Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Gastric Bypass


Related Terms

  • Adjustable Gastric Banding
  • Biliopancreatic Bypass
  • Biliopancreatic Bypass with Duodenal Switch Procedures
  • Biliopancreatic Diversion (BPD)
  • Horizontal Gastroplasty
  • Jejunoileal Bypass Procedures
  • Lap-Band Surgery
  • Laparoscopic Gastric Banding
  • Laparoscopic Sleeve Gastrectomy
  • Roux-en-Y Gastric Bypass
  • Silastic Gastric Banding
  • Sleeve Gastrectomy
  • Stomach Stapling Procedure
  • Tube Gastrectomy
  • Vertical Sleeve Gastrectomy

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include the development of complications or preexisting medical or surgical conditions, particularly the obesity and related disorders that prompted the surgical intervention.

Medical Codes

ICD-9-CM:
43.6 - Gastrectomy, Partial with Anastomosis to Duodenum
43.7 - Gastrectomy, Partial with Anastomosis to Jejunum
43.81 - Partial Gastrectomy with Jejunal Transposition; Henley Jejunal Transposition Operation
43.89 - Open and Other Partial Gastrectomy; Partial Gastrectomy with Bypass Gastrogastrostomy, Sleeve Resection of Stomach
44.31 - Printen and Mason Gastric Bypass
44.38 - Gastroenterostomy without Gastrectomy, Laparoscopic Gastroenterostomy; Bypass: Gastroduodenostomy, Gastroenterostomy, Gastrogastrostomy; Laparoscopic Gastrojejunostomy without Gastrectomy NEC
44.39 - Other Gastroenterostomy; Bypass: Gastroduodenostomy, Gastroenterostomy, Gastrogastrostomy; Laparoscopic Gastrojejunostomy without Gastrectomy NEC
44.95 - Laparoscopic Gastric Restrictive Procedure; Adjustable Gastric Band and Port Insertion

Overview

Gastric bypass surgery, also known as bariatric surgery, is designed for severely (morbidly) obese individuals who have not had success with other programs for weight loss. There are different types of surgery for obesity, but all of them involve partitioning off parts of the stomach to make it smaller. Restrictive obesity surgery involves reducing the physical capacity of the stomach, thereby permitting a restricted or smaller intake of food; restrictive/malabsorptive obesity surgery not only reduces the physical capacity of the stomach but also disrupts the digestive process by restricting the amount of nutrients, protein, and calories the body absorbs.

The most commonly performed restrictive surgeries are adjustable gastric banding, (AGB) or "Lap-Band" procedure, and vertical banded gastroplasty (VBG), also known as "stomach stapling." An AGB involves the use of a hollow band that portions off a small pouch of the upper stomach, leaving a narrow passage into the larger remainder of the stomach. The band, which is inflatable with a saline solution, can be loosened or tightened over time to change the size of the stomach pouch. AGB is the least invasive form of gastric bypass. A VBG involves the use of staples and a band to create a small pouch of the upper stomach. The pouch initially holds about 1 ounce of food and later expands to 2 to 3 ounces. Both these procedures are designed to reduce the intake of food and increase the individual's feeling of fullness. In addition, both procedures can be performed laparoscopically, which involves smaller incisions, less chance of infection, and usually a shorter recovery time.

The Roux-en-Y gastric bypass (RGB) is the most commonly performed restrictive/malabsorptive surgery, used in approximately 70% of cases (Klein). This procedure involves partitioning the stomach to create a much smaller stomach pouch at the top and then shaping a portion of the small intestine into a "Y." The "Y" portion of intestine is then connected to the smaller pouch, causing food that is being digested to travel directly into the lower part of the small intestine, bypassing the duodenum and the jejunum. Weight loss results from a smaller intake of food (due to the small stomach pouch that initially holds 1 tablespoon of food and eventually expands to hold about a cup of chewed food), and from far fewer calories and nutrients absorbed due to the bypass of the intestine. An RGB can be performed through traditional open surgery or through laparoscopic surgery.

Another restrictive/malabsorptive surgery that is not as frequently performed is the biliopancreatic diversion (BPD). This procedure, which is performed on individuals with severe obesity, involves removing a portion of the lower stomach and connecting the remaining portion to the ileum, or the last part of the small intestine. Because of the interruption in the digestive process, in which food completely bypasses the duodenum and the jejunum, the procedure may result in serious nutritional deficiencies. A variation on the BPD is the duodenal switch. In this procedure, less of the stomach is removed, and the pyloric valve, which controls the release of food into the small intestine, and a small part of the duodenum are retained.

