Gastric Bypass - Roux-En-Y Procedure
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.
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 learn to determine where instruments are by seeing them on TV. The benefits of the laparoscopic approach come from making five to six very small ¼ to ½ inch incisions. 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 breathe easier, and move with minimal 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 post-operative 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.
After surgery, patients must maintain scheduled follow-up visits. Follow-up may require twelve or more visits during the first year and include a review of the patient’s progress and discussion of any concerns or problems that are pertinent at that time. Patients are encouraged to eat a balanced diet and to avoid the problematic eating patterns of their pre-surgery lifestyle. At the appropriate time, patients are encouraged to increase physical activity and exercise, which is very important to weight loss, good health, and improved quality of life.