What is Roux-en-Y Gastric Bypass?
The Roux-en-Y Gastric Bypass has been around since the 1960′s, so we know the most about this procedure and it has the longest follow-up. It works primarily by restriction, although it does have some malabsorption.
Restrictive: The stomach is divided to make a small pouch (15-20 cc) which limits how much one can eat or drink during a given period of time.
Malabsorptive: The first 100-150 centimeters of small intestine are rerouted in such a way as to “bypass” food absorption in that portion of intestine. Bile from the liver and enzymes from the pancreas don’t mix with the food to aid digestion until after the first 100-150 centimeters in intestine. There is still usually 15-20 feet of small intestine left below the bypassed intestine, which is where most all medicines, antibiotics, vitamins and minerals are absorbed and is generally unaffected by weight loss surgery. The bypass does affect the absorption of certain vitamins, however, so supplementation is required after surgery. Typically this involves taking an adult multivitamin, calcium, and Vitamin B12. We will discuss this in detail with you at your appointments.
In addition, the gastric bypass works on behavioral modification through dumping syndrome. Dumping syndrome is a constellation of physical symptoms that can occur if a patient with a gastric bypass eats something high in simple sugars (i.e. a cupcake). This can cause symptoms such as nausea, abdominal pain, flushing, diarrhea – you feel horrible! This psychologically will change the way you look at sweet foods, thereby helping patients stay away from foods that got them into trouble in the first place. It can be a valuable tool to help patients stay true to a healthy diet, thereby keeping the weight off long-term. This phenomena is only seen with the gastric bypass procedure. We are big fans of dumping syndrome.
Traditionally, the Roux-en-Y gastric bypass has been done through a large upper midline incision in the abdomen. However, because of our extensive laparoscopic experience, Atlanta Bariatrics performs the same Roux-en-Y gastric bypass procedure using minimally invasive techniques. This means tiny incisions with a laparoscopic approach. Using a laparoscopic approach may decrease the amount of time necessary to stay in the hospital, increase speed of recovery, and decrease the risk of some surgical complications.
Be Aware – some surgeons do not divide (disconnect) the small stomach pouch from the large gastric remnant, thus greatly increasing the chance that the staple line will break down. That means that food will once again go into the large part of the stomach and the patient will regain weight. This requires repeat surgery with associated risks. The expert surgeons at Atlanta Bariatrics agree with other experienced bariatric surgeons who understand the importance of disconnecting the small stomach pouch from the large stomach remnant.
The Roux-en-Y gastric bypass is the most common bariatric surgery procedure performed in the United States. We typically perform the procedure in about 1 hour. Patients will usually stay in the hospital for 1 – 2 days following surgery, and are back to work 1 – 2 weeks following surgery. Gastric bypass surgery has an excellent track record in achieving and maintaining weight. The majority of the weight loss generally occurs over the first 12 months after surgery. Average weight loss is 60-70% of the patient’s excess weight. There have been multiple studies showing the success in maintaining the weight loss, something no diet or exercise plan can show. Even 15 years later, there is still an average of 50-60% excess weight loss. The weight comes off and stays off, allowing for improved health. The health benefits from gastic bypass surgery are profound. Studies show up to 90% resolution of diabetes, 70-80% resolution of high blood pressure and high cholesterol, 85% resolution of sleep apnea, and almost 100% resolution of gastric reflux just to list a few of the benefits. For some health problems like diabetes or gastro-esophageal reflux, gastric bypass surgery is far superior at curing the condition than any of the other bariatric surgery procedures.
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