Procedures: Gastric Bypass

Laparoscopic Bariatric Surgery

Laparoscopic surgery involves making five to six 1/2- inch incisions and performing the operation by observation through a small camera. The laparoscope, which is connected to a video camera, is inserted through one of the small abdominal incisions, giving the surgeon a magnified view of the patient’s internal abdominal space on a television monitor. The entire operation is performed “inside” the abdomen after gas has been inserted to expand the space.

For patients who are not eligible for the laparoscopic method, surgery is done with an “open” incision extending from just below the breastbone to just above the navel. Advantages of the laparoscopic approach include reduced post-operative pain, shorter hospitalization, faster return to work and improved appearance. The recovery time for the laparoscopic procedure also is expected to be shorter, though similar possible complications exist.

Laparoscopic Roux-En-Y Gastric Bypass

The gastric bypass is both a restrictive and a malabsorptive operation. The stomach is divided into a small pouch that holds approximately 2 tablespoonfuls of food. The small intestine is then divided and sewn to the pouch so that food goes from the stomach pouch directly into the small intestine.

Roux en Y (RNY) is a bariatric procedure that staples off a 1-ounce stomach pouch at the upper portion of the stomach. A section of small bowel is then attached to the pouch via a small opening, which simulates the pyloric valve.

RNY evolved from other bariatric surgeries to provide more consistent and successful weight loss. The small upper pouch is completely separated from the distal stomach which is left in place. A "Y" shaped segment of small bowel is attached to the pouch with a narrow opening. This delays the mixing of food and digestive juices from the distal stomach resulting in poorer absorption of calories and nutrients. This both restricts food intake and interferes with absorption resulting in more consistent weight loss. 80% of patients lose at least half their excess weight with the RNY procedure.

The RNY averages a 3-day hospitalization with a return to full activity in 7-10 days. A liquid protein and soft diet is suggested for 3 weeks post op.

Advantages:

1. Excellent weight loss results; near 85-90% of excess weight within 12-18 months after surgery.
2. Allows patients to eat almost normally, with a small probability of feeling nauseous, vomits or a "food stuck" sensation (called dysphagia).
3. Due to the dramatic weight loss, this surgery diminishes the diseases associated with obesity, and may even allow the patient to stop medication.
4. If this surgery is performed laparoscopically, there is significantly less pain and a faster recovery.
5. This procedure usually maintains weight loss for more than 15 years, even if patients eat high-calorie foods.
6. 85% of patients report significant weight loss.

1. Because stomach resections and intestinal connections are performed, the probability of intestinal content leaks is possible in the first few days after the operation. This is called 'fistula' and happens in approximately 1% or 2% of the cases.
2. Longer recovery time in the hospital than other procedures (somtimes around four days), because it is necessary to pay special attention to fistula problems and other potential complications.
3. Requires taking vitamins and calcium supplements permanently after the surgery. In addition, it may require periodic supplements of B12 and iron.
4. The probability of diarrhea after the surgery is from 1% to 3%, but this can be corrected with diet and medicine adjustments. Generally, if this problem appears, it will be within the first 6 months.
5. The patient should visit the doctor three or four times during the first year, with controlled examinations. Then, annual visits are sufficient to watch for possible lack of vitamins or minerals.