Here is a topic where it is of the highest importance to have access to good data and leave one’s judgments at the door. The issue in this particular topic is the “safety” of the gastric bypass procedure. When talking about the relative safety of a surgical procedure, one needs to put the procedure in context. The gastric bypass or commonly known as the RNY in the U.S. Is a surgery not intended for overweight people, not even intended for obese people, but a surgery intended for the morbidly obese people in society. That is, people with a body mass index of 35 or greater. Here lets just look at the safety, I hope that soon there will be a topic on “should people have the gastric bypass surgery”.
Right off of the bat, you have entered a surgical demographic where complication rates are exponentially higher that those not morbidly obese. So, the patient factors are EXTREMELY important here. Morbidly obese patients succumb to complications of the simplest surgeries. There is very little any surgeon can do about the patient factors. Some require patients to loose a specific amount of weight prior to the surgery, some require a special liquid diet prior to surgery, it all just depends.
The procedure it self is complex, and invasive. I have read a few people’s comments on the surgeon’s ability, and this cannot be stressed enough in the case of the RNY. The complication rate, major and minor, are cut to minuscule levels when the surgeon has performed the operation on the level of the thousands. In addition, there is a grading system performed by the American Society for Metabolic and Bariatric Surgery that can give an hospital and surgery group the distinction of a “Center of Excellence”. What does this mean? It means the hospital, nurses, surgeons, anesthesiologists, the pre and post-surgical programs have met standards from the society in terms of outcomes and success that warrant the distinction. And the difference is quite measurable in terms of surgical outcomes and complications between Centers of Excellence and those without such distinction.
Also, know that until the late 1990s, the RNY was done as what’s known as “open”. This is one long incision down the belly and the operation is done with the surgeon’s hands and fingers in the abdominal cavity. Now, the procedure is done almost exclusively as a “laproscopic” surgery (lapRNY). Done with 6-7 tiny holes (ports) in the abdomen and instruments used through these ports. The complications are lower in the lapRNY, some incredibly lower.
So, what does this all mean?
It is impossible to give a verdict of safe or not safe on any real surgical procedure without putting a myriad of pieces into play. As a physician, this is much easier and this is how we have to make decisions on every patient we see. But to the layman, it can sometime be difficult to grab hold of this, and understandably probably rather unsatisfying.
Is the gastric bypass a “safe” surgery. Yes. If done my an experienced surgeon, with help of experienced hospital and nursing staff, and the patient has followed all of the preoperative and postoperative instructions, the odds are it will be a successful procedure. It is not without risks and should be reserved for patients in the morbid obesity category or above, where if you look at all of the studies that have been done on the effects, long term, of diet and exercise on weight loss surgery at this point in time is the best option for these individuals…but that is a topic of a future discussion I hope.
I am a physician but not a surgeon and do not favor surgical therapy of any kind over nonsurgical therapy except when medically indicated.
