Laparoscopic Roux-en-Y gastric bypass

With the Surgical Obesity Service, the Roux-en-Y gastric bypass procedure is usually performed laparoscopically (i.e. keyhole surgery with a telescope); however in some cases it may be necessary to perform an open procedure. This type of bypass operation has proven to be an effective, consistent way of losing weight and keeping it off.

In this gastric bypass operation, the stomach is completely divided with a stapler to leave a pouch that initially measures only 25mls. The small bowel is divided and the divided end brought up and joined to the small stomach pouch. The other small bowel end is joined back on to the small bowel about a metre down from the stomach. Thus the whole stomach is bypassed apart from a tiny pouch. This operation works in two ways:

  1. The small pouch creates a sense of fullness early so that only a small amount of food can be taken in at any sitting.
  2. When undigested high fat or high sugar food passes into the small bowel, it causes significant symptoms ( nausea, sweaty, clammy and dizzy feelings called dumping), putting people off eating the wrong sort of foods.

When performed laparoscopically, most patients stay in hospital 3 nights and are back at work in two weeks.

Laparoscopic Roux-en-Y gastric bypass

Advantages:

Effective weight loss operation in most patients (although where patients end up is always dependent on how they use the tool they are given)

  • More rapid weight loss than banding
  • Dumping offers a useful deterrent to eating high calorie food and drinks
  • Long track record- the operation has been around in various forms for 30 years
  • There is nothing to break or erode

Disadvantages:

This procedure has a slightly higher serious complication rate than some of the other operations (i.e. gastric banding) because of the bowel joins. There is a need to take oral supplements of iron, vitamins and calcium for life, and some patients also need Vitamin B12 injections. Recovery time slightly longer than after banding.

Residual stomach capacity: 30-50mls

Estimated weight loss: 60-70% EWL over 2 years.

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