Roux-en-Y Gastric Bypass

[MsJacquiiC]

Roux-en-Y Gastric Bypass
About the Laproscopic Procedure

The above charicature shows the principles and surgery technique used in the Roux-en-Y Gastric Bypass.

Gastric bypass surgery combines the creation of a small stomach pouch to restrict food intake and construction of bypasses of the duodenum and other segments of the small intestine to cause malabsorption (decreased ability to absorb calories and nutrients from food).

Roux-en-Y gastric bypass (RGB): This operation is the most common gastric bypass surgery performed in the U.S. First, a small stomach pouch is created by stapling part of the stomach together or by vertical banding. This limits how much food you can eat. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum as well as the first portion of the jejunum. This causes reduced calorie and nutrient absorption. This procedure can now be done with a laparoscope (a thin telescope-like instrument for viewing inside the abdomen) in some people. This involves using small incisions and generally has a more rapid recovery time.

Advantages to Gastric Bypass Surgery

• More rapid weight loss following surgery than with purely restrictive methods
• Smaller stomach limits amount of food that can be eaten at any one time
• Intestinal rerouting limits amount of calories absorbed by the body
• Intake of sweets controlled because of Dumping Syndrome
• Resolves and/or improves certain obesity-related health conditions as weight loss occurs

Disadvantages to Gastric Bypass Surgery

• Complex operation, surgery risks include infection, leaks, and blood clots
• Vitamin and mineral deficiencies, can lead to metabolic bone disease and anemia
• May experience ulcers, bowel obstruction, or reflux
• Dumping Syndrome

What To Expect After Surgery

Most people can return to their normal activities within 3 to 5 weeks.

Gastric bypass surgeries may cause dumping syndrome. This occurs when food moves too quickly through the stomach and intestines. It causes nausea, weakness, sweating, faintness, and possibly diarrhea soon after eating. These symptoms are made worse by eating highly refined, high-calorie foods (like sweets). In some cases you may become so weak that you have to lie down until the symptoms pass.

Why It Is Done

Although guidelines vary, surgery is generally considered when your body mass index is 40 or higher or you have a life-threatening or disabling condition related to your weight.

Your doctor may only consider doing gastric bypass surgery if you have not been able to lose weight with other treatments.

The following conditions may also be required or are at least considered:

• You have been obese for at least 5 years.
• You do not have an ongoing problem with alcohol.
• You do not have untreated depression or another major psychiatric disorder.
• You are between 18 and 65 years of age.

All surgeries have risk, and it is important for you and your health professional to discuss your treatment options to decide what is best for your situation.

For many obese or overweight Americans, shedding weight has led them to lifestyle changes, such as a healthier diet and a new exercise regimen.

How Well It Works

Most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months. One study noted that people lost about one-third of their excess weight (the weight above what is considered healthy) in 1 to 4 years. 1 Some of the lost weight may be regained.

The laparoscopic approach showed similar results, with 69% to 82% of excess weight lost over 12 to 54 months.

Risks

Risks common to all surgeries for weight loss include an infection in the incision, a leak from the stomach into the abdominal cavity or where the intestine is connected (resulting in an infection called peritonitis), and a blood clot in the lung (pulmonary embolism). About one-third of all people having surgery for obesity develop gallstones or a nutritional deficiency condition such as anemia or osteoporosis.

Fewer than 3 in 200 (1.5%) people die after surgery for weight loss.

After a Roux-en-Y gastric bypass:

• An iron and vitamin B12 deficiency occurs more than 30% of the time. About 50% of those with an iron deficiency develop anemia.
• The connection between the stomach and the intestines narrows (stomal stenosis) 5% to 15% of the time, leading to nausea and vomiting after eating.
• Ulcers develop 5% to 15% of the time.
• The staples may pull loose.
• Hernia may develop.
• The bypassed stomach may enlarge, resulting in hiccups and bloating.

What To Think About

In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, you may need to work with a dietitian to plan meals, and you may need to take extra vitamin B12 as pills, shots, or nasal spray.

There is also a possibility that you may develop gallstones after gastric bypass. Sometimes the gallbladder is removed as part of the surgery. But if your gallbladder is not removed, then you may need to take medicine to prevent gallstones.

Early studies of the laparoscopic approach to surgery for obesity suggest that it reduces recovery time and postsurgery complications.

Roux-en-Y Gastric Bypass Video:

Body Mass Index BMI A statistical method of figuring out the degree of excess or insufficient weight based on one's height & weight. Though the controversial BMI does not actually measure the percentage of body fat, it is a useful tool to estimate a healthy body weight based on how tall a person is.

Malabsorption Malabsorption is a clinical term: A state arising from abnormality in the digestion and absorption of food nutrients across the gastrointestinal (GI) tract. The digestion or absorption of a single nutrient component may be impaired, as in lactose intolerance due to lactase deficiency. The Roux-en-Y gastric bypass combines the malabsorption and restrictive techniques to achieve major weightloss.

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Laparoscopy Laparoscopic surgery, also called minimally invasive surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions as compared to larger incisions needed in open surgical procedures. Laparoscopic surgery belongs to the broader field of endoscopy. The key element in laparoscopic surgery is the use of a laparoscope: a telescopic rod lens system, that is usually connected to a video camera. Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm Trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system.

Dumping Syndrome Gastric dumping syndrome, or rapid gastric emptying, happens when the lower end of the small intestine, the jejunum, fills too quickly with undigested food from the stomach. "Early" dumping begins during or right after a meal. Symptoms of early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness and fatigue. "Late" dumping happens 1 to 3 hours after eating. Symptoms of late dumping include weakness, sweating, and dizziness. Many people have both types... It is speculated that "early" dumping is associated with difficulty digesting fats while "late" dumping is associated with carbohydrates.

Obesity Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk. CLICK HERE TO OPEN THE JOURNEY BMI CALCULATOR!

Duodenum The first 12 inches of small intestine immediately below the stomach. Bile and pancreatic fluids flow into the duodenum from the liver and pancreas. Ducts from the pancreas and gallbladder bring in bicarbonate to neutralize stomach acid, pancreatic enzymes to further digestion, and bile salts to break up fats. Nutrient absorption begins in the lower duodenum.

Gastric Banding Surgery The adjustable gastric banding is a restrictive surgical procedure during which a silicone band is placed around the stomach, creating a small pouch. The band includes a balloon that is filled with a nontoxic fluid, most commonly a saline solution; periodic adjustments are performed by a healthcare professional who accesses the balloon via a subcutaneous port. Gastric band placement, unlike malabsorptive weight loss surgery (e.g. Roux-en-Y gastric bypass surgery, Biliopancreatic Diversion, and Duodenal Switch), does not cut or remove any part of the digestive system. See WLS Videos for animated surgery technique.

Jejunum The middle part of the small intestine responsible for digestion. It's approximately ten feet in length and is between the duodenum and the ileum.

Pouch Most bariatric surgeries restricts the amount of food a patient can eat by reducing the size of the stomach by gastric banding, stapling or removal. What results is known as the gastric pouch.