Plain talk about bypass Weight Loss Surgery (RNY, gastric bypass, duodenal switch, gastric sleeve)

Dr Edward Mason, inventor of the gastric bypass: "For the vast majority of patients today, there is no operation that will control weight to a "normal" level without introducing risks and side effects that over a lifetime may raise questions about its use for surgical treatment of obesity."

***The RNY (gastric bypass) trades one disease for another: it trades obesity for malabsorption. By re-arranging your guts you sometimes have severe side effects, and can have long-term problems such as iron deficiency anemia, calcium deficiency leading to osteoporosis. (Dr Terry Simpson, MD, WLS surgeon)

"The American Society of Bariatric Surgery says weight loss surgeries have increased from about 20,000 in 1995 to an estimated 45,000 in 2001. It estimates a 7 percent complication rate. But [Dr] Livingston's own study of 800 patients found complication rates of 20 to 40 percent, with everything from intestinal leaks to nutritional deficiencies. "

ABC News story, March 2001 (note: later in 2005, the insurance company actuarials also found a 20 percent re-operation rate in gastric bypass patients)

A non bariatric industry study which CT scanned 72 gastric bypass patients and found by CT scanning, that 41 of the 72 patients (i.e. 56 percent) had some 62 "abnormalities" in their digestive tract.

7. Weight Loss Surgery (WLS) might not fix depression. Sometimes WLS can cause an eating disorder.

JoAnn Mann, RN and eating disorders specialist: "I've seen massive infection, I've seen people hospitalized for malnutrition. I've seen people obsessed with food. I've seen people unable to stop vomiting. I've seen people develop massive eating disorders, I've seen people who are terrified of gaining weight. Terrified. It runs their lives."

Dr. Jenn Berman, a Los Angeles psychotherapist and an expert on eating disorders, has counseled more than 70 gastric bypass patients in the past six years. The patients who come to her are unable to keep down food and suffer from chronic diarrhea and/or vomiting. Berman said some patients have developed eating disorders and are afraid that if they eat too much, they will be sick.

http://fresnobee.com/bypass/story/1391404p-1467981c.html

7. Prolonged strict dieting (lower caloric intake) can permanently damage your metabolism which means you may gain back weight faster.   Your body does this by cannibalizing it's own muscles and even parts of organs. There is a growing body of evidence that starvation can cause brain damage and a lessening of mental abilities as well. This would make sense as the brain is not necessary to maintain life. (see Pool, Robert: FAT - FIGHTING THE OBESITY EPIDEMIC, also the studies of the Food Institute in UK on starvation or prolonged dieting or calorie restriction and permanent brain damage)

8. The gastric bypass is NOT a new procedure. It was invented in the 1960's and modeled on a surgery invented in 1880 for bleeding duodenal ulcers.  When the gastric bypass was invented, scientists did not know how important vitamins are and how people can become very ill if they are lacking in even trace elements like zinc.  Recently the inventor of the gastric bypass wrote for an article published by the U of I, that since the 1990's we have discovered that the digestive tract is in delicate balance and that he felt it was best to NOT disturb that balance by rearranging the small bowel or bypassing the small bowel.

The only thing 'new' about the gastric bypass is the mass advertising we see on TV featuring stars who are "new ops" who do not tell about what complications they have experienced.

7. Experts differ about how many die from the gastric bypass.  Estimates of death rate range from 1 in 1000 ( http://www.asbs.org  )  to many surgeons stating that the death rate within 2 weeks of surgery is more like .5 percent to 1 percent.  (The David Flum study of 62,000 actual patient records found that 2 in 100 died within 30 days of surgery). Many deaths from gastric bypass are attributed to other causes mostly "obesity". This is due to the manner in which the M.E. investigates a death - the M.E. may not have access to the information that the patient recently had a gastric bypass. In the Fresno investigation (2001) investigators found some 27 deaths directly attributable to gastric bypass in the last 3 months of 2001 - none of them had been officially recorded as deaths from gastricbypass.  Often the media tries to cover up a death from weight loss surgery. For example when the Detroit council person died after the insertion of an adjustable band, the news service reported that she had died "after minor abdominal surgery" and only when her family hired a very famous attorney to sue the surgeon did it come out that she had, in fact, died from Weight Loss surgery!

Dr Gary Anthone: "As a matter of fact, one patient out of 200 that has weight loss or obesity surgery dies."

Merkle, associate professor of radiology at Duke University Medical Center in Durham, N.C., worked with a team of investigators when he practiced at University Hospitals of Cleveland. They followed 335 patients who underwent a type of gastric bypass surgery known as Roux-en-Y between March 1998 and December 2002.

Among these patients, 57 had complications and 17 required readmission to the hospital within 30 days after surgery. Two patients, or less than 1%, died as a result of postoperative complications.

The complications included a leak in the juncture attaching the intestine to the stomach, which occurred in eight patients, and a disruption of the staple line compartmentalizing the stomach, occurring in five patients. Other complications of gastric bypass surgery included a blood clot in the lung, blood infection, bleeding, pneumonia, bowel obstruction, and injury to the esophagus.

