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Outline:GastricBypassSurgery

I. Introduction
A. Background(ProvideBackgroundinformationforyourtopic)
1. Hook Everyyear,over40,000peopleturntoalifethreateningsurgery
becauseoftheirdespairoverlosingweightalone.
2. Background
a. Duringthe1960S,medicalprofessionalsbegantonotice
significantweightlossinthosewhohadportionsoftheirstomachs
removedasatreatmentforstomachulcers.(Pritikin)
b. Drs.MasonandItoinitiallydevelopedthisprocedureinthe1960s.
(Mason)
c. TheRYGBPisthemostcommonlyperformedoperationfor
weightlossintheUnitedStates.IntheU.S,approximately140,000
gastricbypassprocedureswillbeperformedin2005,far
outnumberingtheLAPBAND,duodenalswitch,andvertical
bandedgastroplastyprocedures.(Mason)
d. Gastricbypassisoneofthemostcommontypesofbariatric
surgeryintheUnitedStates.(MayoClinicStaff)
e. Bycreatingasmallerstomach,thepersonfeelsfullerfaster,and
sincesomeofthedigestivesystemisskipped,asmalleramountof
caloriesisabsorbedfromthefood.(Pritikin)
f. Youmayneedtomeetcertainmedicalandlifestylerequirements
toqualifyforgastricbypass.Yourdoctorwillperforman
extensivescreeningprocess.Youwillalsoneedtocommitto
makinghealthierlifestyleanddietarychoices.(Kerr)
3. ThesisStatement(Whatareyoutryingtoprove?)
IbelieveGastric
Bypass
isnottherightchoiceafterconsideringthenumerousrisksandpotential
death.
II. Bodyofresearchpaper
A. ThesisSupport#1(Narrowyoursupportto3maincategories)
1. FirstmainideaofcategoryGastricBypasssurgeryisacomplexandrisky
surgerythatproposesmanyrisks.
a. Allsurgeriescarryrisksofcomplications.Somemaybeusual
complicationsforanyinvasiveprocedure,whileothersarerare.
Andsomecanbeserious.Inthecaseofbypasssurgery,these
includeanallergicreactiontotheanesthesia,bloodloss,infection,
andbloodclots.(Kerr)
b. Whilethetypicalgastricbypasspatientwillnothave
complicationsaftersurgery,itisimportantthatyouunderstandrisk
beforeundergoingsurgery.(Hallmark)
c. Further,gastricbypassisamajorsurgery,andassuchitcarries

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significantrisks,suchasbloodclotsandinfections.(Pritikin)
d. Woundinfectionoccursinasmanyas8%ofpatientsafteropen
RYGBPandlateincisionalherniaoccursinasmanyas20%of
patients.(Mason)
e. Whileuncommon,thereareveryseriouscomplicationsthatcan
occurifa
patient
hasareactiontothe
anesthesia
drugs.Most
problemsassociatedwithanesthesiaarerelatedtotheprocessof
intubation
,orinsertingthebreathingtube.
Aspiration
,orbreathing
foodorfluidintothelungs,canbeaproblem,duringsurgery.
Somepatientsalsoexperienceanincreasedheartrateorelevated
bloodpressureduringtheprocess.(Whitlock)
f. Malignanthyperthermia
,areactiontoanesthesiathatcausesthe
patientstemperaturetoriserapidly,islifethreatening.(Whitlock)
g. Somebleedingisexpectedduringsurgery,butbleedingbeyondthe
normalamountcanmakeatransfusionnecessary.Ifbleedingis
severeenoughtocauseacrisis,surgerymaybeterminatedora
significanttransfusionmaybenecessary.(Whitlock)

B. ThesisSupport#2
1. FirstmainideaofcategoryGastricBypassproposesrisksand
complicationsfortherestofoneslife.
a. Peoplewhoundergoextensivebypassesofthenormaldigestive
processrequirenotonlyclosemonitoring,butalsolifelonguseof
specialfoodsandmedications.(Johnson)
b. Peoplewhohavegastricbypasssurgeryareatriskforpouch
stretching.Thestomachgetsbiggerovertime,stretchingbackto
itsoriginalsize.
c. Inordertoachieveasuccessfuloutcome,gastricbypassalso
requiresapermanentlifelongchangeinyourdietandlifestyle.
(Hallmark)
d. Becausegastricbypassaffectshowyourdigestivesystemabsorbs
calories,anemiaandmalnourishmentcanoccurafterthesurgery
andyoumayhavetosupplementyourfoodintakewithminerals
andvitaminslongterm.(Hallmark)
e. Gastricbypasspatientsmayalsobemoresusceptibletogallstones
asaresultofrapidweightloss.(Hallmark)
f. Patientscouldexperiencewhatisknownasdumpingsyndrome.
Thisiswhenagastricbypasspatientconsumesfoodsthatarehigh
insugarandthenexperiencesdiarrhea,nauseaand/orreflux.
(Hallmark)

