Talk:Gastric bypass surgery

2% mortality figure in opening paragraph appears to be incorrect
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)

Meal Frequency
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)


 * I totally agree with you. My doctor's instructions were to eat 2-3 meals a day. I am permitted 1-2 protein snacks per day - either a protein shake or a protein bar (provided the amount of sugar is low). I am also allowed a low-sugar fruit snack or breakfast. I can't even eat as much as the article says! Also, the article doesn't state this, but my surgeon's instructions are that my meals should take no longer than 20 minutes. If I am feeling full, yet haven't reached my protein intake level within 20 minutes, I am to stop eating and use protein supplementation later in the day. I believe that is to discourage over-eating or "grazing" - even though it is still part of my meal - just to satisfy the protein requirements.Kelelain (talk) 20:28, 21 April 2011 (UTC)

Request for Globalization
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:
 * The first Bariatric Surgery procedure was developed in the USA.
 * The first Gastric Bypass was performed in the USA.
 * The first Gastroplasties were performed in the USA.
 * The first Gastric Band was developed in the USA.
 * The Vertical Banded Gastroplasty was developed in the USA.
 * The Silicone Ring Gastroplasty was developed in the USA.
 * The first Laparoscopic Gastric Bypass (Roux en-Y) was performed in the USA.

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)

Second Para Misleading/Incorrect
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).


 * Error is in reading
 * The above unsigned grumble is not helpful or constructive. The complainer states "a lot of misleading and inaccurate statements", with neither identification of what he thinks they are, nor substantiation of his assertion of error.  The single cited "inaccuracy" results from a misinterpretation of the sense of the sentence, which refers to both portions of the stomach remaining connected (to the intestines).  I have edited and elaborated that sentence to remove the potential ambiguity.

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)


 * well, not to be a jerk, but you yourself say, "for an experienced surgeon." The article states that it takes about 100 surgeries to be skilled in this surgery, and (as common sense would dictate) a surgeon usually learns to overcome complications only by encountering complications over time. So the mortality rate listed is a general one, which includes inexperienced, under-experienced, and experienced surgeons together. Taking that into account, then the mortality rate is not going to only reflect the outcomes for only experienced surgeons, and is another reason one should look for an experienced surgeon, or a medical university where the inexperienced surgeon is being supervised by a highly experienced surgeon. My surgeon is the head of the gastric bypass department of the nearest large medical university - her mortality rate is currently 0.00% That is why I chose her. Kelelain (talk) 20:38, 21 April 2011 (UTC)

Reduced size as a percentage of original size?
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)

Answer

 * Look at your thumb. It's about 15 ml, which is the preferred size of the stomach pouch.  Mine is even smaller.  The old size of 30 - 60 ml is invalid, since larger pouches, particularly those formed from the upper part of the stomach, have a tendency to stretch too much.
 * The normal stomach is about 400 ml when empty, but can stretch to hold 1000 ml or more (watch those chug-a-lug beer drinkers or champion hotdog eaters, to see what I mean). The gastric bypass pouch has 5-10% of the volume of a normal empty stomach.
 * Topnife 00:21, 15 June 2006 (UTC)

Copy and Pasted from a pamphlet
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?

What happens after the weight is lost?
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)

:Not to Worry -- It stops

 * Body weight is a function of energy balance - energy used versus energy taken in as food. After surgery, intake is greatly reduced, so the body burns stored fat to make up the difference.  When body weight is very much reduced, energy usage is also reduced, while the amount of food that can be eaten increases somewhat, over the first year, bringing one back into balance at the lower body weight, usually at or 10 -20% above ideal body weight.  It's best not to start eating high-calorie foods, or snacking, which can cause weight regain in the long-term.

