Gastric Bypass Surgery (Roux-en Y Gastric Bypass)
Often called the “gold standard” procedure for weight loss surgery by the American Society for Metabolic and Bariatric Surgery (ASMBS) and the National Institutes of Health (NIH), the Roux-en-Y gastric bypass surgery is ideal for patients with a high number of obesity-related conditions, like Type II diabetes, high blood pressure and sleep apnea.
Here is a brief description of the Roux-en-Y Gastric Bypass:
- Six ports between one-fourth inch and one inch (one to three centimeters) each are placed in the upper abdomen.
- The stomach is transected with a stapling device to create a gastric pouch the size of a small egg (the rest of the stomach is "bypassed").
- The intestine is divided approximately 18-inches (30-centimeters) into the small bowel.
- A 40-inch (100-centimeter) Roux limb of small intestine is created.
- A connection between the two portions of the small bowel is then formed.
- One limb of the small intestine is brought up to the stomach to create a connection between the stomach and the small bowel.
Many patients at Fresh Start Bariatrics at Riverside Methodist have selected this surgical option because it provides good quality, sustained weight loss. In fact, the loss of 85 percent of excess weight after one year is not uncommon. Thereafter, there may be a small amount of weight gain, but it usually does not approach the previous weight. Significant weight loss of greater than 50 to 70 percent of excess weight is often sustained over many years and decades.
Because of the change in the anatomy in bypassing the stomach and first part of the small intestine, several vitamin and mineral deficiencies can develop. This potential problem is easily corrected by taking calcium and vitamin supplements. An iron supplement also may be needed, especially for menstruating women. Vitamin and calcium supplements should be continued for life.
Why select the gastric bypass procedure?
- The Roux-en-Y Gastric Bypass is an excellent choice, especially for those patients who are most interested in resolution of many of their obesity-related health problems.
- It offers consistently reliable results. Many studies have confirmed that this operation results in an average loss of 85 percent of excess weight.
- The gastric bypass procedure resolves diabetes and sleep apnea about 80% of the time and high blood pressure and elevated cholesterol about 70% of the time.
- There is minimal risk of obesity recurrence.
- There are minimal risks of long term complications, as long as patients maintain adequate vitamin and mineral supplementation.
Four reasons why this operation works
There are four reasons why a Roux-en-Y Gastric Bypass gives superior results. Each of these is important, but together they provide excellent sustainable weight loss.
Gastric restriction
The size of the functional stomach decreases from a potential volume of approximately two-liters to about the size of a small egg. Because of the decrease in size, it is no longer possible to eat the same volume of food that previously was consumed.
Malabsorbtion
A portion of the small intestine is either physically or functionally no longer available to absorb nutrients, resulting in weight loss.
Reduced hunger
A study recently published in a New England Journal of Medicine suggests there is a hormonal component to this operation. Certain cells found within the wall of the stomach secrete the hunger-stimulating hormone called Ghrelin. This hormone peaks before each meal and stimulates the sense of hunger. After the Roux-en-Y gastric bypass surgery is completed, this hormone no longer spikes, and presumably no longer causes episodes of hunger. This may explain why many patients do not feel the same level of hunger between meals that they previously felt.
Biofeedback
Because of the changes in anatomy, when patients eat carbohydrates beyond what is recommended the excess quickly empties into the small intestine causing a response the surgeons call "dumping syndrome." When this occurs, food quickly empties into the small intestine, requiring it to dilute the food quickly with body fluids instead of allowing the food to be slowly diluted as would a normal sized stomach with a larger reservoir sugar is rapidly absorbed and the insulin level rises. Symptoms felt by the patient in these instances include a very rapid heartbeat, upper abdominal discomfort, sweating and a general sense of impending difficulty. These symptoms do not resolve for at least 25 minutes.
Because of these potential symptoms, patients are more likely to comply with the recommended amounts of food ingestion and learn healthy limits.
Although there have been operations that address some of these components, the Roux-en-Y gastric bypass surgery addresses all four. Because of that, it is a reliable procedure that results in consistent weight loss which is sustainable throughout a patient’s lifetime.
What to expect after surgery
After your surgery, the Fresh Start Bariatrics team will be there to give you extensive nutritional counseling, post-surgery follow-up visits, emotional and relational support along with therapy and long term weight management. Read more about what to expect after surgery here.
Decreasing the risks of gastric bypass surgery
| Possible Risk | Preventive Measure or Solution |
| Weight gain prior to surgery | Low-carbohydrate meal replacement plan prior to surgery |
| A leak from the staple line on the connection between the stomach and small intestine |
During surgery, the staple lines are secured with reinforcing material and the connection between the stomach and small bowel is checked at the end of the operation. Occasionally, this requires an urgent second operation to repair. |
| Deep vein thrombosis: Formation of blood clot in the veins of the legs or pelvis | In the hospital, you will be encouraged to walk soon after surgery and special stockings, leg or foot pumps and blood thinner injections could be used. |
| Anastomotic stricture: A narrowing of the connection between the new gastric pouch and intestine occurs as a result of the healing process | This narrowing is very infrequent but can be dilated through a scope as an outpatient procedure if necessary. |
|
Pulmonary embolism: A blood clot that travels from the legs or pelvis to the heart and lungs |
In the hospital, you will be encouraged to walk soon after surgery and special stockings, leg or foot pumps and blood thinner injections could be used.
If you are at high risk, Dr. Myers may send you to have a removable filter placed in the large vessel that returns blood to the legs so that large clots cannot reach the heart or lungs. |
| Incisional hernia: A defect in the abdominal wall | Surgical repair of defect. This is very rare in laparoscopic surgery. |
| Bowel obstruction: Scar tissue that creates obstruction or intestinal blockage | Surgical removal of scar tissue. |
| Marginal ulcer | Managed with medicines, such as a stomach acid inhibitor and antacids. |
| Mortality | This is a safe operation. The risk of mortality of a gastric bypass operation is less than 1%. Fresh Start Bariatrics has experienced zero mortalities in the surgery program at Riverside Methodist Hospital. |
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