Gastric bypasses are surgical procedures done on an individual to make the stomach smaller. There are three types of gastric bypasses; Roux en-Y (distal), Roux en-Y (proximal), and Loop Gastric bypass (Rogers 2). Gastric bypass is indicated for treatment of morbid obesity; prognosis which is made when the patient is critically obese, with body mass index greater than 40(Rogers 3). This could be coupled to incapability of achieving sustained and satisfactory loss of weight by dietary methods, and is ailing from co-morbid conditions, which are either, grave or cause severe impairment of the quality of life. It is also applied in the treatment of sleep apnea, type II diabetes and hypertension (Rogers 5-7). It is one of the most effective methods of weight loss and control. The reduction in the size of the stomach makes one feel full more rapidly; this cuts down on the amount of food consumed and thus the calories ingested. Besides, the circumventing of a part of intestines also lessens the amount of calories absorbed; these results in weight loss (Rogers 15). The increasing interests in the topic are due to the gradual increase of morbid obesity among the Americans. There has been an increasing desire for the gastric bypass surgeries with an estimated over 200,000 individuals undergoing this procedure annually (Georgianna 77). The main focus of this paper is reviewing information on gastric bypasses, and highlighting how the information impacts on my original views and thoughts on the subject.
The gastric bypass surgery involves making of a small, 5-30 milliliters thumb-sized pouch from the upper stomach, followed by circumventing of the remaining stomach, usually approximately 400 milliliters or more (Woodward 21). This limits the amount of food that the person can consume at a single sitting. The stomach is basically divided usually by the use of surgical staples or it can be fully partitioned into two pouches with staplers and placement of a marlex band - a polypropylene mesh (Woodward 22). Total partition is usually preferred, to avoid the risk that the two pouches of the stomach will fistulize back together, negating the operation. The gastrointestinal tract is then re-constructed to allow drainage of both pouches of the stomach. The reconstruction technique varies and it determines the degree of food absorption, the rate of emptying food from the stomach and in general the name given to the procedure. The reconstruction technique also largely determines the postoperative risk of occurrences of nutritional deficiencies and the various complications associated with gastric bypasses.
Gastric bypass surgery is currently the most potent method to treat obesity. In the majority of individuals, it produces considerable weight loss that is well sustained and linked to significant improvements in mortality, physical and psychological co-morbidities. Research findings indicate that significant weight loss is always achieved with two-thirds of the excess weight being a reasonable expectation (Woodward 12). Additionally, gastric bypass has facilitated a reduction of at least half of the excess weight in 80 per cent of those having the surgery (Woodward 12). It has also been widely performed on individuals particularly amongst celebrities for cosmetic purposes to help reduce weight and attain a slim figure so coveted by current society. To determine if one is a candidate for gastric bypass surgery, the body mass index (BMI) is calculated, and the physician makes the decision based on the index. In general, gastric bypasses are considered for people with BMI of 35- 39.5, if they have obesity-related illnesses and those with BMI greater than 40 with or without related illnesses (Woodward 13-14). Gastric bypass surgery may boost the chances of living longer. Studies have confirmed that individuals who have undergone the procedure have a lower likelihood of dying of diabetes, heart diseases, or cancer (Woodward 13).
Unfortunately, these impressive results are not experienced by all patients who undergo gastric bypass surgery. A considerable percentage of patients who have undergone the gastric bypass get suboptimal outcomes and many others experience noteworthy side effects of the procedure. Gastric bypass procedures results in a marked diminution of the functional volume of the stomach, accompanied by an altered response to food, both physiologically and physically (Buchwald, Cowan and Walter 49). After surgery, individuals experience fullness after consuming only a small amount of food, followed by a sense of satiety and loss of appetite. Overall food ingestion is markedly reduced. Owing to the reduced volume of the stomach pouch after surgery, and reduced intake of food, the patients face the risk of nutritional deficiencies of essential minerals and vitamins such as calcium, zinc, iron, vitamins A and B complex as well protein malnutrition. Adequate nourishment requires that the patient observes the dietary instructions for consumption of food, including the number of meals to be taken daily, sufficient intake of proteins, and the use of mineral and vitamin supplements (Buchwald, Cowan and Walter 50-52).
Other risks are those common to all surgeries; for gastric bypass, they mortality during surgery, infection in the incision resulting to peritonitis, hernia, ulcers, hemorrhage and a blood clot in the lungs. About one-third of all patients having gastric bypasses develop gallstones or nutritional deficiencies such as anemia or osteoporosis (Buchwald, Cowan and Walter 53). Bowel obstruction due to scarring of the bowel, dumping syndrome anastomotic leakages and anastomotic stricture are also common complications of gastric bypasses (Buchwald, Cowan and Walter 54). Research has also confirmed that the bypass affects alcohol metabolism; patients who have undergone the surgery alcohol at a faster rate than individuals who have not undergone the surgery (Sarwer, Fabricatore & Wadden 103.
A common addiction that develops after gastric bypass surgery is pica. It occurs due to iron deficiencies that result due to the surgery and is characterized by compulsive tendencies to consume materials other than normal food; for instance paper, ice, plaster, ashes, or clay (Sarwer, Fabricatore & Wadden 105). Reports have also confirmed increased addiction to alcohol amongst gastric bypass patients (Sarwer, Fabricatore & Wadden 103). Another common occurrence is the addiction transfer whereby the gastric bypass patients formerly suffering from an eating disorder before the surgery transfer the compulsive tendencies into other addictions such as smoking, compulsive gambling, shopping addiction, or even compulsive spending (Sarwer, Fabricatore & Wadden 103-109).
In this paper, I sought to review information about gastric bypasses and how such information impacts on my initial thoughts on the topic. The research on gastric bypasses has enriched the original thoughts that I had about the about the topic. It has improved the knowledge I had about determining the individuals who are candidates for the gastric bypasses, the possible benefits, as well as the risks and addictions associated with the surgical procedure. There seems to be many psychological and mental issues relating to gastric bypasses; regardless of gastric bypass surgery being the most potent technique of treating morbid obesity, a sizeable percentage of patients who undergo the procedure experience suboptimal results. These are commonly linked to behavioral and psychological causes rather than surgical failure. For that reason, it is apparent that mental health professionals have a significant part to play in the post operative management of psychological and behavioral interventions for gastric bypass surgery patients. A remedy would be to analyze the psychological and behavioral patterns of these patients and refer them to mental health professionals for help. I would recommend further research on the role of postoperative support groups and mental health professionals in the management of psychological and behavioral effects of gastric bypass surgery.
