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Roux-en-Y Gastric Bypass
Surgery Procedure
What is "Gastric Bypass Surgery"?
Gastric Bypass Surgery via the Roux-en-Y is generally
considered to be the best surgical procedure for permanent
weight loss. Weight loss is achieved by reducing the
functional portion of the stomach during a laparoscopic
procedure reducing the stomach to a pouch one ounce or less
in size, and by creating a stoma, a small opening between the
stomach and the intestine. For information about lap
band surgery please follow this link:
The small size of the stomach pouch causes the patient to have a
sensation of fullness after eating only a small portion of food.
The small stoma delays stomach emptying, making the sensation of
fullness last longer. These are called the Restrictive
components of the procedure.
The limb of intestine coming down from the small pouch is called
the Roux limb. The limb of intestine coming down from the
bypassed portion of the stomach can be called the Biliary or
Bypassed limb. The remaining portion of the intestine is called
the Common Channel.
Food
does not pass down the Bypassed limb, only the Roux limb and the
Common Channel. The longer the Bypassed limb, the less the
length of intestine actively working to absorb nutrients from
the food that is eaten. Digestive juices that normally help
absorb nutrients from the food enter the Bypassed limb from the
larger portion of the stomach, the liver, and the pancreas, and
pass down the Bypassed limb to the Common Channel.
These juices
do not mix with the food while it is passing down the Roux limb.
The longer the Roux limb, the longer the portion of intestine
trying to absorb nutrients without the benefit of these
digestive juices. Both of these changes result in less
absorption of nutrients and contribute to weight loss, and are
called the Malabsorptive components of the procedure.
Exactly how the operation is done for an individual patient
depends on their individual anatomy, their general health
status, whatever changes they may have from prior surgeries, and
what they hope to be achieve from the operation. The stomach
compartments can be completely divided from each other or simply
partitioned, the small stomach pouch and the intestinal limbs
may be connected to each other with either staples or sutures, a
small band may be placed around the stomach pouch, and the two
intestinal limbs may be made longer or shorter.
Patients will be on a clear liquid diet for the first few days
immediately following gastric bypass surgery, and then advance
to a pureed diet. These foods will be very soft, so as to pass
through the small, newly formed pouch and stoma. One of the main
issues during this period will be adequate fluid intake, and
dehydration can be a problem for patients recovering from this
surgery. We will ask patients to take in at least 32 ounces of
liquid a day before leaving the Gastric Bypass Surgery Center.
Approximately one month after the gastric bypass surgery the
patients can expect to advance to a transitional diet. They
begin to take more regular table foods, but will often still go
back to eating the pureed foods that they have tolerated well.
They will still be learning how to eat right, including chewing
food carefully, learning to drink most of their liquids between
rather than with meals, and learning that eating the wrong
foods, such as sweets or fatty foods, can make them ill.
Patients experience the most rapid weight loss during this
period. They are often thrilled to see the weight coming off,
sometimes at the rate of 20 pounds a month, but it is not an
easy time. Patients feel the loss of calories taken in, and are
sometimes low in energy. Their small pouch will make them
uncomfortable when they eat too much or too fast. They may have
diarrhea, which can usually be controlled by avoiding certain
foods or by taking medication. They may experience hair loss,
though the hair usually begins to grow back within a few months.
At
6 months after the gastric bypass surgery the patients will
probably be on their long-term maintenance diet, which is more
or less what and how they will eat for the rest of their lives.
The maintenance diet for the most part consists of regular table
foods, but in small portions. Most patients describe their meals
as child sized, and they often do not finish what they are
served. The patients generally become comfortable eating these
small meals, and almost always say the loss of the ability to
enjoy large meals or certain foods is more than compensated for
by being able to successfully control their weight.
Patients may expect to lose approximately 70% of their excess
body weight during the first 2 years following surgery.
Sometimes a weight regain of about 10% is seen between years 2
and 5, perhaps because the small pouch increases several ounces
in size, and perhaps because the patients learn how to take in
extra calories without making themselves sick.
