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Roux-en-Y gastric bypass is a combined restrictive and malabsorptive procedure, meaning that it not only decreases food intake but also alters digestion. These procedures are performed both as open surgery and hand-assisted laproscopic surgery. At Good Samaritan Hospital, all Roux-en-Y gastric bypass surgeries are performed using a hand-assisted laparoscopic approach unless open surgery is medically necessary.
In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.
According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States.
In this procedure, stapling creates a small (15 to 20 cc) 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, thus bypassing calorie absorption. 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.
View an animation that details Roux-en-Y gastric bypass.
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Advantages and Disadvantages
There are advantages and disadvantages associated with Roux-en-Y gastric bypass:
Advantages |
Disadvantages |
Average excess weight loss is generally higher in a compliant patient than with purely restrictive procedures. |
Requires cutting and stapling of the stomach. |
Minimally invasive approach is possible. |
Because a portion of the digestive tract is bypassed, absorption of essential nutrients, primarily vitamin B12, iron, and calcium, is reduced, which could cause medical deficiencies. These deficiencies, however, can be managed through proper diet and vitamin supplements. |
Has been performed longer than laparoscopic adjustable gastric banding. |
Is non-adjustable and extremely difficult to reverse. |
Procedure has higher total average weight loss than with laparoscopic adjustable gastric banding. |
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. |
About Hand-Assisted Laparoscopic Surgery
Your gastric bypass procedure may be performed using a technique called hand-assisted laparoscopy.
For the last decade, laparoscopic procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still “experimental.” In fact, laparoscopy has become the predominant technique in some areas of surgery and has been used for weight loss surgery for several years.
When a laparoscopic operation is performed, a small video camera and surgical instruments are inserted into the abdomen through small incisions. Since the operating field is not visible, the surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them better visualization and access to key anatomical structures. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen.
Hand-assisted laparoscopy builds on this approach, allowing the surgeon to insert his hand through a small incision via a special pressurized sleeve. The hand is used to aid in sensory perception and to guide the surgical instruments he manipulates with his other hand. With both a hand and laparoscopic instruments doing the work, the surgeon has more control over the operation. He also gains a sense of depth and a sensation of touch that is not attainable in traditional laparoscopy.
Hand-assisted laparoscopic procedures for weight loss surgery employ the same principles as their “open” counterparts and produce similar excess weight loss. A recent study shows that patients having had laparoscopic weight loss surgery also experience less pain after surgery, resulting in easier breathing and lung function and higher overall oxygen levels. Other realized benefits with hand-assisted laparoscopy have been fewer wound complications such as infection or hernia, and patients returning more quickly to pre-surgical levels of activity.
All bariatric surgeons are not trained in the advanced techniques required to perform this less invasive method. Although few bariatric surgeons perform hand-assisted laparoscopic weight loss surgeries, more are offering patients this less invasive surgical option whenever possible. The American Society for Bariatric Surgery recommends that hand-assisted laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open weight loss procedures, such as Dr. Kerlakian.
Learn more about:
Sleeve Gastrectomy
Laparoscopic Adjustable Gastric Banding (Lap-Band®)
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