned comment added by Aifb ( talk • contribs) 22:48, 12 January 2010 (UTC)
Supplemental citation on mortality rate:
A 2010 report published in JAMA looked at 15,275 bariatric surgery patients in Michigan and found a 30-day mortality rate of 0.14% -- "Mortality occurred in 0.04% (95% CI, 0.001%-0.13%) of laparoscopic adjustable gastric band, 0 sleeve gastrectomy, and 0.14% (95% CI, 0.08%-0.25%) of the gastric bypass patients."
"Hospital Complication Rates With Bariatric Surgery in Michigan"
JAMA Vol. 304 No. 4, July 28, 2010
(JAMA. 2010;304(4):435-442. doi:10.1001/jama.2010.1034)
http://jama.ama-assn.org/cgi/content/short/304/4/435
http://dx.doi.org/10.1001%2Fjama.2010.1034
http://www.ncbi.nlm.nih.gov/pubmed/20664044 —Preceding unsigned comment added by Timnemec ( talk • contribs) 13:59, 3 August 2010 (UTC)
Topnife 05:31, 14 June 2006 (UTC)
It seems to me like the article needs a succint definition of what this surgery is, other than "for weight loss", i.e., what is performed in the surgery (aside from what can be deduced from its name, which doesn't give you a lot of precise information). I was trying to find out whether this was the "stomach reduction" surgery, and had to scan the long article several times before I found this information amidst lots of technical details. -- Cotoco 16:30, 16 February 2006 (UTC)
Is this surgery physically reversible (e.g.: can the stomach be put back together, etc.)? I think this fact (whatever the answer is) should be mentioned in the article. Some people may be looking at this article wondering if they could reverse the surgery after the weight is lost so their body can be in tact again. I'd imagine healthier eating habits are learned after this surgery, so reversing the surgery--I would think--would not have any adverse effects on the person's weight. Cparker 06:05, 23 February 2006 (UTC)
Topnife 05:47, 14 June 2006 (UTC)
It might be nice to cite one or more of the "multiple studies:" "The gastric bypass, through multiple studies, has been shown to improve or cure ..." Brainhell 01:01, 8 May 2006 (UTC)
The update to the article lists current references. Topnife 00:23, 15 June 2006 (UTC)
I found buried in the External link section Risks of Gastric Bypass surgery. When you follow this link it takes you to a site trying to sell something. I took the liberty of removing the link. Jerry G. Sweeton Jr. 20:59, 5 June 2006 (UTC)
Jerry, Dan Schulz is a gastric bypass patient, an author of several books about gastric bypass surgery, and a nationally syndicated radio host of Lighten Up America, a radio show dedicated to educating people about Gastric Bypass. His site features has interviews with many of the world's top bariatric surgeons, as well as hundreds of patients. His site is an inviable source of free information. His radio shows are free for the world to listen to. His site should be added.
I do agree however with the decision to remove the gastric.us link. It looks like is selling drugs of some kind.
A number of the external links are blog sites. I feel these should be deleted. Any comments? Jerry G. Sweeton Jr. 21:11, 5 June 2006 (UTC)
Agree - There are now thousands of commercial sites, advertising sites, forums and blogs regarding Gastric Bypass. WP is not a search engine. Topnife 07:02, 11 December 2006 (UTC)
I have been performing a major re-edit of the topic, and trying to address all the above concerns, as well as re-organization, and deletion of some inaccurate info. I still have to add graphics and internal links.
There are several external links (I've looked at all of them) which I think violate the criteria under WP:EL (very helpful of Mwanner to provide that reference,above). I am planning to remove links which refer to any individual surgical group, or individual users, both of which appear to violate WP policy. I will replace with NIH references, ASBS references, and a couple broad-based user forums.
Topnife 05:13, 14 June 2006 (UTC) Topnife
I am part of the http://www.renewedreflections.com/forums/ forum. Over 700 members. Started by Craig Thompson who had weight loss surgery. It offers mental and emotional support regarding WLS - per your article "potential patients should ensure they have a strong support system". It is a very active forum, moderated by a doctor, and others that have had WLS themselves. Is this an appropriate website to link to? I consider it can be considered a "highly regarded User Forum" or a "broad-based user forums" - as mentioned in the discussion. T2dman 22:46, 5 December 2006 (UTC)
As advised by WP, there have been numerous discrepancies and inaccuracies on this page. I have been completely re-editing the page, making the following changes:
This is a first-pass at the re-edit. Please provide suggestions.
