Gastric Bypass: Statistics
In 1991 the national Centers for Disease Control and Prevention reported that nearly 12 percent of American adults were considered obese. In 2001 this number had risen to 20 percent. According to the Journal of the American Medical Association, 280,000 morbidly obese people die each year from weight-related problems, such as diabetes, high blood pressure and heart failure. It is expected that within the next few years obesity related deaths will surpass tobacco as the number one cause of preventable death.
For the rising population of persons suffering from obesity there are difficult choices. Research indicates that diets are nearly always ineffective: a full 90 percent of dieters gain back all the weight they loose and Clinical dietitians warn that this "yo-yo phenomena" disorients the metabolism, making future weight loss even less likely. It's for this reason that more and more people are turning to Gastric bypass surgery as the only viable option.
In 1997 the American Society for Bariatric Surgery in Gainesville, Fla., estimated that approximately 22,000 gastric bypass surgeries were performed in the United States. In 2000 the number had risen to around 47,000. In 2002 it was around 65,000 and the ASBS predicts that upwards of 90,000 will be performed in the year 2003.
In Fresno, Calif. a gastric bypass surgeon makes anywhere between 4,000 to 6,000 dollars an operation. One Fresno surgical team, consisting of three doctors, performed 1,128 gastric bypass surgeries last year, in some cases performing as many as seven surgeries in a single day (roughly 376 a piece). They expect to increase the number of surgeries they perform this year. Also this year, hospital revenue from the gastric bypass surgery is expected to reach somewhere in the neighborhood of $1.8 billion and may increase an additional 80% next year. Yet while gastric bypass surgery has become a burgeoning industry, some fear that as more and more people require the surgery, there are less and less qualified and experienced surgeons to go around.
In January 2003 a series of articles in the Fresno Bee reported that thirteen patients had died in Fresno hospitals since February 2000 as a result of bariatric surgery. However, because other causes of death, such as heart attack, were listed on the death certificates, the true cause of their deaths was not known until later.
The usually quoted fatality rate for gastric bypass is 1 in 200. And even though this rate is nearly twice the rate of other major operations of similar complexity (1 in 350) leading legal professionals believe the rate to be "much higher". As was the case in Fresno, poor physician reporting procedure and inaccurate death certificates are believed to account for the discrepancy.
Laparoscopic Roux-en-Y Gastric Bypass Surgery takes on average roughly two hours to complete and there are three basic steps involved.
The first step is the division of the stomach into two parts; a smaller upper portion called the proximal pouch, and a larger lower portion called the distal pouch. The proximal pouch, which will serve as the "new stomach", is significantly smaller than the original stomach (approximately 40 cc or about the size of an egg). It is created from the more muscular side of the stomach so that it will stretch less overtime and remain relatively small.
The next step is dividing the jejunum (the second section of the small intestines) approximately 50 cm beyond its origin and creating what doctors refer to as the "Roux Limb". The "Roux Limb" is brought up behind the distal pouch (larger portion of the stomach) and joined ("anastamosed") to the bottom portion of the proximal pouch. This new junction allows food entering the mouth to travel from the esophagus, into the proximal pouch and then, bypassing the larger portion of the stomach, directly into the jejunum. The larger portion of the stomach, now called the gastric remnant, is left in side the body for three reasons 1) removing it would make the procedure riskier 2) should the patient desire to reverse the operation the gastric remnant can be "hooked back up" and 3) the secretions from it continue to assist the digestion of proteins, fats and carbohydrates.
The third and final step involves reconnecting the bowel (the first 50 cm of the duodenum and the jejunum called the "common limb" or "biliopancreatic limb") to the "Roux limb" in order to allow the juices of the stomach, pancreas, and liver to assist in digestion.
When the operation is complete, the newly configured digestive system allows food to bypass the distal pouch (larger portion of the stomach), the duodenum and a portion of the jejunum so that digestion can not occur in these areas. Instead, digestion occurs only where the "common limb" joins with the "Roux limb". Than, once the food enters the colon the body no longer has an opportunity to digest it. Since much of the food enters the colon undigested the patient losses weight.
When the operation is a success it provides an excellent means of long term weight control. Studies show that in the first two years after a successful gastric bypass, a patient will lose on average 2/3 to 3/4 of their excess weight. Though typically some of this lost weight returns, studies indicate that in the 5 to 15 years after the operation, the patient will, on average, keep off 1/2 of the additional weight. Many obesity related problems such as hypertension, diabetes, and sleep apnea generally improve dramatically with this weight loss. Patients who have undergone successful surgery generally report their quality of life has greatly improved and that they no longer experience the discomfort of the food cravings associated with dieting.
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