| ICD-9-CM: |
| 43.7 - | Gastrectomy, Partial with Anastomosis to Jejunum |
| 43.8 - | Partial Gastrectomy, Other |
| 43.81 - | Partial Gastrectomy with Jejunal Transposition; Henley Jejunal Transposition Operation |
| 43.89 - | Other Partial Gastrectomy, Other; Partial Gastrectomy with Bypass Gastrogastrostomy, Sleeve Resection of Stomach |
| 44.3 - | Gastroenterostomy without Gastrectomy |
| 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 |
| 44.69 - | Other Repair of Stomach, Other; Inversion of Gastric Diverticulum; Repair of Stomach NOS |
| 45.51 - | Isolation of Segment of Small Intestine; Isolation of Ileal Loop; Resection of Intestinal Segment |
| 45.91 - | Small-to-Small Intestinal Anastomosis |
| Gastric bypass surgery, also known as bariatric surgery, is designed for severely obese individuals who have not had success with other forms of weight loss. There are different types of surgery for obesity but they all 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 involves reducing 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 the Adjustable Gastric Banding (AGB) and the Vertical Banded Gastroplasty (VBG). 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 salt solution, can be loosened or tightened over time to change the size of the stomach pouch. A VBG involves the use of staples and a band to create a small pouch of the upper stomach. Initially the pouch holds about 1 ounce of food and later expands to 2 to 3 ounces. Both of these procedures are designed to reduce the intake of food and increase a feeling of fullness due to the small pouches. In addition, both of these 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. This procedure involves partitioning the stomach to create a much smaller stomach pouch at the top 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 which initially holds 1 tablespoon of food and eventually expands to hold about a cup of chewed food), and far fewer calories and nutrients absorbed due to the bypass of the intestine. The Roux-en-Y gastric bypass can be performed through traditional open surgery or through laparoscopic surgery that results in a smaller incision and often less post-operative discomfort and a faster recovery period.
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 since food completely bypasses the duodenum and the jejunum, the procedure may result in serious nutritional deficiencies. A variation upon the BPD is the duodenal switch. In this procedure, less of the stomach is removed but the valve that controls the release of food into the small intestine and a small part of the duodenum is retained.
With any of these procedures, long-term weight loss will not be successful without a healthy diet, nutritional counseling, and regular exercise regime. After massive weight loss of greater than 100 lb (45 kg), body contouring surgery may be performed for hygienic or health reasons, and may include abdominoplasty, panniculectomy, flankoplasty and thigh lift, belt lipectomy, brachioplasty, and liposuction. |
Source: Medical Disability Advisor
| These procedures are for severely obese individuals who have not had success with other types of weight loss programs. |
Source: Medical Disability Advisor
| All of these surgeries can be performed through a classic open surgical approach or through a laparoscopic surgical approach. Because a laparoscopic incision is smaller and less invasive, 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 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 with 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 pancreatic fluid and bile, and aids the absorption of vitamins and minerals.
For an open adjustable gastric banding procedure, an incision in made in the abdominal area. In laparoscopic gastric banding, a series of tiny incisions are made in the abdomen. In both procedures, a band is placed around the upper part of the stomach, creating a pouch. On the inner lining of the band there is a balloon that is attached, through a small tube, to a subcutaneous port. Through an injection, fluid is increased or decreased, depending on the desired size of the band. This makes it possible to enlarge or reduce the stomach pouch.
The vertical banded gastroplasty (VBG) involves placement of a band around the upper end of the stomach, creating a pouch and a narrow passage into the remaining portion of the stomach. Staples are sometimes used to create the small pouch instead of a band. The narrow passage delays the emptying of food from the pouch, causing a feeling of fullness. 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 procedure in which smaller incisions are made.
In a biliopancreatic diversion, which can also be performed either open or laparoscopically, a large part of the lower stomach is removed. The remaining portion of the stomach is connected to the lower portion of small intestine. In a biliopancreatic diversion with duodenal switch, a smaller portion of the stomach is removed, but the remaining stomach remains attached to the duodenum (the upper part of the small intestine). The duodenum is connected to the lower part of the small intestine. |
Source: Medical Disability Advisor
| Success rates vary depending upon which procedure is performed. Approximately 80% of individuals who undergo VBG lose some weight with an estimated 30% reaching normal weight. Long-term weight loss success rate with VBG is 40% to 63% of excess body weight over a 3-year period and 50% to 60% after 5 years ("Obesity in the US").
A study by the National Heart, Lung, and Blood Institute found that individuals who had gastric bypass surgery lost more weight than those who had gastroplasty (VBG) surgery. Individuals who have undergone a gastric bypass (RGB) procedure lose between 68% to 72% of excess body weight over a 3 year period, and 75% for BPD. After 5 years, the average excess weight loss from gastric bypass surgery ranges from 48% to 74% ("Obesity in the US").
In many cases, surgery also results in improvement of obesity-related conditions such as diabetes and sleep apnea. |
Source: Medical Disability Advisor
| Complications occur in an estimated 10% of obesity surgeries ("Obesity in the US"). These may involve the heart or liver, rupture of blood vessels in the lungs, respiratory problems, infection around the diaphragm area, leaking and bleeding of the stomach and intestines, blood clots, and obstruction of the small intestine. Approximately 10% to 20% of individuals require follow-up procedures to correct abdominal hernias ("Obesity in the US").
Complications of VBG includes 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, which 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 also a possible complication as well as an increased risk of gallstone development. An infection at the incision occurs in approximately 5% of surgeries; laparoscopic surgery reduces that risk to less than 1% (Mayo Clinic Staff).
Death has been reported in less than 1% of individuals ("Obesity in the US").
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
| 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. |
Source: Medical Disability Advisor
| Mayo Clinic Staff. "Weight-Reduction Surgery Available at Mayo Clinic." MayoClinic.com. Mayo Foundation for Medical Education and Research. 5 Jan. 2005 <http://www.mayoclinic.org/bariatricsurgery/surgery.html>. "Obesity in the US." American Obesity Association. 5 Jan. 2005 <http//www.obesity.org/subs/fastfacts/obesity_US.shtml>. |
Source: Medical Disability Advisor
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