People with clinically severe obesity are at great medical risk of disability or premature death.


High blood pressure caused by clinically severe obesity can contribute to heart attacks, congestive heart failure and stroke. Other health concerns such as sleep apnoea, asthma, low-back pain, urinary stress incontinence and severe acid reflux are also a result of increased weight. Significant weight loss can often ease these conditions or reverse them completely.


In today’s progressive medical science, surgery to promote weight loss by restricting food intake and interrupting digestive processes is an option for clinically severe obese patients, who have been unsuccessful with other weight loss treatments.

These should be patients whose body mass index, or BMI, is 40 or greater (equivalent to about 100 pounds over ideal body weight for men or 80 pounds over ideal body weight for women).



Roux-en-Y gastric bypass is performed by creating a small stomach pouch using a surgical stapler (1). Next, the small bowel is divided about two feet from the stomach. One end of the small intestine is brought up and attached to the stomach pouch (the gastrojejunostomy) (2). The other end of the small intestine, still connected to the now non-functional stomach remnant, is reconnected to the intestinal tract (the jejunostomy) (3)

Weight loss surgery may also be an option for people with a BMI of 35 or greater who suffer from life-threatening obesity related health problems, such as diabetes, obesity-related heart disease or severe sleep apnoea.

Follow up:

Common types of weight loss surgery include:

Jejuno-ileal Bypass, Biliopancreatic Diversion and Duodenal Switch, Long Limb Roux-en-Y gastric bypass; Vertical Banded Gastroplasty, Silastic Ring Gastroplasty, Adjustable Band Gastroplasty and Roux-en-Y gastric bypass, the latter being the “preferred” choice of surgery (Roux-en-Y gastric bypass).

According to the American Society of Bariatric Surgery (ASBS) Survey, 1999, amongst its members (surgeons), Roux-en-Y gastric bypass is by far the most often performed type of weight loss surgery with restrictive procedures accounting for less than 25% of procedures.

Surgery is performed by creating a small stomach pouch (about the size of a person’s thumb, see diagram) using a surgical stapler (1). The small stomach pouch restricts food intake by allowing only a small amount of food to be eaten at one time. Next, the small bowel is divided about two feet from the stomach.


One end of the small intestine is brought up and attached to the stomach pouch (the gastrojejunostomy) (2). The other end of the small intestine, still connected to the now non-functional stomach remnant, is reconnected to the intestinal tract (the jejunostomy) (3).


As gastric bypass implies, following the surgical procedure, that food is now routed past most of the stomach and the first part of the small intestine.


Endorsed by a 1991 consensus panel convened by the National Institutes of Health as the only effective means of inducing significant long-term weight loss for the vast majority of patients with clinically severe obesity, patients post-gastric bypass surgery have usually lost 50-70% of their excess weight (five years).


Long before that, complications of clinically severe obesity begin to resolve. These include control of diabetes; lowered blood pressure and total cholesterol; relief from sleep apnoea, severe acid reflux, and urinary stress incontinence; and eased low-back and osteoarthritis pain. Patients also report enhanced mobility and their mood and self-esteem also improve. Successful patients also slept seven hours per night on the average and 76% of patients rated their personal energy as being average or high.

According to a clinical study published on Obesity Surgery magazine (16,2006), a 10-year study of the Gastric Banding surgery for morbid obesity reveals that patients developed late complications, such as band erosion, pouch dilatation/slippage, catheter-or port-related problems.


Major re-operation was required and the mean EWL (excess weight loss) at five years was 58.5% in patients with the band still in place. The study concludes that Gastric Banding appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material.


Each year adds 3-4% to the major complication rate, which contributes to the total failure rate. With a nearly 40% five-year failure rate, and a 43% seven-year success rate (EWL>50%), Gastric Banding should no longer be considered as the procedure of choice for obesity.

A patient who has undergone the Roux-en-Y gastric bypass would be able to “eat better-solid food”, as compared to a patient with Gastric Banding. Due to the smaller stomach size post-surgery of the Roux-en-Y gastric bypass patient, he/she will automatically feel satiety at each meal time, thus promoting weight loss by ingesting less calories.


In comparison, a patient who has undergone Gastric Banding would need to ingest “almost totally blended food”, due to the restricted stomach. Otherwise, it is recommended that the Gastric Banding patient ensure that food is “chewed thoroughly” in order to avoid “choking or a stuck sensation” in the stomach.


Gastric Banding patients would need to have discipline or otherwise need to train themselves to be very “strong-willed” in following a regimented diet, in order for successful weight loss.

All prospective patients must undergo a thorough pre-screening medical work-up, including a psychological profile. Patients must understand the seriousness of gastric-bypass surgery and its risks. They should have tried and failed conservative medically supervised approaches.


Patients must understand the implications of a mandatory lifelong commitment. Potential patients with a history of substance abuse or major psychiatric problems are usually excluded as gastric-bypass candidates. Although precise details vary, all surgeons have an elaborate system of ensuring that informed patient consent is obtained prior to surgery.

The gastric-bypass surgical process is generally performed and managed by a medical team that specialises in bariatric surgery.


Bariatric surgeons typically have surgical privileges at institutions with dedicated facilities equipped to meet the needs of the obese patient. These facilities require specific instruments for the bariatric surgeons, particularly when performing laparoscopic procedures.


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