The surgical community involved in gastric bypass surgery is
very concerned about this late 10% or any other weight regain.
There is a national effort underway to keep patients involved in
support groups and in follow-up with their doctors to reinforce
what they had been taught after surgery, and what had worked for
them the first 2 years. Long term success with this operation
requires a team effort of both the patients and their doctors.
Gastric Bypass Surgery patients take in less food and absorb
less of what they take in, making them at risk for developing
nutritional deficiencies. They must also make a life long
commitment to taking vitamin, mineral, and possibly protein
supplements, and may become very ill if they don't. These
supplements will cost about $30.00 a month and can be purchased
almost anywhere.
What To Expect After
Surgery:
When you are
able to move about without too much discomfort, to take in food by mouth,
and can do without pain medication (about 3 days), you are
ready to leave the hospital. At the time of discharge, you will be given
specific instructions indicating what you may and may not do and when to
come back to the office for follow-up. You will need to remain on a liquid
diet after discharge and you will receive additional instructions
regarding your diet from the surgeon.
Several weeks
after you have left the hospital, you will be able to eat regular food in
small quantities. Always remember that a few bites of food will make you
feel full. The following points need to be reemphasized: Listen to your
stomach, not your eyes. Stop eating when you feel full, even if it seems
that you have not eaten enough. One bite too many may cause significant
discomfort. One extra bite may cause you to vomit. You do not need a lot
of food.
Eating After Gastric Bypass
Surgery:
After
about six weeks, it should be relatively easy for you to enjoy a small
meal. Eat only three meals a day. Establish regular mealtimes. Your
diet should consist of solid food, mostly meat, including poultry and
fish, and vegetables, in very small quantities. Take very small bites,
chew all your food well, a nd
eat slowly. A meal should take at least thirty minutes to an hour to
consume. DO NOT drink liquids 30
minutes prior to a meal to 30 minutes after a meal, and no drinking during
the meal. Drinking during the meal will cause a sensation of pressure in
the chest that is uncomfortable and can cause the food to backup.
Take
the time to relax just before, during, and after mealtime. Between meals,
it is advisable to drink five or six glasses of water, coffee, or tea
without sugar or non-carbonated diet drinks to maintain your fluid
intake. Do not drink liquids that are high in calories. Remember, if you
take in extra calories between meals, weight loss will be slower and you
will not achieve the weight you desire.
Exercise After Gastric
Bypass Surgery:
Exercise is important in the recovery from any operation. Walking is one
of the most effective forms of exercise for this purpose. A regular
exercise program is highly recommended. Begin with very short walks
several times a day and gradually increase the distance. Walking also
improves muscle tone while you are losing weight. Do not, at first,
engage in strenuous exercise. For example, do not lift more than ten
pounds at a time. About six weeks after surgery, you should be able to
tolerate all but the most strenuous exercises.
Do not
sit or stand in one place for a long period of time. Light housekeeping
chores may be performed when you feel you are able. Driving a car is
usually permitted one week after surgery. Sexual activities may be
resumed unless otherwise specified.
Most
people are able to return to light work after two weeks and to heavy labor
after six weeks. The time of your return to work will depend upon the
physical demands of your job and the rate of your recovery.
Expected Weight Loss
After Gastric Bypass Surgery:
In the
first year, patients lose, on the average, approximately one hundred
pounds, or two-thirds of their excess weight. By the end of the second
year, the average patient has lost 36% of his or her total body
weight. About 10% of patients fail to experience significant weight loss,
primarily because they persist in consuming high-calorie liquids or soft
foods, such as peanut butter, ice cream and sodas, which readily slide
through the little stomach pouch.
You
will need to return for follow-up visits periodically until your weight
has stabilized. Blood tests may be required to help assess your progress.
Unless you understand all of the problems that can arise from this
surgery, accept the risks, and are willing to cooperate fully in follow-up
and treatment, you should not have this operation.