Topnife 05:20, 14 June 2006 (UTC)


 * I don't know what the article looked like in 2004 or 2006 when these comments were made, but currently, the article does state that, essentially, if you fall back into your former eating habits, you will stretch the smaller stomach and/or take in too many calories and "bypass the bypass." I don't know if you had the surgery in the meantime, but when you have it, you are put on a diet. It isn't like you have it and then eat what you want - you are also put on a low-calorie, high-protein, low-sugar diet. Note: NOT a low-fat diet! This should, as all "diets," become your new lifestyle eating habit. If it is, then you will lost the excess fat, and maintain your optimal body weight. The surgery cannot be "undone" - not only will the staples create a seam in the stomach over time (just as using staples to close an outer wound), you will have lost more than a foot of small intestine due to the roux en y, and that can never be brought back. Also, since the small intestine must be removed from where it is in the bottom of the stomach and reattached at the new stomach, that "hole" created by pulling the small intestine away from the original stomach is stitched closed, and cannot be re-opened. So to address your question, no the surgery cannot be undone, it is a lifetime decision. If you want the benefits of a gastric bypass surgery but also are concerned about these lifetime changes, I would suggest looking into a lap band procedure, which does not require any re-sectioning of your intestines. Kelelain (talk) 20:46, 21 April 2011 (UTC)

Answers to questions
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)


 * 1) First off, Childoferna, congratulations to you! Your weight loss has been fantastic, I wonder how you are now, 7 years after you made these comments? I sure hope you are at your optimum weight and enjoying a healthy life.


 * 2) I don't know how things were "back then," but now doctors suggest you take chewable vitamins, even ones labeled for children can be taken twice a day for a full adult dose. That way, you don't have to crush the medications. I had to crush my other medications, and threw them up a lot, soon after surgery (meds for other conditions). I finally figured out I could put the crushed meds in a teaspoon of applesauce (a permitted pureed food after surgery), and they went down more easily and I had less instances of throwing them back up. And you will be taking vitamins every day for the rest of your life. If you have to decide between buying gasoline or vitamins, you are gonna have to walk! It's that important to your future health.


 * 3) Thank you, Childoferna, for talking about the hair loss. Due to other conditions, I cannot wash my own hair right now (has nothing to do with obesity), but the woman who does it has been shocked at how much hair I lose during washing, and that is in addition to what I lose in my hairbrush. They checked my thyroid, again, but it is good, so I can only assume I need to increase some of my supplements.


 * 4) Some things NO ONE told me before the surgery: YOUR TASTEBUDS WILL CHANGE - and sometimes, NOT for the better! I used to love soy milk, and I actually had bad pica before the surgery (obsessively chewed ice cubes, and ate cereal with soy milk all day). I was looking forward to eating my low-calorie cereals with soy milk after surgery (that would have been a great source of protein), but I can no longer have dairy or soy or any other kind of milk - it all tastes sour and bland to me, and the cereals I used to love, I am indifferent towards now. I am glad that the article does mention, in passing, indifference towards food. While I had that prior to the surgery, it has gotten a whole lot worse. There are days now that I practically cry when I think, "you have to eat, you need the protein," because I just don't feel like eating at all. I have found that LOW SUGAR protein bars and shakes come in handy at those times (it is a daily struggle). I have confirmed these things with others who have had the roux en y, and with my doctors. Another thing they didn't tell me until a week and a half before the surgery - you can no longer take ANY medication that comes in capsule form, or any that are specifically Extended Release (they will have a name that has "ER" at the end, like Opana ER). Those are medications that need to sit in your stomach for a long time, and nothing will be in your stomach that long anymore. That is something to take into consideration. You CAN take meds that are once a day meds, but if they are specifically extended-release, you will not benefit from them at all. This surgery changes your life, many good ways, and a few bad ways. The program I was in, you do 6 months of supervised diet and exercise prior to surgery - if you can lose weight that way, it is still the preferred method. You do not want to drastically have your intestines re-sected on a whim. You will also have psychological counseling (if you are in a good program like I was), and have a registered dietitian to work with before and after the surgery. You will learn by trial and error what foods you can tolerate post-surgery and which you cannot. But you WILL be on a diet - high-protein, low-calorie, low-sodium, low-sugar. NOT low fat! As the nurse above says, your complex carbs will be the next-to-last foods to be reintroduced to your diet. Meats will be the last. You may never tolerate pasta or rice again. Luckily for me (because I love them), I can, but it's a crap shoot. A good surgical program will tell you most of this, but even going to the best in my area, I still had a learning curve on my own.Kelelain (talk) 21:17, 21 April 2011 (UTC)


 * I would like to addend my former comments, as time has passed. I have now been advised - and experienced - that ER medications can be taken if you are into the final phase of diet (when you are allowed to eat whatever you want within the confines of the diet). Also, I have successfully taken capsule medications. I am not deleting what I wrote above, despite this new information, because I would like it to stand that these are things you can be told by your bariatric team that can be false or misleading. The sheer fact, I have found, is that they don't know many things that have nothing to do with the actual surgery. Even the dietitians cannot be blindly trusted. Kelelain (talk) 16:10, 9 June 2012 (UTC)

WP:Naming
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
 *  copied from duplicative talk page Talk:Roux-en-Y gastric bypass surgery. 