Topnife 20:00, 14 June 2006 (UTC)
Update
Topnife 00:13, 15 June 2006 (UTC)
Update
Topnife 19:44, 21 June 2006 (UTC)
It will be difficult to globalize the section on Centers of Excellence, because there is no international counterpart, yet. Bariatric surgery originated in the USA, and the ASBS was the founding professional organization. Overseas surgeons initially became members of ASBS, and then the International Federation for Surgery of Obesity was formed, with national member societies in many countries. IFSO was initially an offshoot of ASBS, and as an ASBS member, I am a member of IFSO. Many foreign surgeons continue to maintain a membership in ASBS, in addition to their own national societies and IFSO.
I can put in a paragraph about IFSO, and a link to their website [3], which is operated as a subpage of a privately operated info website out of Austria. It does not have a listing of member surgeons, except national society officers. It has no referral service - surgeons must list with the parent site, for a fee.
Center of Excellence is a new concept even in the USA, and there is no counterpart, to my knowledge, in other countries. However, the USA Medicare administration has already endorsed the concept, by limiting re-imbursement only to designated centers. Other insurance is sure to follow, and the Center concept is certainly valid, but the justification is complex and probably beyond the scope of WP. Topnife 02:46, 25 June 2006 (UTC)
Drclark ( talk · contribs) has made several statement titled Living with Gastric By-Pass. It is my personal experience that most surgical center have programs in place to minimize the emotional impact of gastric bypass (pysch eval before surgery, manadatory support group meetings pre- and post-surgery). I would like to see verifible sources for these statements. If not, I feel this section should be edited or deleted. Jerry G. Sweeton Jr. 22:42, 19 July 2006 (UTC)
What happens 6-12 years Post Op? Everything I see in this article deals with the short term and mostly what happens in the first year after gastric bypass. I'm three years post op and it seems that I really have to get off the program to regain even 10 lbs. Wondering if others also have to go to extremes of eating and being sedentary to regain weight?
Topic 2: There are rumors that eating carbohydrates post op eventually ruins the effects of the bypass portion of the surgery, causing weight to be more easily regained. Wondering if these rumors have any scientific basis? —Preceding unsigned comment added by Postopnongainer ( talk • contribs) 22:40, 5 May 2009 (UTC)
User 68.215.81.71 has made a series of edits, changing the words 'gastric bypass' to "gastro bipolar" in the leading paragraph. As a 20 year member of the ASBS, I am unfamiliar with this term being applied to any current procedure, and it is definitely not an accepted synonym for gastric bypass. I suggest that 68.215.81.71 discuss this here, before further edits. Topnife 00:22, 16 October 2006 (UTC)
I have deleted this paragraph:
"In a genetically susceptible individual (MHC HLA B27, or family history of Reiter's, Crohn's, Behçet's, iritis, chronic Ulcerative Colitis, IBS, or similar autoimmune conditions), this procedure will increase the probability of developing severe ankylosing spondylitis from [15-20%] to [a near certainty]. Before pursuing this option, it would be wise for anyone of Inuit, N. European, Haida, Tarahumara, or N. Indian extraction to consider testing for the gene related to this disease. Every population except those from Equatorial Africa posses some level of risk. Other options should then be explored."
I know of no medical reference which supports the above statement, nor have I heard or seen even a single case report of such a coincident occurrence, let alone a causal relationship. In 20 years of bariatric surgery, and several thousand operations, with diligent long-term follow-up, I have not seen a case of Ankylosing Spondylitis occur, even as a coincidence, in a post-operative patient. Pending contrary demonstration of valid scientific support, with references, I think this statement is wildly speculative nonsense.
Topnife 15:47, 29 January 2007 (UTC)
I am a 36 year old female who had the full Ruen Y gastric bypass surgery along with my Mother and my younger Sister. With all do respect, I believe the information in the above paragraph should be re-considered. I lost about 150 pounds and have kept it off however it felt as though my body began to deteriorate almost immediately. About 5 years ago I started to get sick on a regular basis. I was either having extreme diarreaha or vomitting immediately after I ate. I had to pretty much stop eatiing solid foods to avoid being sick so that I could still work, attend school and be a single mom. That worked for about 2 years I was still having the same symptoms in addition to some complications due to vitamin defficiency even though I was taking supplements on a regular basis. Now after 3 years of being uemployed and primarily bed ridden my doctors have finally found the cause of my issues and we are still trying to manage the affects. I am positive for the HLAB27 gene. I have been diagnosed with spondyloarthritis and chrons disease. I have been on TNF Inhibitors because I am unable to take NSAIDS as recommended however I am just now recovering from a major staph infection and my 3rd bout with pneumonia and have had to stop taking the TNF Inibitor for the time being. From what I understand HLAB27 is something you are born with yet I did not start having major symptoms until about a year after having gastric bypass. In addition ER meds are not effective for me and I wish I could just take aleve or ibuprofen because when I am in enough pain and have risked taking them they are effective but the do burn my stomach to some degree. I am afraid to take them regularly because my younger sister that had gb just had her second emergency surgery for a perforation two weeks ago from taking anti-inflammatories. She too is having the same symptoms I do however she has not had the genetic testing done to find out if she is positive. I really appreciate all of the information you have provided and just wanted to offer my experience. Although I cannot say for certain if its all related or not. — Preceding unsigned comment added by GBHLAB27 ( talk • contribs) 05:40, 15 June 2015 (UTC)