Surgery by itself will not miraculously cure obesity. Best results are
obtained when patients practice good dietary and exercise habits. Your
cooperation is essential. The surgical procedure was the physical vehicle
you needed to curb overeating.
There are many changes and adjustments to be made with weight
loss. However, the frustrations you may experience will seem
insignificant in comparison to the overwhelming satisfaction produced by
increased self-esteem and a sense of accomplishment.
Cost of Gastric
Bypass Surgery:
Cost of
the lap band surgery can be as little as $12,000. Insurance often
will cover the procedure. Contact our trained staff and find
out if you qualify for this procedure. All information is kept
strictly confidential. The roux en y surgery cost begins at
$25,000 depending on your particular case.
Click here to find out more.
Will
my insurance cover the
surgery?
Many
insurance companies will cover gastric bypass surgery. A partial
list of those companies is included here:
and many
more...
Click here and we will work with your
insurance company even if they denied you the surgery before. GASTRIC BYPASS, ROUX-EN-Y, LAPAROSCOPIC
Surgical Procedures to help
control obesity generally are divided into two categories: malabsorptive
and restrictive.
Malabsorptive Surgical
Procedures: These procedures decrease intestinal absorption by the patient.
Although there are some more radical procedures, the most widely used method is
the Roux-en-Y Gastric Bypass. In this procedure, the surgeon utilizes
staples to construct a proximal gastric pouch with an outlet that is a limb of
the small bowel, thus bypassing most of the stomach and some of the small
intestine.
Complications associated with the
Roux-en-Y Gastric Bypass are:
-
Disruption of the staple line forming
the proximal gastric pouch. (1)
-
Gastrointestinal leaking at the
anastomosis (0.5%-3.9%). (1) (2)
-
Long-term, micronutrient deficiencies,
particularly of B12, Folate and Iron. (15) (16)
-
"Dumping syndrome" a gastrointestinal
distress reaction to sugar intake. (15)
Complications associated with
gastric bypass surgery are often the result of cutting and suturing of the
gastrointestinal tract. Disruption of the staple line used to create the small
proximal pouch in gastric bypass surgery has frequently been cited in literature
(1) as well as leaking and ulceration at site of the anastomosis of the small
bowel.
Another common complication
associated with gastric bypass surgery is the occurrence of long term
micronutrient deficiencies, particularly of vitamin B12, folate, and iron
(15)(16). This vitamin deficiency is commonly treated with oral supplements;
but, sometimes conservative treatment is not effective and long-term
complications may result (4). In addition to vitamin deficiencies gastric bypass
patients commonly react to the ingestion of substances with high sugar content
with gastrointestinal distress. This is referred to in the literature as
"dumping syndrome".
Restrictive Surgical
Procedures: These procedures decrease the amount of solid food a patient is
able to ingest. Common restrictive surgical techniques are:
In the Vertical Banded
Gastro-plasty and Silicone Ring Gastro-plasty, reduction in stomach
size is achieved by using rows of staples to create a small stomach pouch along
the lesser curvature of the stomach. The pouch outlet (stoma) is reinforced with
a marlex band or silicone ring, sometimes placed through a hole in the stomach
created by a circular stapler. Complications associated with the VBG and SRG
include:
-
Operative Complications: leakage
(2.6%) (7), sepsis, pneumonia (5%) (8), deep vein thrombosis (0.1%) (6), (1%)
(7)
-
Disruptions of the staple line over a
period of time leading to weight regain (2.8%) (4), (5.4%) (8), (45%) (9), (48%)
(9)
-
Obstruction/Stenosis of the reinforced
stoma outlet (2%) (8), 4% (11), 10.4% (9), 14%(13)
-
Migration and/or erosion of the
reinforced band or ring (1.6%) (11)
In Gastric Banding, a small upper
pouch and reinforced stoma are created in one step by placing a band or ring
around the upper stomach. This procedure avoids the complications associated
with staple line leakage and disruption, but is believed to have been associated
with a higher rate of pouch enlargement and obstruction (14).
Source: International
Federation for the Surgery of Obesity
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