Roux-en-Y Gastric Bypass

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Roux-en-Y Gastric Bypass

The Gastric Bypass is the most commonly performed Weight Loss

Surgery procedure in the United States at this time. It has also

been the procedure of choice in our practice since the late 90's,

though we find that the Lap-Band is a promising option as well. The

Gastric Bypass is almost always done laparoscopically in our

practice.

Full Description of The Procedure

During surgery, the surgeon uses a surgical stapling device to

divide the upper stomach and create a tiny stomach " pouch " at the

upper end. This pouch is shaped to be about the size of your thumb,

and will hold 15 ml or less. In other words, the new stomach pouch

is even smaller than a shot glass. This means that 2-3 tiny bites of

food is all a patient can hold, and this restriction on the amount

of food eaten is the main way that the Gastric Bypass promotes

weight loss.

Food leaves this tiny stomach pouch into a segment of small

intestine (the Roux limb) which is brought up from the mid-abdomen

and is surgically attached to the stomach pouch. A key feature of

this small intestine (medical name is " jejunum " ) is that it cannot

handle concentrated calories. If the patient consumes foods that

contains sugar or fat (ice cream or M & M's would be classic " no-

no's " ) this segment of intestine reacts by creating a temporary

illness called dumping syndrome.

Dumping syndrome can be caused after gastric bypass by intake of

simple carbohydrates (sugar, or some starches). Dumping syndrome is

characterized by palpitations (fast heart rate), a clammy feeling,

queasiness and nausea, sometimes vomiting, and sometimes diarrhea.

Usually the patient feels weak, and must lie down for 30-60 minutes.

Dumping syndrome is not dangerous but it feels absolutely horrible.

For best weight loss patients should stay away from sugar and other

carbohydrates - the thought of dumping syndrome seems to help change

habits away from these types of food.

A short Roux limb - almost all of our Gastric Bypass procedures have

a 150 cm Roux limb - this probably enhances dumping syndrome but

does not create a true malabsorptive situation. In the surgeon's

hands, the Gastric Bypass operation always includes a blue dye

pressure test to be sure there is no leak from the stomach pouch or

the anastomosis (hookup) to the Roux limb. The surgeon uses a

slender plastic tube drain near the stomach pouch that is brought

out through one of the skin incisions - this is our " sentry " that

lets us know what is going on in the area of the stomach pouch so

that we can detect a leak very quickly if it occurs (the drain is

almost always removed before the patient leaves the hospital). All

this is done because a leak is a very serious complication, even

though our rate of leaks is far less than 1%.

Some additional operations may be done during the Gastric Bypass

procedure, as outlined on the accessory procedures page.