A newer form of restrictive surgery, sleeve gastrectomy, may be performed for severely obese individuals (BMI greater than 60) as the first part of a two-stage operation: after an initial period of weight loss over 6 to 18 months, a second procedure (gastric bypass or duodenal switch) may safely be performed (Mann). With gastric sleeve surgery, approximately 60% of the stomach is surgically removed (excised) along the entire length of the stomach, leaving a narrow, banana-shaped tube through which food passes.

Source: Medical Disability Advisor



Reason for Procedure

These procedures are for severely obese individuals who have not had success with other types of weight loss programs.

Source: Medical Disability Advisor



How Procedure is Performed

All these surgeries can be performed through a classic open surgical approach or through a laparoscopic surgical approach. Because a laparoscopic incision is smaller, there is less tissue damage, which often results in a shorter hospital stay, a quicker recovery, and a reduced risk of hernia or wound complications.

In an open Roux-en-Y gastric bypass (RGB) procedure, the surgeon makes a single large incision in the abdominal area. The abdominal muscles will be separated, and the abdominal cavity is opened. In a laparoscopic RGB, the surgeon makes a series of small incisions in the abdomen. The abdominal cavity is inflated with carbon dioxide gas to aid visibility through the laparoscope, which is then inserted along with other instruments. In both procedures, the surgeon uses staples to separate the stomach, creating a small pouch at the top. Once the stomach has been divided, a section of the small intestine is connected to the pouch so that food will now travel directly from the pouch through this newly created connection (often called a “Roux limb”), bypassing the lower section of the stomach. The base of the Roux limb is then reattached to the remaining portion of the small intestine from the bottom of the stomach, forming the shape of a “Y.” This type of connection permits food to mix with gastric juices, pancreatic fluid, and bile, which aids the absorption of vitamins and minerals. A variation of the Roux-en-Y surgery called the “very, very long limb gastric bypass” is used for severely obese individuals (women over 350 pounds and men over 400 pounds), which attaches the Roux limb farther down the intestinal tract, close to the large intestine, to increase restriction of calories (“Weight-Reduction Surgery”).

For an open adjustable gastric banding procedure, an incision is made in the abdominal area. In laparoscopic AGB, a series of tiny incisions is made in the abdomen. In both procedures, an inflatable band is placed around the upper part of the stomach, creating a pouch. On the inner lining of the band is a balloon that is attached, through a small tube, to a port beneath the individual's skin (subcutaneous). Through an injection, the amount of fluid in the band is increased or decreased, depending on the desired size of the band. This makes it possible to enlarge or reduce the stomach pouch.

Vertical banded gastroplasty (VBG) involves cutting a small hole, or window, in the upper part of the stomach and placing a vertical line of staples from the window to the esophagus to section off a small pouch. Then a band is placed through the window at the lower end of the pouch to create a narrow passage, delaying the emptying of food from the pouch and causing a feeling of fullness (Frey). Immediately after the operation, the pouch holds about 1 ounce of food and later expands to hold 2 to 3 ounces of food. The size of the passage can be loosened or tightened over time by the adjustable bands. VBG can also be performed laparoscopically, a less invasive but lengthier procedure in which smaller incisions are made.

With gastric sleeve resection, the lateral two-thirds of the stomach are stapled and then surgically removed (excised). The stomach outlet (pyloric valve) remains intact. The excised portion of the stomach is thought to produce the majority of the hunger-stimulating hormone ghrelin, so gastric sleeve resection works permanently to control hunger and restrict the amount of food that can be eaten at any one time.

In a biliopancreatic diversion, which can also be performed either as an open procedure or laparoscopically, a large part of the stomach is removed. The remaining portion of the stomach is connected to the lower portion of the small intestine. In a biliopancreatic diversion with duodenal switch, a smaller portion of the stomach is removed, the rest of the stomach remains attached to the duodenum (the upper part of the small intestine), and the pyloric valve, which controls the flow of food from the stomach, is retained. The duodenum is connected to the end part of the small intestine, close to the large intestine.

Source: Medical Disability Advisor



Prognosis

Success rates depend on which procedure is performed. Overall, the in-hospital mortality rate is 0.5% when gastric bypass is performed by an experienced surgeon (Klein); mortality rates are much greater for the surgeon’s first 19 procedures (Klein). The mortality rate within 30 days of gastric banding surgery is 0.1% (Klein).

Roux-en-Y gastric bypass (RGB) results in up to a 68% loss of excess weight in individuals having laparoscopic RGB, and a 62% loss of excess weight with open RGB (Richards). After RGB, diabetes resolves in 74% of individuals, hypertension in 67.5%, and obstructive sleep apnea in 80.4% (Richards).

Following biliopancreatic diversion with duodenal switch, individuals lose up to 70.1% of excess weight, with nearly all experiencing resolution of diabetes; 83.4%, resolution of hypertension; and 91.9%, resolution of obstructive sleep apnea (Richards). In severely obese individuals (BMI greater than 60), duodenal switch has a 6.5% mortality rate; when gastric sleeve surgery is performed as a first step with duodenal switch following within a year, the mortality rate drops to 0% (Richards).

