Talk:Gastric bypass surgery

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[edit] Request for Globalization

It is difficult to globalize a topic with less than uniform global implications. Gastric Bypass is most commonly performed in the USA. Fundamental methods of doing surgery do not vary by country, nor does basic physiology, but choice of procedure is influenced by many factors.

By way of background, the USA has been a leader in this area of surgery, since its inception:

  • The first Bariatric Surgery procedure was developed in the USA.
  • The first Gastric Bypass was performed in the USA.
  • The first Gastroplasties were performed in the USA.
  • The first Gastric Band was developed in the USA.
  • The Vertical Banded Gastroplasty was developed in the USA.
  • The Silicone Ring Gastroplasty was developed in the USA.
  • The first Laparoscopic Gastric Bypass (Roux en-Y) was performed in the USA.

Bariatric surgery has now developed in many countries, as an increasing need has been recognized, although most of the techniques continue to draw on the methods originated in the USA. The Bilio Pancreatic Diversion, developed by Nicola Scopinaro of Genoa, Italy is a notable exception, and has strongly influenced the latest methods of bariatric surgery.

Different countries and areas of the world differ markedly with respect to the favored operative procedures, while other areas offer little or no such surgery (mainland China and most of Africa, at last report). The banding procedures are favored in most of Europe, and in Australia. South America tends toward the Scopinaro procedure, with some Gastric Bypass. At this time, the International Federation for the Surgery of Obesity (IFSO) remains loosely organized, without a developed website. Estimates of the usage of the various procedures can mainly be gleaned by observing reported series from various countries, and by attending surgical meetings, which is well beyond the scope of this article.

Those non-US surgeons who perform the Gastric Bypass typically employ one of the two technical methods, both originally developed in the USA. The physiological principles apply to all peoples, although some ethnic variables have been recognized, and cultural variability in diet influences choice of procedure and outcomes. Regional economic factors also influence availability, and choice of procedure.

I believe that the information provided in the article applies to the procedure regardless of where performed. I would welcome alternative input from my non-US colleagues.

Topnife 20:00, 14 January 2007 (UTC)


[edit] Second Para Misleading/Incorrect

There are a lot of very misleading and inaccurate statements in this article. The first one I can find is the explanation that gastric bypass divides the stomach into two pouches which "remain connected." They are actually NOT connected. Gastric acid and other substances from the "old stomach" or the portion your food no longer travels through do join the digestive process farther on in the intestines. But there is no connection between the new "pouch" and the rest of the stomach which it's been divided from. Actually, that's exactly WHY the operation is called a BYPASS: because most of the stomach and a section of the large intestine are bypassed.

This article still needs a lot of work.


—The preceding unsigned comment was added by 198.180.131.16 (talk) 16:12, 11 January 2007 (UTC).

Error is in reading
The above unsigned grumble is not helpful or constructive. The complainer states "a lot of misleading and inaccurate statements", with neither identification of what he thinks they are, nor substantiation of his assertion of error. The single cited "inaccuracy" results from a misinterpretation of the sense of the sentence, which refers to both portions of the stomach remaining connected (to the intestines). I have edited and elaborated that sentence to remove the potential ambiguity.

Topnife 19:12, 14 January 2007 (UTC)

[edit] Reduced size as a percentage of original size?

The 30-60 mL measure sounds small, but doesn't give any idea of scale. Is there anyone who can add in the parenthesis a measurement in terms of the size of the original stomach? I feel it will be more useful to the laity. --66.207.89.14 06:31, 16 Jun 2004 (UTC)

[edit] Answer

Look at your thumb. It's about 15 ml, which is the preferred size of the stomach pouch. Mine is even smaller. The old size of 30 - 60 ml is invalid, since larger pouches, particularly those formed from the upper part of the stomach, have a tendency to stretch too much.
The normal stomach is about 400 ml when empty, but can stretch to hold 1000 ml or more (watch those chug-a-lug beer drinkers or champion hotdog eaters, to see what I mean). The gastric bypass pouch has 5-10% of the volume of a normal empty stomach.
Topnife 00:21, 15 June 2006 (UTC)

[edit] Copy and Pasted from a pamphlet

This reads like a copy and paste job, it even says " Please see the written consent form for a more detailed written listing of complications." what is that?