I did some general copyediting. I removed the 10 {{ fact}} templates and replaced them with an {{ unreferencedsect}} on the whole section. I also deleted the list of celebrities as unsourced and unencyclopedic. Further, I've changed all the {{ cite journal}} templates to {{ citation}} templates for uniformity. DrGaellon ( talk | contribs) 06:18, 5 March 2007 (UTC)
I was under the impression that the Roux-en-Y procedure is used for reasons other than gastric bypass surgery. (e.g. in the treatment of choledochal cysts - reference Lissauer & Clayden's Illustrated Paediatrics, 3rd Edition; in the treatment of any blockage or interruption of the common bile duct - personal clinical experience). This article seems to imply that the Roux-en-Y is only used for gastric bypass surgery, and as roux-en-y redirects to this page, I would have thought that the other uses of this procedure would have been listed. Ged3000 21:12, 1 December 2007 (UTC)
What is the estimated recovery time for this? 12.160.89.130 ( talk) 05:31, 10 April 2009 (UTC)
This page has huge sections with practically no inline references, and is therefore very hard to fact check any of. I'm adding a "more footnotes" template. If you disagree, please remove/discuss here. Jder ( talk) 01:02, 20 July 2009 (UTC)
Transfer of addiction is a huge problem after GPS. It has become a serious problem with alot of patients. Addiction of food is transferred to either alcohol, drugs, shopping etc. Alcohol consumption affects GPS patients immediately. This is an issue that needs to be put out there for those interested in having this procedure done. —Preceding unsigned comment added by 75.57.162.161 ( talk) 03:54, 3 August 2009 (UTC)
I did a thorough copy edit of the article, focusing on capitalization errors, and removed the capitalization tag. I also remove the wikify tag after adding more internal links, though I'm worried there are too many in the "Nutritional deficiencies" list. Can anyone help with that? Prof. Squirrel ( talk) 22:02, 13 January 2012 (UTC)
Currently the section reads "...but bariatric surgeons abandoned use of the construction in the 1970s, when it was recognized that the risks were not justified for weight management." Which is immediately followed by "The mini-gastric bypass, which uses the loop reconstruction, has been suggested as an alternative to the Roux en-Y procedure due to the simplicity of its construction, which reduces the challenge of laparoscopic surgery."
This seems contradictory... is this saying that before it was abandoned in 70's it has been suggested as an alternative?
Certainly today some surgeons are doing Collis gastroplasty with an antecolic Billroth II loop gastrojejunostomy.
Are their references available that indicate that the procedures being done today by Dr Robert Rutledge and others in fact has a propensity to "allowe[d] bile and pancreatic enzymes from the small intestine to enter the esophagus, sometimes causing severe inflammation and ulceration of either the stomach or the lower esophagus."
Can someone rewrite that section to include references that indicate mini gastric bypass is more troublesome than Roux en Y and maybe clarify what was stopped in the 70's vs what is being done today. JJ Bosch ( talk) 04:33, 6 February 2012 (UTC)
Why are the patient's lab results in different units than the stated normal levels? I'm not going to do the conversions right now, but I have a hunch that since there is such a large discrepancy between the numbers, this method of data presentation would make the patient's results look much worse compared to the standard results to the average reader (who may not notice the different units). — Preceding unsigned comment added by Xc stallion92 ( talk • contribs) 21:12, 1 July 2013 (UTC)
Good review of latest research.
http://www.nature.com/news/weight-loss-surgery-a-gut-wrenching-question-1.15560
Weight-loss surgery: A gut-wrenching question
Gastric-bypass surgery can curb obesity as well as diabetes and a slew of other problems. Researchers are now trying to find out how it works.
Virginia Hughes
Nature
16 July 2014
Volume 511
Issue 7509
--
Nbauman (
talk) 05:30, 18 July 2014 (UTC)
Information should be added regarding needed changes to medications. Roux-en-Y patients, in particular, have difficulty with enteric-coated medications, including the proton-pump inhibitors many must take to avoid ulcers. In the US, many also have difficulty obtaining insurance coverage for the oral-dissolving variety that their surgeons recommend. Don't Be Evil ( talk) 19:16, 10 February 2016 (UTC)
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”However, the first months following the surgery can be very difficult, an issue not often mentioned by physicians suggesting the surgery”
The second part of this sentence should be removed. It’s nearly impossible to actually source that statement. Prove that this issue is “not often mentioned.” Unless there’s an extremely large scale survey that quantifies the number of times it is or isn’t mentioned, it can’t be proven. Soul schizm ( talk) 04:31, 5 December 2019 (UTC)
Candy cane syndrom is a rare complication that can occur after the surgery [1], resulting in the appearance of a kind of pouch in the afferent limb of the anastomosis. I am new to Wikipedia editing, so I don't know if the aim is to relate only the most current cases, or to be as exhaustive as possible. Maybe an "other reported complications" subtitle could be relevant otherwise ? Fhuberla ( talk) 14:09, 7 January 2021 (UTC)
This article is rated B-class on Wikipedia's
content assessment scale. It is of interest to the following WikiProjects: | |||||||||||
|
Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Gastric bypass surgery.