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)

Additions/subtractions?
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)


 * (just a note - one of the authors of the study someone referenced above was my surgeon, she is a professor and the head of the gastric bypass dept. at a large university, and her information is very up to date) Kelelain (talk) 21:29, 21 April 2011 (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)

:Assertions are Invalid

 * Most of these statements are inaccurate, with respect to the Gastric Bypass, Roux en-Y. A need for IV supplements would be very rare after GBP, and nutritional complications are actually quite rare.  Reduced absorption of iron and calcium can and should be offset by use of oral supplements daily.  The Medicare study mentioned is subject to several methodological problems.


 * I've performed about 2500 of these procedures, and have also had one myself.


 * Your relatives may have had an offbeat version of the GBP, called a "Mini-Gastric-Bypass", which easily could cause corrosive gastritis or esophagitis. Ulceration has an incidence of 1-2% in most series, and a functioning pylorus is not the answer to the problem, anyway.

Topnife 05:31, 14 June 2006 (UTC)

Definition
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)

Reversible?
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)

: Reversal Not Indicated

 * While this operation can technically be reversed (the stomach is re-connected, and the bowel is put back into natural configuration), there is almost never a valid reason or indication to perform a reversal, and the risk of the operation is actually greater than that of the original procedure. When the surgery is reversed, the weight lost is rapidly regained over a few months.  Healthy eating habits will rapidly succumb to the recurrence of unphysiologic hunger, which was the cause of the problem in the first place.


 * One should NEVER have the operation with the idea of having it reversed after weight loss, or just to "try it out".

Topnife 05:47, 14 June 2006 (UTC)


 * Cparker, I don't know what you did after 2006, but if anyone else has this kind of issue, I would suggest you consider the lap band instead. It does not require the drastic re-sectioning of your organs that is done in roux en y/gastric bypass. In the surgery, you lose more than a foot of your small intestine that you can't get back and that is necessary if it is connected to the stomach in its normal position; the area where that connection originally occurred is closed off by sutures; the area of your stomach that is stapled creates a bifurcated stomach that cannot be reopened - it is completely irreversible. This is a complete and permanent lifestyle and physiological change that should never be taken lightly. See my comments in other comment sections on this page about the difference between your pre- and post-surgical life. You will be on a diet for life - you will not be returning to your prior eating habits, and as I mention above, you may not even want to. Your tastebuds will change. Your nutritional needs will be re-prioritized. You still have to actively pursue the weight loss - it isn't that they cut your stomach down and you eat what you want and lose weight - that is not how it works at all. You will be nauseated after the surgery - mine lasted for the two and a half months during which I was on pureed food only - I begged people to pray for me, it was so bad, but once I was back on solid food, it went away. That may have been unique to me. There are many problems that occur with everyone, but some will be unique to you. My program made me do 6 months of supervised 1,500 calorie a day diet and exercise (as much as I could with other conditions hampering me), and prior to that my PCP and I tried a similar program ourselves. So there is no "trying it out" - you are either in the program or not. But I can tell you, after almost a decade of obesity caused by medications I take for other conditions (and to be honest, exacerbated by over-eating for the first time in my life, also a side-effect of those meds), I have lost about 55 lbs. in the 5 months since my surgery. Seeing the scale keep going down and down is a good feeling. With the surgery, it happens quickly at first and then slows down, with the lap band it's just the opposite. Make sure you are totally informed before you make a choice, and choose your surgeon and their program wisely. Do your homework. Plus, they have screening methods, also, to make sure you are not wasting their time. You will be given a psychological evaluation - similar to having plastic surgery - to make sure you understand the risks, the benefits, the amount of involvement you play in your weight loss journey, and if you are ready for it. Kelelain (talk) 21:47, 21 April 2011 (UTC)

citations needed
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)


 * I found the source. This article was lifted (word for word) from this site http://www.plasticsurgeryindex.net/gastric_bypass_surgery.htm .  This site needs a serious re-write immediatly.  I cited the source for the time being.  Jerry G. Sweeton Jr. 14:18, 5 June 2006 (UTC)

See Updated Article
The update to the article lists current references. Topnife 00:23, 15 June 2006 (UTC)

Advertisment
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)


 * Found another advertisment Patient hosted radio show features interviews with top gastric bypass surgeons and patients Jerry G. Sweeton Jr. 21:07, 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.

