Procedures

Gastric Bypass (Roux-en-Y )



The Roux-en-Y Gastric Bypass is considered the "gold standard" of bariatric surgical procedures, and it is the most commonly performed weight-loss operation in the United States. It has the most proven, long-term results compared with other bariatric procedures, because the effects have been documented for more than 20 years. Roughly 70 percent of American weight-loss surgeons use it as their primary weight loss operation.

The Roux-en-Y Gastric Bypass is a combined restrictive/malabsorptive operation, which restricts both food intake and the amount of calories and nutrients the body absorbs.

During this procedure, the stomach is partitioned with a stapler, creating a small pouch (15mls), and stomach capacity is reduced from the size of a football to the size of an egg. This smaller capacity produces a feeling of fullness with small amounts of food.

Next, the pouch is connected to a Y-shaped section of the small intestine (called the Roux limb), allowing food to bypass the lower stomach and the first two parts of the small intestine. Because of this, food bypasses most of the stomach and duodenum and empties directly into the Roux limb. Most patients do not experience significant malabsorption of food. The ability to consume fluids is not affected, as liquids pass through the pouch very quickly.

The operation can be performed either laparoscopically, through five or six very small incisions in the abdominal wall, or open, through a traditional midline abdominal incision. In general, Dr. Lord prefers the laparoscopic approach because of its many patient benefits, including decreased pain, faster recovery, quicker return to normal activities, and a lower incidence of incision-related problems like infection or hernia.

Advantages:
  • • Weight loss ranges from 60 to 80 percent of excess body weight within two years.
  • • Most co-morbidities such as diabetes, high blood pressure, sleep apnea and high cholesterol improve after the surgery, and some are even cured.
Disadvantages
  • • Roux-en-Y surgery is generally safe, but it can lead to serious and potentially fatal complications. In a gastric bypass, the stomach and intestines are cut and then reconnected using staples and stitches, which have the potential to tear in the first few weeks after surgery. This can lead to peritonitis and bleeding.
  • • Intestinal blockage, due to scar tissue or intestinal twisting, is a possibility.
  • • After two years, some patients regain 10 to 30 pounds of weight they previously lost due to stretching of the pouch and its outlet. This results in return of appetite and loss of fullness.
  • • The Roux-en-Y operation causes food to bypass areas of the small intestine that are responsible for absorbing protein, calcium, and certain vitamins. In addition, less iron is absorbed because of the small size of the new stomach pouch. To avoid nutritional deficiencies, you will need to take daily vitamin and mineral supplements every day for the rest of your life.

Laparoscopic Sleeve Gastrectomy
Gastric sleeve surgery (also known as gastrectomy) is a weight loss procedure that purposely restricts the amount of food that you can eat because you feel full more quickly.

In this procedure, a thin, vertical sleeve of stomach (approximately eight inches long) is created using a stapling device and the rest of the stomach is removed. Food passes through the digestive tract as usual and is fully absorbed into the body.

Patients who have elected this approach have been shown to experience significant weight loss and improvements in their health. Weight loss outcomes are comparable to gastric bypass.

Revisional Surgery
What is Revisional Bariatric Surgery?
In some instances, patients may need another surgery to revise a previous bariatric surgery. This usually occurs for those patients who may have had an outmoded operation performed many years ago. In the past, many patients underwent "stomach stapling," another term for the Vertical Banded Gastroplasty, or VBG.

Although this operation may work for some individuals, a large proportion of VBG patients do not lose as much weight as they would like to, and they may experience unpleasant side effects such as excessive vomiting.

A VBG procedure may be converted to a gastric bypass, and it can be performed open or laparoscopically.

Traditional Revision Surgery
Traditional revision surgery is performed using the Roux-en-Y gastric bypass technique, the “gold standard” of bariatric surgery. It can be performed open or laparoscopically. It is important to understand that any revisional procedure is a very major operation, with risks that are greater than for a primary procedure. Nonetheless, many patients may benefit substantially from a conversion of their VBG.