|
The last sentence of the first paragraph appears to contain incorrect information that does not reflect the reference cited. The article currently reads "complications are common and surgery-related death occurs within one month in 2% of patients." citing reference 3.
Reference 3, to the Swedish Obese Subjects study published in NEJM, states in its "Adverse Events" section: "Within 90 days after surgery, five subjects in the surgery group (0.25%) and two subjects in the control group (0.10%) died."
-- 71.228.220.189 ( talk) 02:24, 23 January 2011 (UTC)
I have revised the stated meal frequency to the original, of 2 to 3 meals per day. I base this statement on experience of several thousand patients, and on living with my own gastric bypass. Patients who eat 2 to 3 meals a day, the normal eating pattern for slender persons, seldom can gain weight again, following the gastric bypass. After gastric bypass, eating a normal small meal will produce physiological satiety which lasts for several hours. When I eat my breakfast, I seldom have any real sense of hunger till mid-afternoon. or later -- but I do have several impulses to snack, and usually not on healthy foods; more often on pecan pralines or dark chocolate. Patients will misinterpret these snack impulses for hunger, act upon them by having a "meal", and lose control of their weight.
Eating 5 to 6 meals a day is not a normal or natural pattern, probably even for our hunter-gatherer ancestors. It subverts the physiology of satiety, and encourages grazing, which is the worst possible behavior for weight control. A new patient will need to eat 5-6 very small meals daily but as time passes and food offerings change the patient must convert to the w to 3 daily meals.
Bottom line: A patient should always follow the specific recommendations of the surgeon they trusted to perform their operation.
Topnife ( talk) 19:01, 8 April 2008 (UTC)
It is difficult to globalize a topic with less than uniform global implications. Gastric Bypass is most commonly performed in the USA. Fundamental methods of doing surgery do not vary by country, nor does basic physiology, but choice of procedure is influenced by many factors.
By way of background, the USA has been a leader in this area of surgery, since its inception:
Bariatric surgery has now developed in many countries, as an increasing need has been recognized, although most of the techniques continue to draw on the methods originated in the USA. The Bilio Pancreatic Diversion, developed by Nicola Scopinaro of Genoa, Italy is a notable exception, and has strongly influenced the latest methods of bariatric surgery.
Different countries and areas of the world differ markedly with respect to the favored operative procedures, while other areas offer little or no such surgery (mainland China and most of Africa, at last report). The banding procedures are favored in most of Europe, and in Australia. South America tends toward the Scopinaro procedure, with some Gastric Bypass. At this time, the International Federation for the Surgery of Obesity (IFSO) remains loosely organized, without a developed website. Estimates of the usage of the various procedures can mainly be gleaned by observing reported series from various countries, and by attending surgical meetings, which is well beyond the scope of this article.
Those non-US surgeons who perform the Gastric Bypass typically employ one of the two technical methods, both originally developed in the USA. The physiological principles apply to all peoples, although some ethnic variables have been recognized, and cultural variability in diet influences choice of procedure and outcomes. Regional economic factors also influence availability, and choice of procedure.
I believe that the information provided in the article applies to the procedure regardless of where performed. I would welcome alternative input from my non-US colleagues.
Topnife 20:00, 14 January 2007 (UTC)
There are a lot of very misleading and inaccurate statements in this article. The first one I can find is the explanation that gastric bypass divides the stomach into two pouches which "remain connected." They are actually NOT connected. Gastric acid and other substances from the "old stomach" or the portion your food no longer travels through do join the digestive process farther on in the intestines. But there is no connection between the new "pouch" and the rest of the stomach which it's been divided from. Actually, that's exactly WHY the operation is called a BYPASS: because most of the stomach and a section of the large intestine are bypassed.
This article still needs a lot of work.
—The preceding
unsigned comment was added by
198.180.131.16 (
talk) 16:12, 11 January 2007 (UTC).
