Laparoscopic Gastric Bypass
Overview
The Gastric Bypass (Roux-en-Y) procedure is the
current gold standard procedure for weight loss surgery.1 It
is one of the most frequently performed weight loss procedures in the United States.
The Roux-en-Y Gastric Bypass is a combined restrictive & malabsorptive
surgical procedure. By adding malabsorption, food is delayed in mixing with bile and pancreatic
juices that aid in the absorption of nutrients.
The result is an early sense of fullness, combined with a sense of satisfaction that reduces
the desire to eat.
Procedure
Briefly, the procedure involves the following
steps:
- Stapling creates a small (15 to 20cc) stomach pouch.
- The remainder of the stomach is not removed, but is completely stapled shut and divided
from the stomach pouch.
- The outlet from this newly formed pouch empties directly into the lower portion of the
jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine
just beyond the duodenum for the purpose of bringing it up and constructing a connection
with the newly formed stomach pouch.
- The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape
that gives the technique its name.
- The length of either segment of the intestine can be increased to produce lower or higher
levels of malabsorption.
Advantages
- The average excess weight loss after the Roux-en-Y
procedure is generally higher in a compliant patient than with purely restrictive procedures.
- One year after surgery, weight loss can average
77% of excess body weight.
- Studies show that after 10 to 14 years, 50-60%
of excess body weight loss has been maintained by some patients.
- A 2000 study of 500 patients showed that 96%
of certain associated health conditions studied (back pain, sleep apnea, high blood pressure,
diabetes and depression) were improved or resolved.
Risks
- Because the duodenum is bypassed, poor absorption
of iron and calcium can result in the lowering of total body iron and a predisposition to
iron deficiency anemia. This is a particular concern for patients who experience chronic
blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk
for osteoporosis that can occur after menopause, should be aware of the potential for heightened
bone calcium loss.
- Bypassing the duodenum has caused metabolic
bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures
of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed
through proper diet and vitamin supplements.
- A chronic anemia due to Vitamin B12 deficiency
may occur. The problem can usually be managed with Vitamin B12 pills or injections.
- A condition known as "dumping syndrome " can
occur as the result of rapid emptying of stomach contents into the small intestine. This
is sometimes triggered when too much sugar or large amounts of food are consumed. While generally
not considered to be a serious risk to your health, the results can be extremely unpleasant
and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating.
Some patients are unable to eat any form of sweets after surgery.
- In some cases, the effectiveness of the procedure
may be reduced if the stomach pouch is stretched and/or if it is initially left larger than
15-30cc.
- The bypassed portion of the stomach, duodenum
and segments of the small intestine cannot be easily visualized using X-ray or endoscopy
if problems such as ulcers, bleeding or malignancy should occur.
