title: Gastric bypass for treating severe obesity.
abstract: Gastric bypass (RY-GBP) has a very small gastric pouch with a 1-cm diameter Roux-Y gastrojejunostomy. RY-GBP is associated with early satiety and an aversion to sweets secondary to dumping syndrome symptoms and has a significantly better weight loss than various gastroplasty procedures, including the vertical banded gastroplasty. However, it may be associated with vitamin B-12 deficiency and iron deficiency anemia in menstruating females, preventable with prophylactic oral iron and vitamin B-12. With an 80% 5 y follow-up, RY-GBP patients lose two-thirds of their excess weight within 2 y, 60% at 5 y, and greater than 50% at 9 y. The RY-GBP can be beaten by nibbling "junk foods" (potato or corn chips). Conversion to a malabsorptive procedure may cause severe malnutrition and fat-soluble vitamin deficiencies and should be used only for "superobese" patients who fail a standard RY-GBP and have severe comorbidity. RY-GBP is the most effective procedure for morbid obesity, especially in patients addicted to "sweets."
authors.affiliation: Department of Surgery, Medical College of Virginia, Richmond 23298.
authors.forename: H J
authors.initials: HJ
authors.lastname: Sugerman
authors.forename: J M
authors.initials: JM
authors.lastname: Kellum
authors.forename: K M
authors.initials: KM
authors.lastname: Engle
authors.forename: L
authors.initials: L
authors.lastname: Wolfe
authors.forename: J V
authors.initials: JV
authors.lastname: Starkey
authors.forename: R
authors.initials: R
authors.lastname: Birkenhauer
authors.forename: P
authors.initials: P
authors.lastname: Fletcher
authors.forename: M J
authors.initials: MJ
authors.lastname: Sawyer
mesh_terms: D015390:Gastric Bypass; D009767:Obesity, Morbid / Q000601:surgery*