Topnife 19:12, 14 January 2007 (UTC)
I too am concerned about accuracy of facts in this article. The quoted death rate for example, is 2%. Most reports now put the mortality rate at 0.5% for an experienced surgeon. Aifb ( talk) 21:54, 12 January 2010 (UTC)
The 30-60 mL measure sounds small, but doesn't give any idea of scale. Is there anyone who can add in the parenthesis a measurement in terms of the size of the original stomach? I feel it will be more useful to the laity. -- 66.207.89.14 06:31, 16 Jun 2004 (UTC)
This reads like a copy and paste job, it even says " Please see the written consent form for a more detailed written listing of complications." what is that?
The reason I looked up this article tonight in the first place was because the question came to my mind: "What happens when the patient has lost all the weight they wanted to lose, but they are still unable to take in a normal ammount of food?" Is there surgery to re-expand their stomach, do they just make sure to eat high-calorie foods, or do they just waste away? Is there someone more knowledgable who can add this information? -- 66.207.89.14 06:31, 16 Jun 2004 (UTC)
Topnife 05:20, 14 June 2006 (UTC)
I am a nurse who takes care of Gastric Bypass patients, I work in one of the nation's largest surgical weight loss centers, and I had the surgery myself 14 months ago. I was 345 lbs then and I am 185 pounds now. I wrote the original version of this article.
Answers to questions:
1. It would be useless to estimate "natural" stomach size" because it varies so widely between individuals. It's also very hard to measure. All of the textbooks say between 1 liter and 4 liters. My stomach now holds about 300cc of food.
2. Gastric patients only have one surgery. Their bodies heal, then adapt to their new conditions. We are on a liquid diet for about a month, then reintroduce soft foods. My pouch was about 40cc (about the volume of an egg) when I first introduced soft foods and has expanded to hold more over the last year or so. That said, I will always have problems with maintaining adequate nutrition. I take a vitamin every day (which I cut into tiny pieces or crush - as I do with all pills - so that it will fit through the ring at the opening of my pouch). I have had problems with iron absorption so I added a supplement for that. At each meal I eat protein first, then complex carbs, then whatever else I want. We also have to have B12 injections about once a month (I give my own). I always carry my bottle of water with me to make sure I don't get dehydrated. I have been at this weight (about 185) for the last three months. The only surgery I want now is a tummy-tuck!!
Many gastric patients lose hair after surgery (I did) because of the lower protein intake. Others have other problems associated with malnutrition, but most can be remedied by a vitamin supplement.
Childoferna 03:05, 25 Jun 2004 (UTC)
Wow!!! you lost a lot of weight I bet you feel like a diffrent person? was it hard to cope with your life again. See I was approved to do my surgery but im scared dont know what I should do ive been heavy my whole life but dont know why if i dont eat that much im weighing about 385 and im only 5"5 so i look very big
it is wikipedia policy to use the most common name for an article. in this case gastric bypass surgery would be much more common. I'm stating my intention WP:Be bold and do this soon; although I will wait a day or two to see if someone has an objection. Themindset 01:46, 1 September 2005 (UTC)
This article has been renamed after the result of a move request. Dragons flight 04:38, 14 September 2005 (UTC)
As most research and Childoferna mentioned, there is a significant problem with nutrient absorption after the surgery. Different parts of the intestines absorb specific vitamins & minerals. The surgery specifically bypasses some of these areas, making normal function impossible. I think the article should include information about how most patients will require IV supplements (beyond simply b12) for the rest of their lives, are prone to violent nausea/diarrhea, and complications are VERY common. A recent (2005) study conducted by Medicare shows a 2% morbidity rate for the procedure itself (died during surgery) and 5% mortality in the first year.
My mother and aunt both had this done about 2 years ago and have had no end of problems. For example, the "new" stomach attaches to the small intestines about 12 inches down, the remainder of the stomach drains normally. This new stomach does not have a pyloric valve to prevent material from the intestines from backing up into the stomach. The stomach is acidic, the intestines are alkaline. When material does back up (and it does in the majority of patients at some point), it causes these horrifically painful ulcers.
If nobody has any objection I would like to add the above information (minus personal story) with relevant citations.-- Legomancer 04:07, 3 January 2006 (UTC)
MORTALITY RATE IS NOT CURRENT - 2% is much higher than current figures in large surveys show.
N Engl J Med. 2009 Jul 30;361(5):445-54. Perioperative safety in the longitudinal assessment of bariatric surgery. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ, Thirlby R, Wolfe B. —Preceding unsigned comment added by Aifb ( talk • contribs) 22:48, 12 January 2010 (UTC)
Supplemental citation on mortality rate:
A 2010 report published in JAMA looked at 15,275 bariatric surgery patients in Michigan and found a 30-day mortality rate of 0.14% -- "Mortality occurred in 0.04% (95% CI, 0.001%-0.13%) of laparoscopic adjustable gastric band, 0 sleeve gastrectomy, and 0.14% (95% CI, 0.08%-0.25%) of the gastric bypass patients."