[edit] What happens after the weight is lost?

The reason I looked up this article tonight in the first place was because the question came to my mind: "What happens when the patient has lost all the weight they wanted to lose, but they are still unable to take in a normal ammount of food?" Is there surgery to re-expand their stomach, do they just make sure to eat high-calorie foods, or do they just waste away? Is there someone more knowledgable who can add this information? --66.207.89.14 06:31, 16 Jun 2004 (UTC)

[edit]  :Not to Worry -- It stops

Body weight is a function of energy balance - energy used versus energy taken in as food. After surgery, intake is greatly reduced, so the body burns stored fat to make up the difference. When body weight is very much reduced, energy usage is also reduced, while the amount of food that can be eaten increases somewhat, over the first year, bringing one back into balance at the lower body weight, usually at or 10 -20% above ideal body weight. It's best not to start eating high-calorie foods, or snacking, which can cause weight regain in the long-term.

Topnife 05:20, 14 June 2006 (UTC)

[edit] Answers to questions

I am a nurse who takes care of Gastric Bypass patients, I work in one of the nation's largest surgical weight loss centers, and I had the surgery myself 14 months ago. I was 345 lbs then and I am 185 pounds now. I wrote the original version of this article.

Answers to questions:

1. It would be useless to estimate "natural" stomach size" because it varies so widely between individuals. It's also very hard to measure. All of the textbooks say between 1 liter and 4 liters. My stomach now holds about 300cc of food.

2. Gastric patients only have one surgery. Their bodies heal, then adapt to their new conditions. We are on a liquid diet for about a month, then reintroduce soft foods. My pouch was about 40cc (about the volume of an egg) when I first introduced soft foods and has expanded to hold more over the last year or so. That said, I will always have problems with maintaining adequate nutrition. I take a vitamin every day (which I cut into tiny pieces or crush - as I do with all pills - so that it will fit through the ring at the opening of my pouch). I have had problems with iron absorption so I added a supplement for that. At each meal I eat protein first, then complex carbs, then whatever else I want. We also have to have B12 injections about once a month (I give my own). I always carry my bottle of water with me to make sure I don't get dehydrated. I have been at this weight (about 185) for the last three months. The only surgery I want now is a tummy-tuck!!

Many gastric patients lose hair after surgery (I did) because of the lower protein intake. Others have other problems associated with malnutrition, but most can be remedied by a vitamin supplement.

Childoferna 03:05, 25 Jun 2004 (UTC)

[edit] WP:Naming

copied from duplicative talk page Talk:Roux-en-Y gastric bypass surgery.

it is wikipedia policy to use the most common name for an article. in this case gastric bypass surgery would be much more common. I'm stating my intention WP:Be bold and do this soon; although I will wait a day or two to see if someone has an objection. Themindset 01:46, 1 September 2005 (UTC)

This article has been renamed after the result of a move request. Dragons flight 04:38, 14 September 2005 (UTC)

[edit] Additions/subtractions?

As most research and Childoferna mentioned, there is a significant problem with nutrient absorption after the surgery. Different parts of the intestines absorb specific vitamins & minerals. The surgery specifically bypasses some of these areas, making normal function impossible. I think the article should include information about how most patients will require IV supplements (beyond simply b12) for the rest of their lives, are prone to violent nausea/diarrhea, and complications are VERY common. A recent (2005) study conducted by Medicare shows a 2% morbidity rate for the procedure itself (died during surgery) and 5% mortality in the first year.

My mother and aunt both had this done about 2 years ago and have had no end of problems. For example, the "new" stomach attaches to the small intestines about 12 inches down, the remainder of the stomach drains normally. This new stomach does not have a pyloric valve to prevent material from the intestines from backing up into the stomach. The stomach is acidic, the intestines are alkaline. When material does back up (and it does in the majority of patients at some point), it causes these horrifically painful ulcers.

