Laparoscopic Gastric Bypass
At the Hickory Surgical Clinic, the Roux-en-Y gastric bypass procedure is the cornerstone of our surgical weight loss program. Although we offer other surgical options, the gastric bypass continues to be the weight loss procedure most commonly chosen by our patients.
This procedure reduces the size of the stomach into a small pouch that can only hold a small amount of food (about 1-2 ounces). The food travels from this small pouch directly into the intestine, bypassing the great majority of the stomach.
The stomach pouch fills with food rapidly and empties slowly. When the pouch gets full, the brain responds with a feeling of fullness or satiety, even though the person has only consumed a very small amount of food.
The result is that fewer calories are consumed over the course of the day, which in the long run leads to weight loss that can be maintained for life.
History
Many people are surprised to learn that the Roux-en-Y gastric bypass operation is not a "new" procedure. The "Roux-en-Y" technique was first described by Swiss Surgeon César Roux in 1893, for the treatment of complicated ulcer disease. The "Y" refers to the y-shaped connection that is created in the small intestines during this procedure.Roux-en-Y gastric bypass has been performed for the treatment of morbid obesity for more than 30 years. What is relatively new is laparoscopic approach that we perform today. Thanks to constant advancements in surgical technique and equipment, even complex operations like the gastric bypass can be safely performed through tiny incisions.
MInimally Invasive Approach
In our program, gastric bypass operations are nearly always performed with a minimally invasive laparoscopic technique. This means that instead of a large incision, the operation can usually be completed through 4-6 small incisions in the abdomen. Through these incisions, the instruments needed to complete the steps of the operation are inserted. We use a video camera (called a "laparoscope") to view the inside of the abdominal cavity, and surgical staplers to divide the tissues and make the new connections.The advantages of laparoscopic surgery include better cosmetic results, fewer wound-related complications, and a faster recovery with quicker return to work and other activities.
Surgical Technique
There are four major steps to the Roux-en-Y gastric bypass operation:- A small stomach pouch is created by dividing the stomach. This smaller stomach pouch restricts the amount of food that can be eaten before feeling full.
- The small intestine is separated into two sections. The lower section is called the “Roux” limb.
- The Roux limb is attached to the newly created stomach pouch. This allows food to pass directly into the small intestine, where digestion continues.
- The upper portion of the small intestine is re-connected to the lower portion. This step creates a “Y”-shaped connection, where the bile and pancreatic fluids mix with the food to allow complete digestion.
How Does Gastric Bypass Work?
The primary effect of gastric bypass is the so-called "restrictive" effect, meaning that the small stomach pouch limits the number of calories consumed over the course of the day. In the long run this leads to weight loss that can be maintained for life.This operation has other positive effects as well. For example, bypassing the stomach and duodenum has an immediate effect on blood sugar control. Often patients with adult-onset diabetes who undergo gastric bypass are able to quickly reduce or eliminate their blood-sugar medications. Also a hormone called ghrelin (the so-called “hunger hormone” which stimulates the appetite) actually decreases after gastric bypass, a phenomenon which may help explain the reduction in appetite often associated with this operation.
What are the Risks of Gastric Bypass?
There are risks associated with any major surgical procedure, including pain, bleeding, infection, heart or lung complications, blood clots (deep vein thrombosis or pulmonary embolism), injury to adjacent organs, drug reactions, anesthesia complications, and death. Some laparoscopic procedures require conversion to a traditional "open" approach with a larger incision.Some risks that are specific to the gastric bypass procedure include:
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What are the Results of Gastric Bypass?
After the Roux-en-Y gastric bypass operation, patients typically experience rapid and progressive weight loss for the first 12 to 18 months after surgery. Patients may lose up to 50% of their excess weight in the first 6 months, and up to 77% after 18 to 24 months. Patients with higher initial BMI’s tend to lose more weight, while patients with lower initial BMI’s tend to lose a greater percentage of their initial excess weight. After two years, weight loss usually plateaus. Studies have shown that long-term excess weight loss remains up to 60% at 10-14 years after surgery.Sustained weight loss is not the only benefit of weight loss surgery. Numerous studies have shown improvement or complete resolution of many of the co-morbidities that are commonly associated with obesity. For example, people who are morbidly obese often require treatment for high blood pressure, diabetes or sleep apnea associated with obesity. With weight loss after gastric bypass surgery, most of these patients are able to reduce or even eliminate the medicines they require for these conditions. One study of gastric bypass patients found that gastric bypass surgery reduced the total number of serious health problems of participating patients by 96%.
Making a Choice
Is surgery the right choice? If so, which procedure? How does laparoscopic gastric bypass compare to other choices like the laparoscopic adjustable gastric band or the laparoscopic sleeve gastrectomy? Browse our site for more information, or call us with any questions.If you feel that you or someone you love might benefit from weight loss surgery, or if you would like any additional information, please contact us at 828-327-9178. Or click here to see how to get started in our program.