"Hospital Complication Rates With Bariatric Surgery in Michigan"
JAMA Vol. 304 No. 4, July 28, 2010
(JAMA. 2010;304(4):435-442. doi:10.1001/jama.2010.1034)
http://jama.ama-assn.org/cgi/content/short/304/4/435
http://dx.doi.org/10.1001%2Fjama.2010.1034
http://www.ncbi.nlm.nih.gov/pubmed/20664044 —Preceding unsigned comment added by Timnemec ( talk • contribs) 13:59, 3 August 2010 (UTC)
Topnife 05:31, 14 June 2006 (UTC)
It seems to me like the article needs a succint definition of what this surgery is, other than "for weight loss", i.e., what is performed in the surgery (aside from what can be deduced from its name, which doesn't give you a lot of precise information). I was trying to find out whether this was the "stomach reduction" surgery, and had to scan the long article several times before I found this information amidst lots of technical details. -- Cotoco 16:30, 16 February 2006 (UTC)
Is this surgery physically reversible (e.g.: can the stomach be put back together, etc.)? I think this fact (whatever the answer is) should be mentioned in the article. Some people may be looking at this article wondering if they could reverse the surgery after the weight is lost so their body can be in tact again. I'd imagine healthier eating habits are learned after this surgery, so reversing the surgery--I would think--would not have any adverse effects on the person's weight. Cparker 06:05, 23 February 2006 (UTC)
Topnife 05:47, 14 June 2006 (UTC)
It might be nice to cite one or more of the "multiple studies:" "The gastric bypass, through multiple studies, has been shown to improve or cure ..." Brainhell 01:01, 8 May 2006 (UTC)
The update to the article lists current references. Topnife 00:23, 15 June 2006 (UTC)
I found buried in the External link section Risks of Gastric Bypass surgery. When you follow this link it takes you to a site trying to sell something. I took the liberty of removing the link. Jerry G. Sweeton Jr. 20:59, 5 June 2006 (UTC)
Jerry, Dan Schulz is a gastric bypass patient, an author of several books about gastric bypass surgery, and a nationally syndicated radio host of Lighten Up America, a radio show dedicated to educating people about Gastric Bypass. His site features has interviews with many of the world's top bariatric surgeons, as well as hundreds of patients. His site is an inviable source of free information. His radio shows are free for the world to listen to. His site should be added.
I do agree however with the decision to remove the gastric.us link. It looks like is selling drugs of some kind.
A number of the external links are blog sites. I feel these should be deleted. Any comments? Jerry G. Sweeton Jr. 21:11, 5 June 2006 (UTC)
Agree - There are now thousands of commercial sites, advertising sites, forums and blogs regarding Gastric Bypass. WP is not a search engine. Topnife 07:02, 11 December 2006 (UTC)
I have been performing a major re-edit of the topic, and trying to address all the above concerns, as well as re-organization, and deletion of some inaccurate info. I still have to add graphics and internal links.
There are several external links (I've looked at all of them) which I think violate the criteria under WP:EL (very helpful of Mwanner to provide that reference,above). I am planning to remove links which refer to any individual surgical group, or individual users, both of which appear to violate WP policy. I will replace with NIH references, ASBS references, and a couple broad-based user forums.
Topnife 05:13, 14 June 2006 (UTC) Topnife
I am part of the http://www.renewedreflections.com/forums/ forum. Over 700 members. Started by Craig Thompson who had weight loss surgery. It offers mental and emotional support regarding WLS - per your article "potential patients should ensure they have a strong support system". It is a very active forum, moderated by a doctor, and others that have had WLS themselves. Is this an appropriate website to link to? I consider it can be considered a "highly regarded User Forum" or a "broad-based user forums" - as mentioned in the discussion. T2dman 22:46, 5 December 2006 (UTC)
As advised by WP, there have been numerous discrepancies and inaccuracies on this page. I have been completely re-editing the page, making the following changes:
This is a first-pass at the re-edit. Please provide suggestions.
Topnife 20:00, 14 June 2006 (UTC)
Update
Topnife 00:13, 15 June 2006 (UTC)
Update
Topnife 19:44, 21 June 2006 (UTC)
It will be difficult to globalize the section on Centers of Excellence, because there is no international counterpart, yet. Bariatric surgery originated in the USA, and the ASBS was the founding professional organization. Overseas surgeons initially became members of ASBS, and then the International Federation for Surgery of Obesity was formed, with national member societies in many countries. IFSO was initially an offshoot of ASBS, and as an ASBS member, I am a member of IFSO. Many foreign surgeons continue to maintain a membership in ASBS, in addition to their own national societies and IFSO.
I can put in a paragraph about IFSO, and a link to their website [3], which is operated as a subpage of a privately operated info website out of Austria. It does not have a listing of member surgeons, except national society officers. It has no referral service - surgeons must list with the parent site, for a fee.