If nobody has any objection I would like to add the above information (minus personal story) with relevant citations.--Legomancer 04:07, 3 January 2006 (UTC)

[edit]  :Assertions are Invalid

Most of these statements are inaccurate, with respect to the Gastric Bypass, Roux en-Y. A need for IV supplements would be very rare after GBP, and nutritional complications are actually quite rare. Reduced absorption of iron and calcium can and should be offset by use of oral supplements daily. The Medicare study mentioned is subject to several methodological problems.
I've performed about 2500 of these procedures, and have also had one myself.
Your relatives may have had an offbeat version of the GBP, called a "Mini-Gastric-Bypass", which easily could cause corrosive gastritis or esophagitis. Ulceration has an incidence of 1-2% in most series, and a functioning pylorus is not the answer to the problem, anyway.

Topnife 05:31, 14 June 2006 (UTC)

[edit] Definition

It seems to me like the article needs a succint definition of what this surgery is, other than "for weight loss", i.e., what is performed in the surgery (aside from what can be deduced from its name, which doesn't give you a lot of precise information). I was trying to find out whether this was the "stomach reduction" surgery, and had to scan the long article several times before I found this information amidst lots of technical details. --Cotoco 16:30, 16 February 2006 (UTC)

[edit] Reversible?

Is this surgery physically reversible (e.g.: can the stomach be put back together, etc.)? I think this fact (whatever the answer is) should be mentioned in the article. Some people may be looking at this article wondering if they could reverse the surgery after the weight is lost so their body can be in tact again. I'd imagine healthier eating habits are learned after this surgery, so reversing the surgery--I would think--would not have any adverse effects on the person's weight. Cparker 06:05, 23 February 2006 (UTC)

[edit]  : Reversal Not Indicated

While this operation can technically be reversed (the stomach is re-connected, and the bowel is put back into natural configuration), there is almost never a valid reason or indication to perform a reversal, and the risk of the operation is actually greater than that of the original procedure. When the surgery is reversed, the weight lost is rapidly regained over a few months. Healthy eating habits will rapidly succumb to the recurrence of unphysiologic hunger, which was the cause of the problem in the first place.
One should NEVER have the operation with the idea of having it reversed after weight loss, or just to "try it out".

Topnife 05:47, 14 June 2006 (UTC)

[edit] citations needed

It might be nice to cite one or more of the "multiple studies:" "The gastric bypass, through multiple studies, has been shown to improve or cure ..." Brainhell 01:01, 8 May 2006 (UTC)

I found the source. This article was lifted (word for word) from this site http://www.plasticsurgeryindex.net/gastric_bypass_surgery.htm . This site needs a serious re-write immediatly. I cited the source for the time being. Jerry G. Sweeton Jr. 14:18, 5 June 2006 (UTC)

[edit] See Updated Article

The update to the article lists current references. Topnife 00:23, 15 June 2006 (UTC)

[edit] Advertisment

I found buried in the External link section Risks of Gastric Bypass surgery. When you follow this link it takes you to a site trying to sell something. I took the liberty of removing the link. Jerry G. Sweeton Jr. 20:59, 5 June 2006 (UTC)

Found another advertisment Patient hosted radio show features interviews with top gastric bypass surgeons and patients Jerry G. Sweeton Jr. 21:07, 5 June 2006 (UTC)

Jerry, Dan Schulz is a gastric bypass patient, an author of several books about gastric bypass surgery, and a nationally syndicated radio host of Lighten Up America, a radio show dedicated to educating people about Gastric Bypass. His site features has interviews with many of the world's top bariatric surgeons, as well as hundreds of patients. His site is an inviable source of free information. His radio shows are free for the world to listen to. His site should be added.


I do agree however with the decision to remove the gastric.us link. It looks like is selling drugs of some kind.

[edit] Gastric Bypass Blogs?

