Bariatric Surgery - FAQs
Sutter Health Sacramento Sierra Region
What is obesity surgery?
What are the benefits?
Who is eligible?
Will my insurance pay?
Exactly what happens during the surgery?
How does surgery promote weight loss?
What are the risks?
How much weight can I expect to lose?
What is obesity surgery?
There are several different kinds of surgical procedures to help people who are significantly overweight. By reducing the size of the stomach, these procedures restrict the amount of food you can consume.
Long-term success depends in large part on permanently following a restricted diet and making major lifestyle changes.
Sutter offers the Roux-en-Y (roo-en-wy) Gastric-Bypass Procedure (See illustrations). Roux was the name of the Swiss surgeon who developed this technique of joining the stomach pouch to the small intestine and creating a Y-shaped intestinal junction. The surgery was first performed for weight loss by Dr. Edward Mason in the early 1970s at the University of Iowa.
This surgery is most often considered a last resort for people who are more than 100 pounds overweight, and who have not been successful in permanently reducing through other methods. Gastric-bypass surgery should not be considered reversible. The decision to have this procedure must be made in consultation with a qualified surgeon, and after very careful consideration of the potential benefits and risks and the lifelong consequences.
Back to Top
What are the benefits?
The emotional and physical benefits of achieving a healthy weight are significant. For example:
- People who lose at least 50 percent of their excess weight report they have more energy, endurance, and ability to enjoy physical activities, as well as significant improvement in back and joint pain.
- Research on the effects of major weight reduction have demonstrated a significant decrease in the risk of heart disease, and often improved blood pressure in patients with hypertension.
- Many people with obstructive sleep apnea or respiratory problems enjoy marked improvement.
- The majority of significantly overweight people who have diabetes enjoy tremendous improvement in blood sugar control following major weight reduction, and many no longer require medication.
- Skin problems related to obesity usually resolve.
- Acid reflux (indigestion) symptoms often improve or disappear.
Back to Top
Who is eligible?
You must be at least 100 pounds over your ideal weight and have a Body Mass Index (BMI) greater than 40. Click for Body Mass Index Tool to calculate your score.
If your score is 35 or above, you might be eligible for this surgery. If your score is below 35, you are not eligible for this surgical procedure. However, Sutter offers many other programs and services for weight management. Contact our Education Department (696-5600), Nutrition Counselors (696-4772), Eating Disorders Program (696-5737), Fitness Center or view our Education Calendar.
Persons with a BMI greater than 35 may be eligible if they other diseases associated with their obesity, such as diabetes, obstructive sleep apnea, heart disease or arthritis. The age range for this surgery is generally 16 to 60 years old; however, it may be appropriate for some older people in extreme situations. People with substance abuse issues are not appropriate candidates.
Back to Top
Will my insurance pay?
Many health plans will cover this surgery if the person meets all requirements. For example, you must be able to document that you have seriously tried to lose weight multiple times through conventional methods without lasting results. We can assist you in determining your individual coverage.
We can only accept Medicare patients for evaluation who live locally and are referred by their own physician. We do not accept Medi-Cal.
Back to Top
Exactly what happens during the surgery?
The stomach is stapled closed and separated a short distance below the esophagus (see Roux-en-Y Diagram). A loop of the patient's small bowel (jejunum) is then attached to the stomach pouch, and a 1.5 centimeter opening (stoma) is created so that food and fluids can pass from the pouch into the small bowel.
The loop is called the Roux-en-Y bypass because it is Y-shaped and bypasses the rest of the stomach.
The bypassed part of the stomach will continue to secrete digestive fluids into the small bowel just as it did before.
The surgeon will remove the gallbladder only if it shows signs of disease. Patients may also have a liver biopsy to check for fatty liver changes.
Back to Top
How does surgery promote weight loss?
When the stomach is stapled closed, it leaves a 20 to 30 cc (1 ounce) stomach pouch and severely restricts the amount and kind of food or fluid that can be consumed at one time (see Roux-en-Y Diagram at rouxeny.html.)
The majority of patients report feeling full and satisfied after a small amount of food, and not feeling excessively hungry most of the time.
If much more than a quarter cup of food is eaten at once, the patient will feel uncomfortable and may vomit.
The procedure also bypasses part of the small bowel, so calories and nutrients from foods eaten are not completely digested and absorbed. Daily vitamin and mineral supplements and a high protein intake are required to prevent the problems of nutritional deficiencies.
Back to Top
What are the risks?
The gastric-bypass operation has a mortality rate of 1 percent or less; however, significant obesity itself increases the risk for many life-threatening diseases, including diabetes, heart disease, respiratory problems and liver dysfunction.
Complications which may occur during surgery, or soon after, include bleeding, a leak or narrowing of the anastomosis (where the loop of bowel is attached to the stomach pouch), abscesses inside the abdomen, wound infection, blood clots developing in the legs (deep venous thrombosis) or a blood clot going to the lungs (pulmonary embolism). Between 5 to 10 percent of patients experience a post-operative problem that requires medical attention.
Some patients may require up to 24 hours on the breathing machine (ventilator) following surgery, particularly those with existing respiratory problems such as sleep apnea.
Complications which may occur later include incisional hernia, narrowing or stricture of the anastomosis, small bowel obstruction, gallstone formation, anemia and diarrhea. Some complications may require additional surgeries.
Many patients experience an unpleasant side effect known as "dumping syndrome" when they consume food with high sugar content. This may include weakness, nausea and light-headedness. It usually passes within about 45 minutes.
Back to Top
How much weight can I expect to lose? Weight loss after surgery depends on how successful you are in making significant dietary and lifestyle changes. Sutter is designed to support you in making those changes. Most patients lose 10 pounds or more a month during the first year and continue to lose weight, usually at a slower rate for another year.
Successful habits include eating three small, well-balanced meals, and a maximum of two low-fat snacks each day. Avoid carbonated or sugary beverages and alcohol. Carbonated bubbles over-fill the stomach pouch. Sugar and alcohol add empty calories.
A program of regular exercise is very important for promoting and maintaining weight loss. Patients tend to gain weight if they start eating larger portions, consume high fat or "junk" foods, or drink high-calorie beverages.
Back to Top