Laparoscopic or Open Roux-en-Y Gastric Bypass
Laparoscopic or Open Roux-en-Y Gastric Bypass surgery provides moderate restriction and a moderate degree of malabsorption to aid in weight loss.
Currently, gastric bypass remains the gold standard by which all other procedures are measured. It is the most frequently performed procedure in the United States.
Laparoscopic or open gastric bypass is a combination of both restriction and malabsorption. This includes fixed restriction by dividing the upper portion of the stomach into a one to two ounce pouch and moderate malabsorption by bypassing less small bowel than BPD. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch. The outlet from the newly formed pouch empties directly into jejunum, thus bypassing caloric absorption. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. It requires close follow-up and lifelong vitamin and protein supplementation.
- The average excess weight loss after the Roux-en-Y procedures is generally higher in a compliant patient than with purely restrictive procedures.
- One year after surgery, weight loss can average 77% of excess body weight.
- Studies show that after 10 to 14 years, 50 - 60% of excess body weight loss has been maintained by some patients.
- A study of 500 patients back in 2000 showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, GERD, diabetes, and depression) were improved or resolved.
- 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 of particular concern for patients who experience chronic blood loss during excessive menstrual flow. Women, already at risk for post-menopausal osteoporosis, should be aware of the potential for heightened bone calcium loss.
- 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.
- A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
- 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.
- In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched as a result of patients failing to follow the nutrition plan by overfilling the pouch.
- 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.