Gastric Bypass 2017-07-08T16:12:38+00:00

Gastric Bypass

Overview

In the gastric bypass procedure – which is more specifically called the Roux-en-Y bypass – 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 (part of the small intestines), thus bypassing some of the intestines that take care of 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.

The Operation

In the Roux-en-Y gastric bypass procedure, 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 (part of the small intestines) 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.

 

What are the advantages?

1. The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.

2. One year after surgery, weight loss can average 60-70% of excess body weight.

3. Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.

4. Gastric bypass can be particularly beneficial for patients with type 2 diabetes. According to the American Society for Metabolic and Bariatric Surgery, gastric bypass surgery improves diabetes in nearly 95% of patients, including remission of type 2 diabetes in 80% of patients.

5. We have more data on gastric bypass than any other bariatric operation, because of the length of time this procedure has been performed.

What are the risks?

  1. 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.
  2. 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.
  3. A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
  4. 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.
  5. 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.

Questions about the gastric bypass?

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