Unlike conventional cosmetic surgeries, patients must prove medical necessity in order to be approved for bariatric procedures. While most insurance companies exclude bypasses from their covered surgeries, it is possible, with perseverance and detailed documentation to petition for coverage on a case by case basis, but patients should not expect this result. The average cost of such surgery is about $20,000.
Gastric bypass surgery is not performed on an out-patient basis. The actual procedure lasts for one to four hours, with the patient under general anesthesia, and is generally followed by a hospital stay of at least one, and up to seven, days.
Methods of Gastric Bypass
There are two methods of gastric bypass currently in common use: Roux-en-Y and biliopancreatic.
The Roux-en-Y bypass is the most common version of the procedure and is considered less complicated, since it does not involve removing portions of the stomach. It can be performed either traditionally, via a single long incision, or laparoscopically, using multiple small incisions and a laparoscope to provide a visual guide to the inside of the abdomen. It is this version that results in the least amount of scarring, and a shorter recovery time, though it is also newer, without long-term evaluation.
The biliopancreatic diversion bypass is more complicated than the Roux-en-Y procedure, and is always performed via open surgery with one long incision. In this procedure, parts of the stomach are removed and the bypass is attached to the distal illium. This procedure carries a far greater risk of nutritional deficiency after recovery, which is one of the reasons it is less commonly used.
What both techniques share is the use of a bypass. The bypass is literally a reshaping of the digestive system. A small stomach pouch is created by stapling part of the stomach, and then a Y-shaped section of the small intestine is attached to the pouch, allowing food to bypass the duodenum, decreasing the absorption of nutrients from food. By restricting food intake - patients are literally unable to eat very much - and reducing hunger, weight loss is virtually guaranteed, with most of it occurring within the first year post-surgery, and almost all by the end of the second year.
After Bypass Surgery
After undergoing gastric bypass surgery, a hospital stay of one to seven days is usual, with the average being about three, followed by two to five weeks of at-home recovery. Patients should expect significant swelling and soreness after surgery, which can be managed with prescription medications.
In addition to a gentle exercise program, aftercare generally includes behavior modification therapy, a strict dietary plan, including avoidance of fatty foods, and vitamin supplements, the latter two of which continue indefinitely.
Risks are the same as with most invasive surgeries, including infection, burst sutures, and discomfort, as well as nutritional deficiencies if the proscribed diet and vitamin regimen are not followed.
Scarring is permanent, but generally able to be hidden by clothing.
Gastric bypass in either form is considered a measure of last resort, but the benefits are generally worth the require pre-surgery counseling, and post-surgery restrictions in diet. As well as improved health, post bypass patients have improved mobility, and increased self-esteem.