A number of the external links are blog sites. I feel these should be deleted. Any comments? Jerry G. Sweeton Jr. 21:11, 5 June 2006 (UTC)

Blogs like these can offer a lot of information from a patient's personal view, as opposed to a strictly medical view. I think they have to be looked at on a case-by-case basis. —The preceding unsigned comment was added by 68.161.190.218 (talk • contribs). (a repeat spammer)
Blogs are specifically mentioned in WP:EL as Links to Avoid. -- Mwanner | Talk 17:49, 9 June 2006 (UTC)

Agree - There are now thousands of commercial sites, advertising sites, forums and blogs regarding Gastric Bypass. WP is not a search engine. Topnife 07:02, 11 December 2006 (UTC)

[edit] Accomplishing Re-Edit

I have been performing a major re-edit of the topic, and trying to address all the above concerns, as well as re-organization, and deletion of some inaccurate info. I still have to add graphics and internal links.

There are several external links (I've looked at all of them) which I think violate the criteria under WP:EL (very helpful of Mwanner to provide that reference,above). I am planning to remove links which refer to any individual surgical group, or individual users, both of which appear to violate WP policy. I will replace with NIH references, ASBS references, and a couple broad-based user forums.

Topnife 05:13, 14 June 2006 (UTC) Topnife

I am part of the http://www.renewedreflections.com/forums/ forum. Over 700 members. Started by Craig Thompson who had weight loss surgery. It offers mental and emotional support regarding WLS - per your article "potential patients should ensure they have a strong support system". It is a very active forum, moderated by a doctor, and others that have had WLS themselves. Is this an appropriate website to link to? I consider it can be considered a "highly regarded User Forum" or a "broad-based user forums" - as mentioned in the discussion. T2dman 22:46, 5 December 2006 (UTC)

[edit] Edit Summary

As advised by WP, there have been numerous discrepancies and inaccuracies on this page. I have been completely re-editing the page, making the following changes:

  • Re-Organized Outline
  • Re-wrote Sections on Indications, Techniques, Results, Complications, etc.
  • Deleted extraneous source of previous info, some of which was inaccurate and redundant.
  • Inserted info regarding NIH Consensus Panel, and American Society for Bariatric Surgery.
  • Added more specific nutritional info
  • Added info about professional societies.
  • Addressed the complaints recorded in discussion page, as above.
  • Upload of new images and videos is pending.
  • External Links have been edited to include info from NIH sites, and ASBS site, as well as public info sites, and highly regarded User Forums, which are predominantly non-commercial. In accord with WP policy, as published in WP:EL, I have deleted links to
  1. Commercial Sites
  2. Proprietary Sites (e.g., advertising a physician practice)
  3. Blogs

This is a first-pass at the re-edit. Please provide suggestions.

Topnife 20:00, 14 June 2006 (UTC)

Looking better already, but references would be a nice addition. --WS 22:24, 14 June 2006 (UTC)
No problem -- coming soon. Topnife 22:42, 14 June 2006 (UTC)

Update

  • Graphic uploaded
  • Some references added

Topnife 00:13, 15 June 2006 (UTC)

Update

  • Added Complication Rate section
  • Modified, and deleted some celebrities who did not have gastric bypass:
    • David Lange - gastric stapling
    • Jerrold Nadler - duodenal switch
    • Ann Wilson - adjustable gastric band
    • Star Jones - appears to be rumors/gossip only - her health is private unless voluntarily disclosed.

Topnife 19:44, 21 June 2006 (UTC)

Nice image you have added, but I think it is hard to see for anyone that doesn't already know what is done in the operation to interpret it. I think a more simplified image would be better. --WS 21:45, 21 June 2006 (UTC)
Good drawings that also meet WP requirements are hard to find. I'm looking. Topnife 02:51, 25 June 2006 (UTC)

[edit] Re: Request for Globalization of Centers of Excellence Section

It will be difficult to globalize the section on Centers of Excellence, because there is no international counterpart, yet. Bariatric surgery originated in the USA, and the ASBS was the founding professional organization. Overseas surgeons initially became members of ASBS, and then the International Federation for Surgery of Obesity was formed, with national member societies in many countries. IFSO was initially an offshoot of ASBS, and as an ASBS member, I am a member of IFSO. Many foreign surgeons continue to maintain a membership in ASBS, in addition to their own national societies and IFSO.

