Obesity is one of the major health problems in the Western world, and due to the fact that it has a number of negative comborbidities like hypertension and heart diseases, its treatment was delegated to surgeons, who nowadays perform gastric bypass surgery in those individuals, who either have high (40 +) body mass index (Graham-Rowe, 2004) or suffer greatly from the diseases, which accompany obesity. Because the operation is associated with purely physical intervention, it provides very notable results, as in the subsequent 4 months patients normally lose more than fifty percent of their redundant kilograms (Graham-Rowe, 2004).
Thus, gastric bypass is defined as a surgical treatment of morbid obesity, associated with the decrease of the stomach’s size. It was performed first by Dr.Mason and Ito in the 1960s (Balsinger, 2000), who noticed a substantial weight loss in the individuals who had a part of stomach removed because of ulcer. Nowadays, there are two vital components of the surgery. First of all, it is necessary to create “ a small (15-30 mL/1-2 tbsp) thumb-sized pouch from the upper stomach” and perform a “bypass of the remaining stomach (about 400 mL and variable). This restricts the volume of food which can be eaten” (Schauer and ikramuddin, 2001, p. 1146). The stomach might be also partitioned completely, if there is a high probability that the two parts will fistulize (Balsinger, 2000). In addition, it is necessary to re-construct “the GI tract to enable drainage of both segments of the stomach” (Balsinger, 2000, p. 674).
There are three types of gastric bypass surgery: mini gastric bypass, extensive gastric bypass and Roux-en Y method.
Mini gastric bypass has been practiced since 1967, when a loop of small bowel was used for re-shaping. This approach, however, is associated with quite high risk, as it allows pancreatic and bile enzymes to access the esophagus thus resulting in ulcers, inflammation and overall physical discomfort. It is suggested nowadays that the loop should be located in the lower part of the stomach instead of placing it closely to esophagus (American Gastroenterological Association, 2002; Graham-Rowe, 2004).
The Roux-en Y method implies the use of vertical banding for the creation of the small pouch from the stomach (Brolin, 2002). Furthermore, the bandage is placed in the “Y” configuration, so that the outflow of nutrients from the upper stomach is allowed only through bypassing the part of jejunum and a part of duodenum; therefore, a less calories are absorbed.
The third approach, extensive gastric bypass, prescribes the removal of the part of the stomach. “The small pouch that remains is connected directly to the final segment of the small intestine, thus completely bypassing both the duodenum and jejunum. Although this procedure successfully promotes weight loss, it is not widely used because of the high risk for nutritional deficiencies” (Medicine.Net, 2007).
The cost of the surgery varies between $ 20,000 and $50,000 (Brolin, 2002), depending on the health risks, the patient’s situation and the hospital’s pricing system. Six weeks of the “sick-list” should be also added to the list of expenses, as the patient in this period is not able to carry out job responsibilities and receives smaller income (bonuses and premiums are necessarily deducted). It is also necessary to include health costs, which might be represented through complications (e.g. ulcer) and mortality possibility (1.5 per cent). During the period of recovery, individuals also need to learn a new lifestyle and food intake behaviors (the process of learning might be followed by stomach pains), so there are also psychoemotional costs. To sum up, healthy lifestyle should be developed deliberately rather than imposed by a surgical intervention, as the prevention of obesity is normally much easier than treatment.
Works cited
American Gastroenterological Association. “AGA technical review on obesity”. Gastroenterology, 2002, 123 (3): 882-932.
Balsinger, B. “Prospective evaluation of Roux-en Y gastric bypass surgery as primary operations for medically complicated obesity”. Mayo Clinical Proceedings, 200, 75 (7): 673-680.
Brolin, R. “Bariatric surgery and long-term control of morbid obesity”. JAMA, 2002, 288 (22): 2793-2796.
Graham-Rowe, D. “Robots boost the surgeon’s art”. New Scientist, 2004, 10: 18-24
Medicine.Net. “Weight Loss: Gastric Bypass Operations”. Web.
Schauer, P. and Ikramuddin, S. “Laparoscopic surgery for morbid obesity”. Surgical Clinics of North America, 2001 81 (5): 1145-1179.