Gastric Bypass Blogs?
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)


 * Blogs like these can offer a lot of information from a patient's personal view, as opposed to a strictly medical view. I think they have to be looked at on a case-by-case basis. —Preceding unsigned comment added by 68.161.190.218 (talk • contribs) (a repeat spammer)


 * Blogs are specifically mentioned in WP:EL as Links to Avoid. -- Mwanner | Talk 17:49, 9 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)

Accomplishing Re-Edit
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)

Edit Summary
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:


 * Re-Organized Outline
 * Re-wrote Sections on Indications, Techniques, Results, Complications, etc.
 * Deleted extraneous source of previous info, some of which was inaccurate and redundant.
 * Inserted info regarding NIH Consensus Panel, and American Society for Bariatric Surgery.
 * Added more specific nutritional info
 * Added info about professional societies.
 * Addressed the complaints recorded in discussion page, as above.


 * Upload of new images and videos is pending.


 * External Links have been edited to include info from NIH sites, and ASBS site, as well as public info sites, and highly regarded User Forums, which are predominantly non-commercial. In accord with WP policy, as published in WP:EL, I have deleted links to
 * 1) Commercial Sites
 * 2) Proprietary Sites (e.g., advertising a physician practice)
 * 3) Blogs

This is a first-pass at the re-edit. Please provide suggestions.

Topnife 20:00, 14 June 2006 (UTC)


 * Looking better already, but references would be a nice addition. --WS 22:24, 14 June 2006 (UTC)
 * No problem -- coming soon. Topnife 22:42, 14 June 2006 (UTC)

Update

Topnife 00:13, 15 June 2006 (UTC)
 * Graphic uploaded
 * Some references added

Update Topnife 19:44, 21 June 2006 (UTC)
 * Added Complication Rate section
 * Modified, and deleted some celebrities who did not have gastric bypass:
 * David Lange - gastric stapling
 * Jerrold Nadler - duodenal switch
 * Ann Wilson - adjustable gastric band
 * Star Jones - appears to be rumors/gossip only - her health is private unless voluntarily disclosed.


 * Nice image you have added, but I think it is hard to see for anyone that doesn't already know what is done in the operation to interpret it. I think a more simplified image would be better. --WS 21:45, 21 June 2006 (UTC)


 * Good drawings that also meet WP requirements are hard to find. I'm looking.  Topnife 02:51, 25 June 2006 (UTC)

Re: Request for Globalization of Centers of Excellence Section
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)

Update

 * As of 1 July 2006, IFSO does not have a Centers of Excellence type program, and their website is being reconstructed. The Executive Director advises they will have a new website soon, and will try to post a listing of member surgeons. Topnife 19:01, 5 July 2006 (UTC)

Living with Gastric By-Pass
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)


 * I agree. Speaking as one who has both done the surgery (2500 times), and who has also undergone the surgery, it is my experience that the effects described are a consequence of either failure of the surgeon to provide necessary support, of failure to follow the instructions given.  Also, the statement that the pouch enlarges is false.  When properly constructed, the pouch does not undergo significant anatomic enlargement.  Surgeons refer to the "functional gastric capacity", which is more an adaptation of the first few inches of small intestine below the pouch (all of which is beyond the scope of this WP article). Topnife 16:08, 27 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)


 * whoever asked the questions about long-term post-op - I am not quite 2 years post-op. I will admit have learned how to over-eat again, however, bear in mind, that is relevant to the size of my new stomach. What is "overeating" for me is maybe having an entire 6" submarine sandwich by eating it over the course of an hour. That may not sound strange to someone who hasn't had the surgery, but if you see my comments in other sections above, that is over-eating and I am trying to rectify the situation, get back on the proper diet. In my experience, and in noticing the experiences of others, over time, your appetite often comes back, as do your cravings. You have to be diligent, and your tendency to relax after a large amount of weight loss is a long-term struggle. If you see celebrities who have had the surgery - Carnie Wilson comes to mind - their long-term results appear similar to mine, i.e., they return to eating wrong or over-eating. You see them regaining weight. They may also not be working out as much. It is still a life-long struggle. Old habits die hard. Kelelain (talk) 16:23, 9 June 2012 (UTC)

