A 48-year-old female asked:
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can a gastricbypass reu n y of ten years reverse itself or stop working? 10 years ago i had gastric by pass surgery, i lost weight, however recently i have been following same routine and i have been gaining weight like crazy. i am on an antidepressant,

2 doctor answers
Dr. John Fung
Dr. John Fung answered
38 years experience General Surgery
The : The roux-en-y gastric bypass is the most common and successful type of gastric bypass procedure. The surgeon begins by creating a small pouch by dividing the upper end of the stomach. This restricts the intake of food. Next, a y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), as well as the first portion of the jejunum (the second segment of the small intestine). The procedure creates a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that absorb calories and nutrients. The success of this procedure to achieve significant long term weight loss is shown by an average 70% excess weigh loss within the firs two years after surgery. It is also been shown to be effective in stabilizing or reversing the complications of obesity, including: type 2 diabetes, heart disease, sleep apnea, gastroesophageal reflux, high blood pressure and elevated cholesterol levels. The surgery should be only part of a comprehensive approach to weight control. Careful monitoring pre- and post-operatively should be done in order to prevent nutritional complications after surgery and maintain weight loss. However in about 20% of patients, weight gain after initial weight loss can occur. This may be due to psychological reasons, such as non-adherence to diets, but also from anatomic reasons, such as the gastric pouch enlarging, or the connection between the stomach and the bypass opening enlarging. On rare occasions, a false connection between the two ends of the stomach, called a gastro-gastric fistula, will allow food to bypass the bypassed intestine. If you are gaining weight, you should see a gastroenterologist that follows such patients, or a bariatric surgeon, to assess why this may be occuring. A consult with a nutritionist may also uncover whether inappropriate diet may be contributing. In some cases, revision of the previous surgery may allow for weight loss.
Answered on Oct 3, 2016
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Dr. Marc Bessler
35 years experience General Surgery
There : There are many reasons why some patients will regain weight some years after a gastric bypass. The most common thinking is that the pouch or the stoma (which is the connection between the stomach and intestine) has enlarged. Less commonly the staple line that separates the stomach pouch from the rest of the stomach can break down. There are also behavioral reasons such as not exercising or making poor food choices. A bariatric surgeon is the best person to evaluate the problem and in concert with a nutritionist. Evaluation should start with a visit to the surgeon and nutritionist who will take a food and medical history and then order some testing which should include vitamin and mineral levels as well as an x-ray study such as barium swallow or upper GI series to evaluate the anatomy. An upper endoscopy may also be recommended. There are several options that may be available depending on a particular situation. These options range from diet and exercise, medication, endoscopic treatments and revision surgery.
Answered on Oct 3, 2016
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