Surgical Weight Loss Options
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Roux-en-Y Gastric Bypass Surgery
|Gastric Bypass Surgery|
Detailed information on gastric bypass surgery, including the reasons and preparation for the procedure, how the procedure is performed, after care, an anatomical illustration of the digestive system, and an illustration of a gastric bypass procedure.
Roux en Y Gastric Bypass Surgery (RYGB) is considered the "gold standard" of all bariatric surgical procedures. It is a time-tested operation dating back to the late 1960’s and has shown durable results.
During normal digestion, food moves into the stomach from the esophagus. While in the stomach, the food is broken down by digestive juices in the stomach. This process takes about twenty to thirty minutes, after which the stomach contents move to the first segment of small intestine. Most of the iron and calcium in the foods we eat are absorbed at this time. The remaining segments of the small intestine complete the absorption of almost all calories and nutrients. The remaining food particles that cannot be digested in the small intestines are stored in the large intestine until eliminated.
The Roux-en-Y operation provides both restriction and malabsorption for weight loss as both the stomach and small intestines are reconfigured. First, a "mini stomach" is created by permanently dividing the stomach, creating a pouch that can hold about 2-3 bites of food. The intestine is then cut approximately one and one half feet beyond the stomach and is attached to the pouch to provide an outlet for the food. The pouch gives a sensation of fullness for a longer period of time. Digestive juices are still produced in the lower part of the stomach and are released into the intestines further downstream where they help the food digest. Nutrients and calories can still be absorbed but in a delayed fashion. Bypassing the distal stomach and proximal intestine, furthermore, alters the normal hormonal milieu, promoting weight loss in ways that are still being studied.
Surgeons at CPRMC perform the Roux-en-Y Gastric Bypass Surgery laparoscopically. The "laparoscopic" approach, also known as "minimally invasive" surgery is performed through 5-6 small keyhole incisions in the abdomen. The surgeon uses a camera and several small instruments to perform the surgery. Previous abdominal surgeries are not a contraindication to laparoscopic bariatric surgery. Traditional "open" gastric bypass is rarely performed and only in cases where the laparoscopic approach becomes technically impossible to perform safely.
Sleeve Gastrectomy is a laparoscopic restrictive procedure which removes a large part of the stomach. This procedure is being performed throughout the world and has been very successful in achieving weight loss and resolving/reducing comorbidities, such as diabetes, heart disease, high blood pressure, and many others. There is no "bypass" performed as in the RYGB so there is no malabsorption caused. If the desired weight loss is not achieved by the sleeve gastrectomy a second procedure may be performed to convert this procedure to a RYGB (see next section).
Two-stage Gastric Bypass: Sleeve Gastrectomy & Large Pouch RYGB
In very large or high risk patients, the RYGB may have to be performed in two stages to prevent complications and even death. The two stage operations include either a sleeve gastrectomy or a large pouch gastric bypass followed by another surgery a few months later. These options are usually reserved for patients with very high BMIs or significant medical comorbidities that preclude a safe performance of the gastric bypass. They are both performed laparoscopically, result in a 40-50% excess weight-loss, and are advocated as a bridge to a more definitive operation which can subsequently be done on a ‘healthier’ patient. You doctor may discuss this option with you.
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