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g. Gastricbypasssurgeryalsomaycause"dumpingsyndrome,"
wherebystomachcontentsmovetoorapidlythroughthesmall
intestine.(Johnson)
h. Someonewhoundergoesweightlosssurgerymusttake
supplementseverydaytomakeupforthesemissednutrients,and
takespecialcaretointakeenoughcaloriestobeabletoexercise
safely.(Pritikin)

C. ThesisSupport#3
1. FirstmainideaofcategoryGastricBypassisacostlyprocedureandcost
evenmoreafterthesurgery.
a. Thehighaveragecostofgastricbypasssurgery$24,000inthe
UnitedStates,$20,000inCanadaand$17,000inAustraliacanbe
asignificantobstacleforpatientstoovercome.(Livingston)
b. Ofthethreemostpopularbariatricsurgeries(LapBand,sleeve
gastrectomy,gastricbypass),gastricbypassisthemostexpensive.
(OCStaff)
c. Nutritionistappointmentsareoftenoutofpocketornegotiated
beforesurgeryThesecanrangefrom$50USDpervisittoover
$100pervisit.(OCStaff)
d. Nutritionalsupplements.Mostpatientstakevitaminsand
occasionallyproteinshakesfortherestoftheirlives.Quality
vitaminsandsupplementsareanecessarypartofyournewlife.
Thesesupplementscanbe$50/month.(OCStaff)
e. Weightlosssurgeryisexpensive.Typicalcostscanrunfrom
$20,000to$25,000,accordingtotheNationalInstituteofDiabetes
andDigestiveandKidneyDiseases.(Davis)
f. Ifyoudonthavehealthinsurance,youlllikelyhavetopaythe
entirebillyourself.(Davis)
g. Additionalcostsmayinclude:anesthesiologist'sfee,surgical
assistant'sfee,devicefees,consultantfees,followupprocedures.
(Davis)
h. Weightlosssurgeryisbothcomplexandcostly.(Hutcher)
D. Counterargument
1. Datainvolvingnearly60,000bariatricpatientsfromASMBSBariatric
CentersofExcellencedatabaseshowthattheriskofdeathwithinthe30
daysfollowingbariatricsurgeryaverages0.13percent,orapproximately
oneoutof1,000patients.Thisrateisconsiderablylessthanmostother
operations,includinggallbladderandhipreplacementsurgery.(ASMBS)

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2. TheNationalInstitutesofHealthExpertsPanelrecognizethatlongterm
weightloss,orinotherwords,theabilitytomaintainweightloss,is
nearlyimpossibleforthoseaffectedbysevereobesitybyanymeansother
thanmetabolicandbariatricsurgery.(ASMBS)
3. Manysurgeonsprefergastricbypasssurgerybecauseitgenerallyhas
fewercomplicationsthandootherweightlosssurgeries.(MayoClinic
Staff)
4. ThisisthemostcommongastricbypasssurgerydoneintheU.S.Surgeons
candoitthroughasmallcut,whichhasaquickerrecoverytimethanmore
complicatedsurgery.(Robinson)
5. Becauseitbothaffectstheamountoffoodyourstomachcanintakeand
howmanycaloriesyoucanabsorb,itisoneofthemostsuccessful
surgeriesinrespecttotheamountofweightpeoplelose.(Hallmark)

III. Conclusion
A. RestateThesisThoughtherearemanybenefitstogastricbypasssurgery,itisnot
theonlynorsafestoptiontoachieveonesgoalwhenconsideringtherisks
proposedduringandafterthesurgeryandthecosts.
B. TieThesistopicstogether
1. Gastricbypasssurgeryisaverycomplexsurgerythatcarriesmanyrisks
duringoperation.
2. Itcancausemanyheadachesandproblemshortlyandlongafterthe
surgery.
3. Thesurgeryisverycostlyitselfandcausefurthercosts.
C. Concludingthoughts
1. Therearebetterwaystoloseweight.