Gastric bypass in morbid obesity.

Gastric operations for the treatment of morbid obesity have been standardized. They require close adherence to specifications for success. The upper stomach volume should be measured intraoperatively and fashioned to a capacity of 50 ml at a pressure of 25 to 30 cm of saline. The outlet should be no larger than 12 mm in diameter. The necessity for bypassing the remainder of the stomach and duodenum has not been established. Early maintenance of gastric decompression and immediate supervision and education of patients regarding new eating habits are crucial in the prevention of gastric rupture. Long-term care is usually minimal, but patients should be followed at least at 6 weeks, 6 months, 1 year, and at yearly intervals thereafter. Increasing numbers of intestinal bypass operations are being replaced by gastric bypass or gastroplasty. Many surgeons who once used intestinal bypass have decided to use the stomach operations instead because of the much less complicated long-term care required after the gastric procedures.