A brief description of the body's mechanism of bringing in calories and nutrients will help you to understand the changes suregery will use to promote weight loss.
First, food is ground up by the teeth, swollowed and enters the esophagus on its way to the stomach. The stomach grinds food into smaller particles and allows it to mix with acid and water until it liquifies. Small amounts at a time are then allowed into the small intestine where chemicles aid in digestion and absorbtion takes place. The chemicals needed for this include bile from the liver to digest fats, and enzymes from the pancreas to digest protein and carbohydrates. The small intestine is very long enabling many food particles to be absorbed. WHat remains passes into the colon as waste products.
Calories are absorbed and used as the body's energy source. If more calories are absorbed then used the body will store the excess as fat. MOst morbidly obese individuals have lower energy and caloric needs than thin individuals. Therefore they are prone to gain weight even if they do not take in as many calories as a thin person.
Roux-Y Gastric bypass suregery changes the anatomy to help achieve a lower caloric intake. As a result of suregery the stomach will be smaller and the small intestine shorter. All of this is accomplished without removing any part of the gastrointestinal tract.
First the stomach is divided int two seperate parts. The small part that is attached to the esophogus is the new stomach. This new stomach is only about the size of a shot glass, roughly 1 ounce in volume. The rest of the stomach remains in place and continues to make gastric juices that will aid in digestion. The small intestine is divided and the downstream end is connected to the new stomach and pass directly into the small intestine. In order to asist with digestion, the upstream small intestine is connected to the Roux limb to create a "Y" intersection, hence the name Roux-Y Gastric Bypass operation.
The anatomic rearrangement allows for weight loss for two reasons. First, with a smaller stomach the pace of eating is slowed. All foods, including liquids must be taken slowly. Second, some of the calories ingested will not be absorbed because the small intestine in now shorter than it was before. However, it is important to remember that most calories will be absorbed.
How will you eat?
The new, tiny stomach must be treated like a funnel. It will hold less then 2 ounces of food at a time and so , like a funnel, time must pass (a few minutes) before it empties and can be refilled. This is done over and over until a meal is done. This means that it wil take much longer to eat a meal after surgery. Eating to fast causes the funnel to spill over. The result is vomitting. You will need to drink your liquids after and between-NOT with meals. Your sense of being "FULL" will be different than it is now. Your diet will consist of high protein, low fat and calorie foods. Although the new stomach will limit the foods you eat it will not chose the foods for you. Unfortunately, it will allow high calorie , junk foods etc to pass through. This will lead to insufficient weight loss and weight regain. Sweets and sugary foods will lead to "DUMPING SYNDROME" which is a combination of diarrhea, cramping, sweating and nausea.
WHAT ARE THE RISKS OF SURGERY
1)Wound infection
2)WOund hernia-a seperation of muscle under the skin which may require operative repair
3)Abnormal heart rhythm
4)Heart attack
5)Bleeding
6)Pneumonia
7)Pulmonary Embolus-blood clots that may form in the leg veins can break off and travel to the heart and lungs
8)Anastomotic leack-the connection between the stomach and the small intestine may leak. Is rare but would require surgicla repair
9)Stricture-narrowing of the stomach/small intestine connection to the point that food can no longer pass through easily
10)Ulcers
11)Bowel Obstruction
12)Anemia
13)Hair thinning
14)High risk pregnancy-All women should avoid pregnancy for the first 2 years following surgery since this is the time of most rapid weight loss. A pregnancy during this time could result in severe maternal malnutrition, fetal malnutrition, premature birth, underweight newborns or miscarriage
15)Death-the overall mortality is < 1%, placing this operation on par with elective gallbladder removal or bowel surgery.
Now that I have bored people who really dont care about this topic you are done reading for now. Enjoy the rest of your day.
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