 Hello, I'm Angela Monroe and I am one of the bariatric coordinators with the Michigan Health Surgical Weight Management Program. When considering bariatric surgery, it's important to understand your surgical options. Listen to one of our bariatric surgeons discuss the Ruin Y gastric bypass option. Next we'll talk about the Ruin Y gastric bypass. What happens with the gastric bypass is the upper part of the stomach here is cut and partitioned and stapled into a small pouch and then part of the small intestine downstream is divided and then reconnected to that pouch. So when somebody with a gastric bypass eats, food's going to come down the esophagus, it's going to go into this pouch here and then it's going to empty into the small intestine and it's not until it joins up with the rest of the digestive juices from the small intestine here that things start to get absorbed. So not only does it limit the volume of calories somebody eats by creating restriction but it also limits the amount of calories that are absorbed. This is the one that a lot of people have thought about when they talk about having their stomach stapled because this has been around for several years. So again this procedure is performed laparoscopically. The average amount of weight loss as far as excess weight loss at three years is about 62%. These surgeries are quite safe and we'll go through the various risks of them all but the gastric bypass does have low rates of complications. These surgeries help change some of the signals to your stomach where we don't necessarily completely grasp all the hormones that are involved in this process but patients will often feel fuller longer, they don't feel the hunger they used to feel beforehand and so a lot of patients with issues like diabetes, they can have improvement in their blood sugars and resolution of their diabetes not strictly because of the weight loss that they have but sometimes some of the changes that happen after these surgeries. As far as the male absorption part, this is something that the body does adjust a little bit to as well because our body does adapt. So as far as how long that lasts, sometimes that can be lifelong, sometimes patients may not notice as much male absorption as time goes on over several years. So as far as the risks and complications, well what we call dehiscence or separation if you will, that's where any of these tissues that we cut, divide, or reconnect can, we have to hope we count on those areas healing together and so if that weren't to happen in those areas separated, well you could have a leakage of either stomach or intestinal contents inside the abdominal cavity and that can make somebody very sick if it happens. So one of the things you'll hear for us after these surgeries is there's a very structured diet that patients follow to help allow things healing okay. There's a risk of forming ulcers after a gastric bypass and this can happen at the connection between the stomach and the small intestine. There's also something called dumping syndrome which is sometimes seen in patients with a gastric bypass. I mentioned the male absorption component of the surgery, well that can sometimes lead to vitamin or mineral deficiencies. Things like B12, calcium, iron, these things can sometimes become deficient in patients after a gastric bypass because of the male absorption component. And also because the way the surgery is conducted, when we divide the stomach and create this pouch, we no longer have typical access to the old part of the stomach or this very first part of the small intestine if we were to do what's called an upper endoscopy because that pathway has now been averted. It may be difficult to detect if somebody were to have an ulcer in that old part of the stomach and develop bleeding from that. So these are some things that patients have to understand and realize. If somebody has developed a cancer in the stomach we may not be able to detect that through normal means because of change in the pathway or the highway if you will that we create. Sometimes patients can experience increased gas or flatulence after surgery. Part of this again speaks to the male absorption part of the surgery where whatever your body doesn't absorb in the small intestine empties into the colon and there's millions upon millions of bacteria in the colon that make use of that extra nutrition and sometimes a byproduct of that can be increased gas. So I mentioned about dumping syndrome earlier, this is kind of a diagram that displays that. So again some people consider it a complication, others use it as a reinforcement partly because they recognize that okay there was a something that had a lot of carbohydrates that I made me feel pretty miserable and so I don't want to do that again so they can tend to avoid those things. If you would like to learn about other surgical weight management options watch the videos on sleeve gastrectomy and adjustable gastric banding.