Weight Loss Procedures
Laparoscopic Roux-En-Y Gastric Bypass
WHAT IS THE ROUX-EN-Y GASTRIC BYPASS?
The ROUX-EN-Y GASTRIC BYPASS procedure has been performed for 3 decades in the United States and is still one of the most popular primary weightloss procedures in that country. It is often performed in Australia as a primary weightloss procedure in patients who are diabetic, patients who have severe gastro-oesophageal reflux, and in patients who are super obese(BMI>50). It is also commonly performed as a revisional or second procedure on patients who have been unsuccessful with GASTRIC BANDING or SLEEVE GASTRECTOMY.
During ROUX-EN-Y GASTRIC BYPASS a small stomach pouch (residual stomach capacity of 30-50mls) is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). Food and nutrients therefore do not pass through the first 150-200cm of the intestine. This bypass reduces the absorption of food and nutrients from the first 150-200cm of the intestine, thereby reducing the calorie intake. Ultimately food reaches to distal part of the small intestine faster, thereby causing the release of certain hormones from the cells in this part of the intestine, which then act to feedback to the brain and stomach causing reduced hunger and emptying of the stomach.
HOW MUCH WEIGHT WILL I LOSE WITH THE GASTRIC BYPASS?
The laparoscopic gastric bypass operation is arguably the gold standard weight loss operation with an estimated weight loss of 70-80% EWL (excess weight loss) over 2 years.
WHAT IS THE ADVANTAGE OF THE ROUX-EN-Y GASTRIC BYPASS PROCEDURE?
The Roux-en-Y Gastric Bypass is the preferred weight loss procedure by many surgeons for patients who have Type 2 Diabetes, severe gastro-oesophageal reflux or Barrett's oesophagitis, or super obesity (BMI>50). It is also preferred by many surgeons as the revisional procedure of choice for patients who have a failed Gastric Band, or complications following Sleeve Gastrectomy such as severe gastro-oesophageal reflux or weight regain.
HOW LONG WILL I STAY IN HOSPITAL FOLLOWING THE GASTRIC BYPfASS?
Patients hospital stay following the procedure is 4 days.
ADVANTAGES OF THE ROUX-EN-Y GASTRIC BYPASS OVER THE GASTRIC SLEEVE AND GASTRIC BAND.
- Tend to lose a little more weight than GASTRIC BANDING and SLEEVE GASTRECTOMY
- Long track record with proven long term weight loss
- Good operation for sweet eaters
- Better weight loss procedure for patients with severe gastro-oesophageal reflux disease or Barrett's osophagitis
- May be better than Sleeve Gastrectomy in causing remission of Type 2 Diabetes in the long term
DISADVANTAGES OF THE ROUX-EN-Y GASTRIC BYPASS
- Not recommended in smokers due to the risk of Stomal Ulcer formation at the join between the stomach and intestine
- Not recommended in patients with Crohn's disease.
- Not recommended in patients taking Immunosuppression medication, eg following Liver or Kidney Transplant.
- Technically more difficult. The ROUX-EN-Y GASTRIC BYPASS is a more complicated procedure and is technically more difficult to perform than GASTRIC BANDING and SLEEVE GASTRECTOMY.
- Higher risk of complications, such as staple line leak, bleeding, dumping syndrome, internal hernias, and vitamin and nutritional deficiencies. It potentially has a greater peri-operative and long term risk profile than GASTRIC BANDING and SLEEVE GASTRECTOMY.
- Nutritional/ mineral supplements required indefinately in all patients following surgery.
- Dumping Syndrome. This is common after Gastric Bypass and occurs in patients if they consume any rich or sweet liquids or sweet solid food. This may beneficial for patients as it deters them from consuming these types of liquids or foods. It is an unpleasant sensation of sweating, shakiness, light headedness, weakness, palpitations, abdominal cramps, and diarhoea, and occurs minutes to hours after eating. Sometimes these symptoms are so severe that they may cause convulsions or fainting. The Roux-en-Y Gastric Bypass may rarely need to be reversed in severe cases of Dumping syndrome.
- Minor late weight regain 10-20% after 2-5 years