LAPAROSCOPIC GASTRIC BYPASS
Dr. Jawad has performed over 1550 laparoscopic Roux-en-y gastric bypasses since 1999 with excellent results and a low complication rate. He has also performed this procedure laparoscopically on some of the largest patients with BMI's ranging from 35 to 94.
Nationwide, statistics indicate the Gastric Bypass surgery is effective in 85 percent of all people who have the surgery. Success means the individual must lose at least 50 percent of their excess body weight and maintain that weight loss for more than five years. Bear in mind, this also means that 15 percent of all people who have had Gastric Bypass surgery did not lose weight, or they lost weight but gained it back within five years.
During the first year following surgery, the greatest amount of weight loss will occur. This is called the "Honeymoon Phase," when weight loss is the easiest and quickest. Losing the excess weight is only the first stage of your weight loss program. The most difficult years are ahead of you. Recognizing obesity as an addictive disease can help you better understand the emotional struggles you will be faced with as you lose weight. The underlying cause of overeating still needs to be addressed.
Often with weight loss, people can expect certain psychological and behavioral changes. This may affect your relationship with the people around you. Most Bariatric surgery patients will need to seek professional help to deal with these changes. Numerous professional agencies and support groups are available to help in this area. We will be glad to assist you in locating these professionals to help cope with the changes ahead.
Gastric Bypass surgery is designed to help with weight loss in several ways. The small stomach pouch initially will only hold one to two ounces of food at a time. Once the pouch is full, it takes about ten or more minutes for food to pass through to the small intestine. It will take, on average, 30 to 45 minutes to eat a meal consisting of two ounces of meat and one-fourth cup each of a starch, vegetable, and fruit.
In addition, the pouch is now too small to help grind foods for you. Only small amounts of digestive juices will be present to turn foods into a paste. This means you will have to thoroughly chew all foods to a baby food consistency before swallowing. Otherwise, the food will be too bulky to pass from the pouch through the opening to the small intestine. Failure to chew foods will result in pain or discomfort and possibly vomiting.
The time it takes to chew foods thoroughly and the limited space in the stomach pouch reduces the amount of food you are able to consume at a meal time. This will cut down on the amount of calories you consume at a given meal, which in turn will help with weight loss.
With the intestinal tract sewn directly to the stomach pouch, food will now flow uncontrolled from the stomach to the intestine. Sugar, which is already in its most fully digested form, is rapidly absorbed across the intestinal tract into the blood stream. If the food you eat contains sugar, you will experience "dumping syndrome". You body's response to consuming too much sugar is to break into a cold sweat, nausea, and possibly vomiting, diarrhea, and overall weakness. This feeling will last for approximately 20-30 minutes. Once this has happened, most people are careful not to consume foods high in sugar. Foods high in sugar are also high in calories. Many foods high in sugar are also high in fat, therefore, high in calories. Eliminating sweets and fats from your diet will help with weight loss.
In review, the Gastric Bypass surgery simply forces the same behavior modification techniques that are found in any sensible diet program: eat three meals a day, eat small portions, eat more slowly, and avoid high calorie foods and when satiety is reached, stop eating. The difference being, with surgery, after the first 20 to 30 pounds of weight loss, you cannot decide to forget about dieting. Surgery is permanent unless you undergo another operation to reverse the surgery. Therefore, unlike other methods of weight reduction, because of the surgical modifications made to your digestive system, you must be prepared, emotionally to stay with the diet for the rest of your life.
It is easier to understand how the gastric bypass surgery works once you understand how the body's digestive system works. Normally, digestion begins in the mouth when we chew our food. From there, the food passes through to the stomach where partial digestion takes place. Small amounts of food slowly pass through a one way valve at the bottom of the stomach into the small intestine where foods are fully digested and nutrients are absorbed into the blood stream. Finally, the contents of the intestinal tract pass through the large intestine where excess fluid is absorbed.
The mouth and teeth are used to grind and chew our foods before swallowing. According to restaurant studies, the typical American consumes their entire full course meal in less than ten minutes meaning most people do not spend time to properly chew their foods before swallowing. Carbohydrates are the only foods where digestion begins in the mouth.
When we swallow, food passes from the mouth through the esophagus into the stomach. It is in the stomach where preliminary digestion takes place. This occurs in two ways. First, the stomach, which is the most complex muscle in our body, helps to grind our food to paste. Also present in our stomach are digestive juices and acids. These are produced in response to sight, smell, taste, and thoughts of food. These digestive juices begin "preliminary" digestion of carbohydrates, proteins, and fats turning the food we have eaten into a paste called chyme. The chyme then passes slowly through the sphincter muscle with a one way valve into the small intestine.
It is in the small intestine where foods are fully digested. Small particles of food called sugars, amino acids and triglycerides are then absorbed across the intestinal wall into the blood stream. Vitamins and minerals are also absorbed into the blood stream from the small intestine.
Undigested food, such as fiber and other body waste products, then pass along to the large intestine where they are made into solid waste and excreted from the body.
Gastric Bypass surgery involves reshaping the stomach and small intestine. An instrument is used to place four even rows of staples across the top part of the stomach or transect the stomach on the top creating a pouch. This completely separates the top part of the stomach from the bottom part of the stomach. In order for food to pass through to the small intestine from the newly created small stomach pouch, the intestinal tract must be rearranged. A portion of the intestinal tract must be cut and re-sewn attaching one portion to the small stomach pouch. The other end is attached to the part of the intestine coming from the bottom of the stomach pouch. The small intestine is 20 feet long. Only 16 to 18 inches from the beginning of the small intestine is transected.
The proximal part (closet to the stomach) is called the afferent loop. The distal part (farthest away from the stomach) is called the efferent loop. Depending on the patient's weight, the afferent loop is attached to the efferent loop at a distance of 75 cm (30") up to 150 cm (50") from its end. This segment of bowel will be inert (non-functional). Food will be absorbed after the attachment of the two bowel segments. At this point, the stomach, duodenal, enteric, and pancreatic juices start to mix with food and digest. The stomach and small intestine will now look like the illustration on the next page:
Now, when foods are eaten, they pass from the mouth, to the small stomach pouch, into the small intestine. The bottom part of the stomach still remains healthy and active. Digestive juices and acids are still produced in the stomach in response to the taste, sight, smell, and the thought of food. Instead of mixing with food in the stomach, these digestive juices travel down the intestinal tract and mix with foods in the small intestine. Now, both preliminary and complete digestion will occur in the small intestine.
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