Center of Excellence is a new concept even in the USA, and there is no counterpart, to my knowledge, in other countries. However, the USA Medicare administration has already endorsed the concept, by limiting re-imbursement only to designated centers. Other insurance is sure to follow, and the Center concept is certainly valid, but the justification is complex and probably beyond the scope of WP. Topnife 02:46, 25 June 2006 (UTC)
Drclark ( talk · contribs) has made several statement titled Living with Gastric By-Pass. It is my personal experience that most surgical center have programs in place to minimize the emotional impact of gastric bypass (pysch eval before surgery, manadatory support group meetings pre- and post-surgery). I would like to see verifible sources for these statements. If not, I feel this section should be edited or deleted. Jerry G. Sweeton Jr. 22:42, 19 July 2006 (UTC)
What happens 6-12 years Post Op? Everything I see in this article deals with the short term and mostly what happens in the first year after gastric bypass. I'm three years post op and it seems that I really have to get off the program to regain even 10 lbs. Wondering if others also have to go to extremes of eating and being sedentary to regain weight?
Topic 2: There are rumors that eating carbohydrates post op eventually ruins the effects of the bypass portion of the surgery, causing weight to be more easily regained. Wondering if these rumors have any scientific basis? —Preceding unsigned comment added by Postopnongainer ( talk • contribs) 22:40, 5 May 2009 (UTC)
User 68.215.81.71 has made a series of edits, changing the words 'gastric bypass' to "gastro bipolar" in the leading paragraph. As a 20 year member of the ASBS, I am unfamiliar with this term being applied to any current procedure, and it is definitely not an accepted synonym for gastric bypass. I suggest that 68.215.81.71 discuss this here, before further edits. Topnife 00:22, 16 October 2006 (UTC)
I have deleted this paragraph:
"In a genetically susceptible individual (MHC HLA B27, or family history of Reiter's, Crohn's, Behçet's, iritis, chronic Ulcerative Colitis, IBS, or similar autoimmune conditions), this procedure will increase the probability of developing severe ankylosing spondylitis from [15-20%] to [a near certainty]. Before pursuing this option, it would be wise for anyone of Inuit, N. European, Haida, Tarahumara, or N. Indian extraction to consider testing for the gene related to this disease. Every population except those from Equatorial Africa posses some level of risk. Other options should then be explored."
I know of no medical reference which supports the above statement, nor have I heard or seen even a single case report of such a coincident occurrence, let alone a causal relationship. In 20 years of bariatric surgery, and several thousand operations, with diligent long-term follow-up, I have not seen a case of Ankylosing Spondylitis occur, even as a coincidence, in a post-operative patient. Pending contrary demonstration of valid scientific support, with references, I think this statement is wildly speculative nonsense.
Topnife 15:47, 29 January 2007 (UTC)
I am a 36 year old female who had the full Ruen Y gastric bypass surgery along with my Mother and my younger Sister. With all do respect, I believe the information in the above paragraph should be re-considered. I lost about 150 pounds and have kept it off however it felt as though my body began to deteriorate almost immediately. About 5 years ago I started to get sick on a regular basis. I was either having extreme diarreaha or vomitting immediately after I ate. I had to pretty much stop eatiing solid foods to avoid being sick so that I could still work, attend school and be a single mom. That worked for about 2 years I was still having the same symptoms in addition to some complications due to vitamin defficiency even though I was taking supplements on a regular basis. Now after 3 years of being uemployed and primarily bed ridden my doctors have finally found the cause of my issues and we are still trying to manage the affects. I am positive for the HLAB27 gene. I have been diagnosed with spondyloarthritis and chrons disease. I have been on TNF Inhibitors because I am unable to take NSAIDS as recommended however I am just now recovering from a major staph infection and my 3rd bout with pneumonia and have had to stop taking the TNF Inibitor for the time being. From what I understand HLAB27 is something you are born with yet I did not start having major symptoms until about a year after having gastric bypass. In addition ER meds are not effective for me and I wish I could just take aleve or ibuprofen because when I am in enough pain and have risked taking them they are effective but the do burn my stomach to some degree. I am afraid to take them regularly because my younger sister that had gb just had her second emergency surgery for a perforation two weeks ago from taking anti-inflammatories. She too is having the same symptoms I do however she has not had the genetic testing done to find out if she is positive. I really appreciate all of the information you have provided and just wanted to offer my experience. Although I cannot say for certain if its all related or not. — Preceding unsigned comment added by GBHLAB27 ( talk • contribs) 05:40, 15 June 2015 (UTC)
