Roux-en-y Gastric Bypass
The Roux en-y Gastric Bypass, is considered the “gold standard” of modern obesity surgery. This operation achieves its effects by creating a very small (around 1 ounce) stomach pouch from which the rest of the stomach is permanently divided and separated. The small intestine is cut about 18 inches below the stomach, and is arranged to provide an outlet to the small stomach, while maintaining the flow of digestive juices at the same time. The lower part of the stomach is bypassed, and food enters the second part of the small bowel. The operation works by reducing food intake, and reducing the feeling of hunger. The result is a very early sense of fullness, followed by a very profound sense of satisfaction. Even though the portion size may be small, there is no hunger, and no feeling of having been deprived. Most patients will experience “dumping syndrome” when they eat sweets. “Dumping syndrome” causes the patient to have crampy abdominal pain, feel faint and have diarrhea. A portion of the small bowel is bypassed causing malabsorption, which leads to more weight loss. Patients feel indifferent to even the choicest of foods.
The Gastric Bypass provides an excellent tool for gaining long-term control of weight, without the hunger or craving usually associated with small portions, or with dieting. Weight loss of 80 – 100% of excess body weight is achievable for most patients, and long-term maintenance of weight loss is very successful. It does, however, require adherence to a simple and straightforward behavioral plan.
Here a small stomach pouch is created to restrict food intake. 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), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the absorption of nutrients and thereby reduces the calorie intake.
- “Dumping syndrome“ if sweets and chocolates taken
- Good operation for sweet eaters
- Long track record
- Tend to lose a little more weight than gastric band
- Longer recovery time
- Not reversible
- Staple line leak
- Minor late weight regain 10-20% after 2-5 yrs
- Nutritional/ mineral supplements required
Residual stomach capacity: 30-50 mls
Estimated weight loss: 60-70% EWL over 2 years.
Laparoscopic or Open refers to the “approach” – it is still the RNY gastric bypass.
Laparoscopic Roux-en-y Gastric Bypass
The purpose of this approach is to have the same surgical procedure with as little discomfort to the patient as possible and to also decrease the chances of some complications.
Laparoscopic surgery allows surgeons to “see” into the abdomen using a pencil-thin optical telescope, and to project the picture from the video camera on a TV monitor at the head of the operating table. The surgeon has to develop skills in operating without being able to feel tissue directly, and by learning to determine where instruments are by seeing them on TV.
The benefits of the laparoscopic approach come from the 5-6 very small ¼ to ½ inch incisions which are made. With laparoscopic surgery there is much less pain and very little scarring. Patients are better able to get up and walk within hours after surgery, can breath easier, and move without discomfort. Bowel activity usually is not affected, as it is with an open incision. Most patients find they can return to normal activities within a much shorter time. People experience similar weight loss and less overall complications.
The anatomic visualization is actually better through the scope than in the open operation. The risks of surgery performed laparoscopically are comparable the “open” procedure. To summarize the advantages of the laparoscopic approach: there is less pain, cosmetic improvement, decreased time in the hospital, shorter recuperation, decrease of some possible complications (wound infection, wound hernias, and pulmonary problems), is cost efficient and maintains the same successful results reported around the world with the open bypass procedure.