DISCLOSURE DOCUMENTS: SECTION 6

The laparoscopic or open Gastric Bypass with Roux en Y Reconstruction is associated with known, potential complications or side effects. This procedure has been performed since the late 1960’s and its postoperative side effects  are well documented. It is essential the bariatric patient be properly educated as to what to expect after surgery. Prospective patients need to read the following carefully.

·        Dumping Syndrome - Considered by many surgeons an essential component or consequence of this procedure, this syndrome is generated by the small bowel bypass or the Roux en Y Limb [malabsorptive component of the procedure]. After the patient has undergone a laparoscopic gastric bypass with Roux Y limb, the nutrients [ food] will pass directly from the small gastric pouch into the small bowel, thus bypassing the usual digestive route [the body of the stomach, the outlet of the stomach or duodenum and the small bowel]. The new digestive or bypassed route poorly handles highly concentrated [high osmolarity] nutrients such as carbohydrate rich-food or certain fat-rich food. The ingestion of these foods will create an unpleasant abdominal discomfort or cramping. As the post gastric bypass patients recover they will learn to avoid this type of nutrients and  naturally will steer their diet toward healthier foods. 

Not all patients will experience this syndrome; some may experience severe manifestations, others may experience a so-called late dumping syndrome. This pronounced syndrome is caused the inappropriate, rapid absorption of highly concentrated sugar which in turn may cause the body [pancreas] to produce delayed, large amount of insulin. This hormone will inappropriately and dramatically decrease blood sugar level and may create a hypoglycemic state. The patient in turn may feel dizzy, clammy, fatigued and may experience heart palpitations. Fluid shifts may occur in the small and large bowel in turn creating diarrhea. It should however be noted patients who do experience severe dumping syndrome always report significant improvement with time.

Dumping syndrome is not dangerous, but frightening to the uneducated patient. It is a natural and expected consequence of this procedure. It is beneficial as it eventually deters patients from the type of food to avoid.  In addition, the patient who do experience severe dumping syndrome always report significant improvement with time.

·        Mineral Absorption – After a Gastric Bypass with Roux en Y Reconstruction, the lower part of the stomach and the upper (proximal) part of the small intestine do not participate in the normal digestion of food. These portions of the gastro-intestinal tract however play an important part in the absorption of some minerals (Iron, Calcium, and to a lesser extent Magnesium) and vitamins (Vitamin B₁₂ and to a lesser extent B₆).  To compensate for this loss of function, patients who have undergone a Gastric Bypass with Roux en Y reconstruction will need to take Multivitamins with Iron, and supplemental Calcium (usually TUMSä) every day for life.  Up to 20% of patients also require supplemental B₁₂, which is taken as a sublingual pill twice a month.

·        Lactose Intolerance - Lactose ("milk sugar") is a particular type of sugar found in milk and dairy products.  Absorption of lactose requires a particular enzyme that is found in the bypassed segment of intestine.  Many of the patients who did well with milk before surgery will find that after Gastric Bypass, dairy products will cause abdominal cramping and flatulence.  Taking Lactaidä, an over-the-counter enzyme supplement, will prevent such problems. Again, an adaptation phenomenon will occur within six months after the procedure.

·        "Starving Mode" – Reduced calorie intake or deprivation will generate significant fatigue in half of the post-operative patients for approximately two weeks after surgery. The energy level of these patients naturally drops generating a sequence of emotional problems including depression. This normal phase will resolve as soon as this adaptation process is complete.

·        Hair Loss - Most patients will report some increase in hair loss about three months following surgery.  For some patients this hair loss is dramatic and  is secondary to sudden calorie and protein deprivation.  This is a temporary process and a year later most patients report their hair has fully regrown. The best prevention of this weight loss is to maintain a 45 gr. daily protein intake at all times.

·        Excess Skin - Unfortunately, the skin that holds all of the excess fat before the surgery does not entirely shrink with the weight loss.  Most patients are left with large floppy areas of skin, especially on the abdomen, upper arms, thighs, and breasts.  Exercise is very important for the patient's overall success, but it is not very effective in shrinking this excess skin.  Actual resection or removal of the excess skin by plastic surgery is frequently desired by the patient. Although most insurance companies view this as cosmetic surgery; we do not share this opinion.  We recommend patients wait at least one year following the gastric bypass to undergo surgery for removal of excess skin. At this time the patient’s weight will have stabilized.

·        Gallstones - Cycles of weight loss and weight gain predispose the patient to the risk of forming gallstones. As a result, most patients who undergo bariatric surgery have already had their gallbladders removed.  For prospective patients who have their gallbladder the rapid weight loss generated by the bariatric procedure will increase their risk of forming gallstones in the early post-operative period. They will be asked to take Actigallä (a bile thinning medicine) for six months after surgery.

·        Marital and Relationship Distress - Every interpersonal relationship in which the patient participates will change substantially as the dramatic weight loss occurs.  This change will affect all relationships, including marital relationships.