Gastric Roux-En-Y Bypass
GASTRIC BYPASS – INFORMATION FOR PATIENTS
The Roux-en-Y gastric bypass as a bariatric, or weight loss operation, has been studied for over 50 years. As such, it is often referred to as the “goldstandard”. It is important to understand that this designation is not meant to imply it is the best operation for everyone. Every procedure has its own characteristics; the choice of operation should only be made after a thorough evaluation of your particular health issues and potential health risks by your physicians. It is important that you find a surgeon with the proper qualifications and experience to advise you of all your options. Because of the long history of the gastric bypass, it is often used as a reference point to evaluate other operations and interventions, thus, goldstandard.
The standard gastric bypass is performed using minimally invasive techniques known as laparoscopic surgery. It is performed routinely in less than one or two hours and hospital stay is one or two days. The incisions, typically four or five are a cm or less in size, so recovery is very quick, and pain is minimal. In the proper center, this is a very safe operation.
The procedure consists of making a small gastric pouch and diverting food past the majority of the stomach and a small portion of the small intestine. Nothing is removed, so this operation can be reversed if necessary. How this operation works is still a matter of debate and ongoing research. One would think: “of course, small stomach…will eat less.” But this is not the case. The small gastric pouch is not used for storage, or to slow down the passage of food. To the contrary, food passes more quickly through the intestine and actives specialized cells, L-cells, further along the gut that are important in the regulation of blood glucose and satiety. Hormones produced by these cells act directly on the pancreas, the liver and the brain. Therefore, the gastric bypass is not mechanically restricting or causing malabsorption of food; it works to restore your body’s natural set point through a highly complex system which is still under investigation. It is important to understand that there are many variations of the gastric bypass and that no two surgeons do it in exactly the same way. Modifications that use bands around the pouch, variations in the lengths of the intestinal bypass or eliminating the “Roux” as in the one-anastomosis bypass are being performed with great success. These variations and their rationale are too complex to discuss here; it is better left to your initial and subsequent consultations with your surgeon.
The results of the gastric bypass continue to be very good. In long-term studies, patients who have the gastric bypass live longer and have better quality of life than those who do not. Not only can your weight loss be sustained, but there is a marked improvement on other diseases such as diabetes, sleep apnea, hypertension, elevated cholesterol, fatty liver, infertility and a significant reduction in the risk of cancer.
- Mortality < 0.2%, major complication <5%
- Long-term weight loss maintenance
- Excellent for treatment of diabetes and GERD
- Reversible Digestive issues such as diarrhea, nausea or vomiting are very infrequent
- Higher risk of some vitamin and mineral deficiencies compared to normal patients: B12, D, iron and calcium in particular.
- Higher risk of gallstones
- Higher risk of ulcers if taking NSAID’s or smoking
- Bowel obstruction
- Dumping syndrome (low blood sugar)
- Risk of alcohol dependance because of more rapid absorption
- Increased suicide risk