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Fad Bariatric Surgery Part 3: Laparoscopic Gastric Bypass

Unlike recent “fad” bariatric operations, the Gastric Bypass was the first stomach operation performed for Severe Obesity in 1966. Since then, many other bariatric operations (like the Gastric Band and Sleeve Gastrectomy most recently) have been developed and proposed as simpler, better alternatives, or even replacements, for the Gastric Bypass. However, despite the failure and discontinuation of other bariatric operations from decades past, the Gastric Bypass has remained in use for 50 years, been revised and refined and researched extensively, and first performed laparoscopically in 1993. This and other developments have dramatically improved the safety of the Gastric Bypass, to the point that now, in experienced hands, the Gastric Bypass has a complication and mortality (death) rate no higher than many other commonly performed operations. Therefore, Gastric Bypass is still regarded as the “gold standard” by bariatric surgeons who offer all the surgical options.

In addition, there are specific clinical conditions (Severe Type 2 Diabetes, Metabolic Syndrome, GERD, high BMI, patients who are “sweet-eaters”, or a combination of factors) that make Gastric Bypass a better choice than Gastric Band or Sleeve Gastrectomy for many patients. Finally, when patients are fully informed, often for the first time, about the specific “pros and cons” of each operation, many patients simply choose Gastric Bypass.

For example, patients with Severe Obesity and GERD (Gastroesophageal Reflux Disease) should undergo Gastric Bypass, which completely eliminates GERD symptoms in virtually all patients. On the other hand, Sleeve Gastrectomy carries the risk of actually worsening GERD or, less commonly, causing a patient without GERD before surgery to develop it after the operation.

Since about 40% of patients with Severe Obesity have GERD, the recommended operation (for this one reason alone) should be Gastric Bypass in at least 40% of the patients in a typical comprehensive bariatric surgery practice. Performing Sleeve Gastrectomy on patients with GERD knowingly places these patients at risk for worsening GERD, which, if it becomes unresponsive to medications, as a final measure, necessitates conversion of the Sleeve Gastrectomy to a Gastric Bypass, the operation that should have been advised in the first place.

A second example concerns bariatric patients who are attracted to sweets, for whom, Gastric Bypass is the best choice. After Gastric Bypass, if a patient eats sweets, they will likely experience “Dumping Syndrome”, a very unpleasant set of symptoms, that will cause them to avoid sweets in the future, which will prove to be advantageous for losing weight and maintaining lost weight. On the other hand, patients who undergo Sleeve Gastrectomy can eat sweets without experiencing any ill effects, thus placing them at risk for repeatedly eating sweets and gaining weight.

A third situation involves Type 2 Diabetes. With Gastric Bypass, the “re-routing” of the upper small intestine to “bypass” the duodenum (the first part of the small intestine), thus preventing food from passing through it, causes immediate improvement in a patient’s blood sugar, which may become normal by the time the patient is discharged from the hospital on the second day after surgery. Therefore, the Gastric Bypass provides an intrinsic benefit to combat or resolve Type 2 Diabetes, before the patient even loses any weight.

However, despite all this, some bariatric surgeons do not even offer or perform Laparoscopic Gastric Bypass at all, because they lack the skill, expertise, and experience necessary to perform the operation and manage the patients. They would rather just perform the surgery that is most convenient for them, rather than the one that is best for you.

Avoid choosing “fad” bariatric surgeries by being informed about the procedures. Check back to our blog soon for the fifth and final post in our series.