 

9. Some physicians link some autoimmune disease like LUPUS and MS with WLS.  This may be because the incoming food, not "sanitized" with stomach acid, retains the bacteria in it and that bacteria can get into the blood stream and cause different reactions to the body's immune system.  Autoimmune disease can also be caused by vitamin deficiencies.
   
   

   Gastric surgery for weight loss causes nutritional deficiency in nearly 100% of individuals who have it done. The most common deficiencies are Vitamin B12, Iron, Calcium, Magnesium, Carotene (beta-carotene and other carotene vitamins) and potassium.****
   
   Kaiser Permanante Release form for gastric bypass

    

10. Reversing the procedure: Dr Flancbaum says it's like when you remodel your house, can you make it go back to the way it looked before you re-modeled it? (re: Flancbaum, Louis, MD: DOCTOR'S GUIDE TO WLS, NY, 2001).  Dr Flancbaum states that the gastric bypass involves some permanent changes so even if they do a "takedown" you may have side effects remaining.  Most procedures cannot be reversed - only the adjustable band can be totally reversed.
    
    

    I am also put off when people say something is reversible -- because while we can change anatomy back, no surgery is truly reversible== kind of like remodeling the house-- try to put it back the same way -- doesn't happen.
    --- Dr Terry Simpson, WLS surgeon

    
     

11. After a gastric bypass or duodenal switch which rearranges your intestines, you will have a "high Maintenance" body. You will have to be careful every day, to take vitamins, eat nutritious foods, eat in a certain manner, be closely followed by medical personnel.  If you are not compliant to the after surgery rules, you will LIKELY get very ill and may die.  The most common cause of illness and death after a gastric bypass is non compliancy.  So if you couldn't stay on a diet, remember with Weight Loss surgery, compliancy won't be any easier but if you are non compliant, it will really bite you.
     

12. Is Surgery the only way? Will you die without it? Truly this is what the diet industry would like us to believe but in truth, for as many studies which have suggested there is a risk to obesity alone, there are the same number of studies which suggest obesity alone does not pose any significantly higher risk.  (ref: "The Diet Myth" by Paul Campos, NY 2006 for one)
    
    One study showed that 50 percent of people who are obese die SLIGHTLY earlier than thin people IF THEY DO NOT EXERCISE. The 30 year Cooper Institute Studies on 30,000 people DID take in consideration whether the participants exercised or not and they found that fat people who exercised, lived as long as thin people who exercised.  They also found that thin couch potatoes were at even higher risk than fat couch potatoes.

9. According to the inventor of the BPD, this surgery was a variation of the JIB intestinal bypass which caused liver failure in many patients (the BPD or bileopancreatic diversion is usually done with the duodenal switch type gastrectomy the DS - in the duodenal switch, 80-90 percent of the stomach is separated off and removed from the body).  In this type of bypass usually done with a duodenalswitch, over 60 percent of the small intestine is bypassed! Many surgeons feel this surgery might carry a high risk of malnutrition.  About 10 percent of BPD patients develop malnutrition regardless of supplementation.  About 30 percent of DS/BPD patients develop anemia, a certain percentage of DS/BPD patients develop kidney stones - this is thought to be because their body does not absorb fat - therefore the fat mixes with the unabsorbed calcium in the small bowel and ends up in the kidneys.  DS/BPD patients are told to be on a low fat diet.  Of course, many folks HAVE this type of surgery so they CAN eat fat but eating fat may really harm them since their bodies can no longer handle it.
    

10. Liver failure: patients are told that the old 'intestinal bypass' is no longer done due to the high incidence of liver failure in patients. However, many post op gastric bypass patients have elevated liver enzymes, a sign of possible liver damage.  Also high levels of vitamin B12 are observed in longer term gastric bypass post ops and this, too, can be evidence of cirrhosis of the liver (also seen in alcoholics).  Presently, the long term effects of the gastric bypass have not been studied (over 20 years from surgery).
     

11. Stomach Cancer: According to medical books, anyone whose stomach is cut open, cut in two or surgically modified (called a 'gastrectomy') is of higher risk for stomach cancer.

What the American Medical Association feels about the gastric bypass and other Weight loss surgeries:

"Short-term outcomes are impressive-patients undergoing bariatric surgery maintain more weight loss compared with diet and exercise. Comorbidities such as type 2 diabetes can be reversed. But long-term consequences remain uncertain. Issues such as whether weight loss is maintained and the long-term effects of altering nutrient absorption remain unresolved."

They instruct their physicians to protect themselves from lawsuits by informing the prospective patient up front that weight loss surgery is investigational and that it is unknown whether Weight loss surgery will help that patient.

1762 JAMA, April 9, 2003-VoL 289, No. 14

Bottom line:

1. ignore ads and testimonials - seek long term patients - look at long term results and what studies we have. Possibly seek the advice of an expert NOT INVOLVED in WLS like a gastroenterologist and have him/her explain the possible repercussions of WLS to you. Read the release form CAREFULLY while you are making your decision.

Also realize that the patients you may encounter on the groups who are telling you it's the greatest thing ever, may not be sharing the whole truth about what they experience on a daily basis.