I did some general copyediting. I removed the 10 {{ fact}} templates and replaced them with an {{ unreferencedsect}} on the whole section. I also deleted the list of celebrities as unsourced and unencyclopedic. Further, I've changed all the {{ cite journal}} templates to {{ citation}} templates for uniformity. DrGaellon ( talk | contribs) 06:18, 5 March 2007 (UTC)
I was under the impression that the Roux-en-Y procedure is used for reasons other than gastric bypass surgery. (e.g. in the treatment of choledochal cysts - reference Lissauer & Clayden's Illustrated Paediatrics, 3rd Edition; in the treatment of any blockage or interruption of the common bile duct - personal clinical experience). This article seems to imply that the Roux-en-Y is only used for gastric bypass surgery, and as roux-en-y redirects to this page, I would have thought that the other uses of this procedure would have been listed. Ged3000 21:12, 1 December 2007 (UTC)
What is the estimated recovery time for this? 12.160.89.130 ( talk) 05:31, 10 April 2009 (UTC)
This page has huge sections with practically no inline references, and is therefore very hard to fact check any of. I'm adding a "more footnotes" template. If you disagree, please remove/discuss here. Jder ( talk) 01:02, 20 July 2009 (UTC)
Transfer of addiction is a huge problem after GPS. It has become a serious problem with alot of patients. Addiction of food is transferred to either alcohol, drugs, shopping etc. Alcohol consumption affects GPS patients immediately. This is an issue that needs to be put out there for those interested in having this procedure done. —Preceding unsigned comment added by 75.57.162.161 ( talk) 03:54, 3 August 2009 (UTC)
I did a thorough copy edit of the article, focusing on capitalization errors, and removed the capitalization tag. I also remove the wikify tag after adding more internal links, though I'm worried there are too many in the "Nutritional deficiencies" list. Can anyone help with that? Prof. Squirrel ( talk) 22:02, 13 January 2012 (UTC)
Currently the section reads "...but bariatric surgeons abandoned use of the construction in the 1970s, when it was recognized that the risks were not justified for weight management." Which is immediately followed by "The mini-gastric bypass, which uses the loop reconstruction, has been suggested as an alternative to the Roux en-Y procedure due to the simplicity of its construction, which reduces the challenge of laparoscopic surgery."
This seems contradictory... is this saying that before it was abandoned in 70's it has been suggested as an alternative?
Certainly today some surgeons are doing Collis gastroplasty with an antecolic Billroth II loop gastrojejunostomy.
Are their references available that indicate that the procedures being done today by Dr Robert Rutledge and others in fact has a propensity to "allowe[d] bile and pancreatic enzymes from the small intestine to enter the esophagus, sometimes causing severe inflammation and ulceration of either the stomach or the lower esophagus."
Can someone rewrite that section to include references that indicate mini gastric bypass is more troublesome than Roux en Y and maybe clarify what was stopped in the 70's vs what is being done today. JJ Bosch ( talk) 04:33, 6 February 2012 (UTC)
Why are the patient's lab results in different units than the stated normal levels? I'm not going to do the conversions right now, but I have a hunch that since there is such a large discrepancy between the numbers, this method of data presentation would make the patient's results look much worse compared to the standard results to the average reader (who may not notice the different units). — Preceding unsigned comment added by Xc stallion92 ( talk • contribs) 21:12, 1 July 2013 (UTC)
Good review of latest research.
http://www.nature.com/news/weight-loss-surgery-a-gut-wrenching-question-1.15560
Weight-loss surgery: A gut-wrenching question
Gastric-bypass surgery can curb obesity as well as diabetes and a slew of other problems. Researchers are now trying to find out how it works.
Virginia Hughes
Nature
16 July 2014
Volume 511
Issue 7509
--
Nbauman (
talk) 05:30, 18 July 2014 (UTC)
Information should be added regarding needed changes to medications. Roux-en-Y patients, in particular, have difficulty with enteric-coated medications, including the proton-pump inhibitors many must take to avoid ulcers. In the US, many also have difficulty obtaining insurance coverage for the oral-dissolving variety that their surgeons recommend. Don't Be Evil ( talk) 19:16, 10 February 2016 (UTC)
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”However, the first months following the surgery can be very difficult, an issue not often mentioned by physicians suggesting the surgery”
The second part of this sentence should be removed. It’s nearly impossible to actually source that statement. Prove that this issue is “not often mentioned.” Unless there’s an extremely large scale survey that quantifies the number of times it is or isn’t mentioned, it can’t be proven. Soul schizm ( talk) 04:31, 5 December 2019 (UTC)
Candy cane syndrom is a rare complication that can occur after the surgery [1], resulting in the appearance of a kind of pouch in the afferent limb of the anastomosis. I am new to Wikipedia editing, so I don't know if the aim is to relate only the most current cases, or to be as exhaustive as possible. Maybe an "other reported complications" subtitle could be relevant otherwise ? Fhuberla ( talk) 14:09, 7 January 2021 (UTC)