Overall, long-term results for weight loss after gastric bypass show individuals losing 58% of their excess weight over the 5-year period following surgery (Laberge). After VBG or AGB, up to 50% of excess weight is lost within the first 2 years after surgery, but over the long term, these individuals are more likely to regain weight than those having gastric bypass (Frey).

With any of these procedures, long-term weight loss will not be successful without a healthy diet, nutritional counseling, and a regular exercise regime. After massive weight loss of greater than 100 lb (45 kg), body contouring surgery may be performed for hygienic, cosmetic, or health reasons and may include abdominoplasty, panniculectomy, flankplasty and thigh lift, belt lipectomy, brachioplasty, and liposuction.

Source: Medical Disability Advisor



Complications

Serious complications occur in an estimated 5% of obesity surgeries (Klein). They may involve pulmonary embolism, wound infection, hemorrhage, gastrointestinal leak that may cause peritonitis, and injury to the spleen (Klein). Death has been reported in less than 1% of individuals (Laberge). The majority of deaths (75%) relate to complications involving leaking and bleeding of the stomach and intestines and peritonitis; up to 25% of deaths result from peritonitis (Klein).

Complications of VBG and AGB include possible leakage of stomach juices into the abdomen, injury to the spleen, band slippage and/or erosion, staple line erosion, and stomach pouch expanding back to its previous size from overeating. A common problem is eating too much at one time or not chewing enough to sufficiently break down food, which can cause nausea or vomiting and may result in protein and vitamin deficiency.

Complications of gastric bypass include nutritional deficiencies that may lead to anemia or osteoporosis, and deficiencies in potassium, magnesium, or iron. Stomach ulcers may occur in individuals who take aspirin or nonsteroidal anti-inflammatory agents (NSAIDs). An expansion of the stomach pouch is a possible complication, and there is an increased risk of gallstone development. After biliopancreatic diversion, individuals commonly experience 2 to 4 bowel movements per day, typically with foul-smelling flatulence (Richards). Other significant complications from gastric bypass include infections, extreme nausea, difficulty in swallowing food, and incisional hernias that occur in approximately 10% to 20% of cases (Laberge).

A relatively common side effect of gastric bypass is “dumping syndrome,” in which food moves too quickly through the small intestine. This may cause nausea, weakness, sweating, faintness, and diarrhea after eating. Sweets in particular may cause severe weakness. Other side effects include constipation, headache, hair loss, depression, and dairy intolerance.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Restrictions on lifting, climbing, prolonged standing, and strenuous physical activity should be expected for as long as 6 to 12 weeks. After recovery, the individual can usually return to work in full capacity with no restrictions, although frequent time off may be needed for follow-up appointments and nutritional counseling.

Source: Medical Disability Advisor



References

Cited

"Weight-Reduction Surgery Available at Mayo Clinic." MayoClinic.com. Mayo Foundation for Medical Education and Research. 28 Aug. 2009 <http://www.mayoclinic.org/bariatric-surgery/surgery.html>.

Frey, Rebecca. "Vertical Banded Gastroplasty." Encyclopedia of Surgery. 2009. Advameg, Inc. 31 Aug. 2009 <http://www.surgeryencyclopedia.com/St-Wr/Vertical-Banded-Gastroplasty.html>.

Klein, Samuel. "Obesity, Chapter 18." Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Eds. Mark Feldman, Lawrence S. Friedman, and Lawrence J. Brandt. 8th ed. Philadelphia: Saunders Elsevier, 2006.

Laberge, Monique. "Gastric Bypass." Encyclopedia of Surgery. 2009. Advameg, Inc. 31 Aug. 2009 <http://www.surgeryencyclopedia.com/Fi-La/Gastric-Bypass.html>.

Mann, Denise. "Gastric Sleeve Surgery." Consumer Guide to Bariatric Surgery. Ed. Christine Ren Fielding. Jan. 2009. Ceatus Media Group. 31 Aug. 2009 <http://www.yourbariatricsurgeryguide.com/gastric-sleeve/>.

Richards, William O., and Bruce D. Schirmer. "Morbid Obesity." Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Eds. Courtney M. Townsend, et al. 18th ed. Philadelphia: Saunders Elsevier, 2007. MD Consult. Elsevier, Inc. 28 Aug. 2009 <http://www.mdconsult.com/das/book/body/156825991-3/0/1565/1.html?tocnode=54736195&fromURL=1.html#4-u1.0-B978-1-4160-3675-3..X5001-1--TOP_1>.

Source: Medical Disability Advisor






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