"Gastro Bipolar"
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)

Ankylosing spondylitis as a complication
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)

Edits I've made
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)

Roux-en-Y procedure for non-gastric bypass reasons
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)


 * Your impression is correct. The Roux en-Y was originally described in the nineteenth century (by Dr. Roux).  It is simply a method of converting a single tube of bowel into a structure which allows two upper ends.  It can be used for biliary surgery, gastric surgery, pancreatic surgery, etc., wherever the two-lumen strategy is needed.  The term has become associated loosely with the gastric bypass in popular culture, but that is just one of its technical uses.  Short of a composing another surgical textbook, I'm not sure how to disambiguate it. Topnife 06:41, 2 December 2007 (UTC)

Recovery time?
What is the estimated recovery time for this?12.160.89.130 (talk) 05:31, 10 April 2009 (UTC)


 * Which "this" are you referring to? I can only speak as to my own experiences with laproscopic roux en y gastric bypass surgery. You are on a liquid diet for one week prior to surgery, and NPO the day before the surgery. The day after surgery, while you are still NPO, they do a barium study to make sure your internal sutures are airtight. You are generally on a liquid diet in the hospital, then released home (after about 3 days - if no complications - after surgery) on a liquid, then pureed, diet. This is to protect those internal sutures, so that there is little pressure on them while they are healing. Generally, after 2 and a half months, you are allowed to start introducing soft-solids, a month later, a little more solid, etc. Also, there are certain food groups you reintroduce into your diet at specific intervals, the last being meats somewhere after the 4 month mark (closer to the 6th month mark sometimes). As for your external sutures, I had laproscopic ones, they healed very quickly - in fact, within 2 weeks they tell you to take off the bandages - mine were butterfly bandages, so they were pretty much holding the skin together. You still need to be careful for several weeks so that you do not bust any stitches - I was more worried about the internal ones that you cannot see, but the external ones can get infected if you do not follow proper cleaning procedures (same goes for your medical staff). Generally speaking, in about 3 - 4 months, you can expect that your internal and external sutures and staples are healed, maybe sooner than that, but I am a cautious person. With the laproscopic surgery, there is very little "down" time. They stand you up the next day to take that barium x-ray, and you start walking a little bit later that day - with assistance. The following day, you are allowed to walk more, and can do so without assistance by the end of the day. By the next day - going home day - you can walk around, maybe a little hunched over, and woozy, but you can walk (I used my cane). Now, this is all considering NO complications and no other conditions that contradict your recovery, and I am a patient, not a doctor. The information I am giving you comes from 3 sources - 1) the workbook given to me from the bariatric program I am in; 2) information and advice from my surgeon, her nurses, assistants, and staff; and 3) personal experience. If you mean, how soon can you return to work after the surgery, only your doctor can tell you, and it depends on how well you do after surgery - and be advised, there WILL be diarrhea after the surgery for a few days, and also when you eat sugary food (which is not allowed on the diet) - that is called "dumping syndrome" - you can avoid it by not eating a lot of sugar. I had complications due to other conditions, and I am also disabled due to those conditions, so I had no job to go back to, and my hospital stay was longer and more difficult, and my recovery at home was not normal, either. If you get into a good program, they will drill all this into your head in the months leading up to the surgery - it is a loooooong process! See my comments in other sections above for more detailed information on how my program works and what happens - in general and specifically for me - before and after the surgery. Kelelain (talk) 22:26, 21 April 2011 (UTC)

Inline References Needed?
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 after GPS
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)

Copy edit
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)

mini gastric bypass section
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)

pica section
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)

Nature news story on latest research
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)

absorption of medication, post-op
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&#39;t Be Evil (talk) 19:16, 10 February 2016 (UTC)

External links modified
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Statement that cannot be sourced
”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)

What about candy cane syndrome ?
Candy cane syndrom is a rare complication that can occur after the surgery, 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)