I can put in a paragraph about IFSO, and a link to their website [3], which is operated as a subpage of a privately operated info website out of Austria. It does not have a listing of member surgeons, except national society officers. It has no referral service - surgeons must list with the parent site, for a fee.

Center of Excellence is a new concept even in the USA, and there is no counterpart, to my knowledge, in other countries. However, the USA Medicare administration has already endorsed the concept, by limiting re-imbursement only to designated centers. Other insurance is sure to follow, and the Center concept is certainly valid, but the justification is complex and probably beyond the scope of WP. Topnife 02:46, 25 June 2006 (UTC)

[edit] Update

As of 1 July 2006, IFSO does not have a Centers of Excellence type program, and their website is being reconstructed. The Executive Director advises they will have a new website soon, and will try to post a listing of member surgeons. Topnife 19:01, 5 July 2006 (UTC)

[edit] Living with Gastric By-Pass

Drclark (talk • contribs) has made several statement titled Living with Gastric By-Pass. It is my personal experience that most surgical center have programs in place to minimize the emotional impact of gastric bypass (pysch eval before surgery, manadatory support group meetings pre- and post-surgery). I would like to see verifible sources for these statements. If not, I feel this section should be edited or deleted. Jerry G. Sweeton Jr. 22:42, 19 July 2006 (UTC)

I agree. Speaking as one who has both done the surgery (2500 times), and who has also undergone the surgery, it is my experience that the effects described are a consequence of either failure of the surgeon to provide necessary support, of failure to follow the instructions given. Also, the statement that the pouch enlarges is false. When properly constructed, the pouch does not undergo significant anatomic enlargement. Surgeons refer to the "functional gastric capacity", which is more an adaptation of the first few inches of small intestine below the pouch (all of which is beyond the scope of this WP article). Topnife 16:08, 27 July 2006 (UTC)


[edit] "Gastro Bipolar"

User 68.215.81.71 has made a series of edits, changing the words 'gastric bypass' to "gastro bipolar" in the leading paragraph. As a 20 year member of the ASBS, I am unfamiliar with this term being applied to any current procedure, and it is definitely not an accepted synonym for gastric bypass. I suggest that 68.215.81.71 discuss this here, before further edits. Topnife 00:22, 16 October 2006 (UTC)

[edit] Ankylosing spondylitis as a complication

I have deleted this paragraph:

"In a genetically susceptible individual (MHC HLA B27, or family history of Reiter's, Crohn's, Behçet's, iritis, chronic Ulcerative Colitis, IBS, or similar autoimmune conditions), this procedure will increase the probability of developing severe ankylosing spondylitis from [15-20%] to [a near certainty]. Before pursuing this option, it would be wise for anyone of Inuit, N. European, Haida, Tarahumara, or N. Indian extraction to consider testing for the gene related to this disease. Every population except those from Equatorial Africa posses some level of risk. Other options should then be explored."

I know of no medical reference which supports the above statement, nor have I heard or seen even a single case report of such a coincident occurrence, let alone a causal relationship. In 20 years of bariatric surgery, and several thousand operations, with diligent long-term follow-up, I have not seen a case of Ankylosing Spondylitis occur, even as a coincidence, in a post-operative patient. Pending contrary demonstration of valid scientific support, with references, I think this statement is wildly speculative nonsense.

Topnife 15:47, 29 January 2007 (UTC)

[edit] Edits I've made

I did some general copyediting. I removed the 10 {{fact}} templates and replaced them with an {{unreferencedsect}} on the whole section. I also deleted the list of celebrities as unsourced and unencyclopedic. Further, I've changed all the {{cite journal}} templates to {{citation}} templates for uniformity. DrGaellon (talk | contribs) 06:18, 5 March 2007 (UTC)

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