Jefferson University Hospitals

Gastric Bypass Surgery

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Jefferson's Bariatric and Metabolic Surgery Program offers gastric bypass surgery, a type of bariatric surgery (weight loss surgery) that alters the process of digestion. Roux-en-Y gastric bypass (or simply gastric bypass) is considered the "gold standard" operation for weight loss. Performed since the 1960s, it is the most common weight loss procedure in the United States and around the world.

Our outcomes, including weight loss and complication rates, are very good. We attribute our success to exacting care of patients before, during and after surgery and adherence to American Society for Metabolic and Bariatric Surgery guidelines. All patients undergo extensive evaluation by our multidisciplinary team to minimize risk.

What Does Gastric Bypass Surgery Involve?

The gastric bypass involves stapling and dividing the stomach to make a new, smaller stomach about the size of an egg. A piece of the intestine (the "Roux" limb) is then connected to the new smaller stomach for food to pass through and is then reconnected to the lower intestine to form a Y.

The smaller stomach helps you feel satisfied, even full, after consuming a very small amount of food. This food then passes through the Roux limb and meets the digestive fluids at the Y connection. The remainder of your stomach still produces these digestive fluids to meet the food at the Y.

Very little digestion occurs until the food and digestive fluids meet. In other words, you not only eat less, but you also don't fully absorb all the calories you eat. This is called malabsorption. Some malabsorption is alright, but too much can have negative effects on your health.

The bypass we perform at Jefferson only bypasses approximately one-third of the intestinal tract, leaving the last two-thirds to be the "common limb," which absorbs food relatively normally. The amount of malabsorption caused by the bypass that we perform is minimal and easily overcome from a nutritional standpoint by taking a few over-the-counter supplements every day.

By eating less and not fully absorbing calories in food, most people will generally lose 60 to 70 percent of their excess body weight with this procedure. Most weight loss occurs in the first one and a half years. At that point, your weight will stabilize and the weight loss from the gastric bypass is done. The gastric bypass will, however, help you to continue to feel satisfied on very little food, and you can maintain this healthy weight for the rest of your life.

Dr. Austin Chiang explains more in the video below:

What are the Risks of Gastric Bypass Surgery?

With gastric bypass, there is a small risk that one of the staple lines develops a leak. We air-test these in the operating room, and they are airtight prior to leaving the operating room at the end of the procedure.

In a small percentage of patients (one out of 50), a leak can develop within the first week and, in rare cases, up to three weeks after surgery. Leakage will almost always require a second surgery to repair the area of leakage. However, even though the leak is fixed, the fluids that have leaked out can still lead to an abdominal infection called peritonitis. For some people, this can become a serious infection; for a few, it is even life-threatening.

Adding up the major risks – leaks, infection (peritonitis) or pulmonary embolism – there is a one out of 200 risk of dying from a complication of gastric bypass surgery. Most of this risk occurs within the first three weeks after surgery and diminishes to preoperative levels after that.

The more minor risks of gastric bypass are:

  • An ulcer can develop in the small stomach, which usually requires only antacids to fix (4 to 5 percent of patients)
  • The opening between the stomach and intestine can narrow from scar tissue requiring us to dilate it (1 to 2 percent of patients)
  • A hernia can form on the inside of your abdomen where the intestine is re-routed requiring a second surgery to fix (fewer than one in 100 patients)