Gastric Bypass Surgery

Types of gastric bypass surgery include:

  • Laparoscopic Roux-en-Y-gastric bypass or Open Gastric Bypass Roux-en-Y
  • Extensive gastric bypass (biliopancreatic diversion)

Laparoscopic Roux-en-Y Gastric Bypass

The gastric bypass procedure for weight loss involves several steps. Initially, the size of the stomach is reduced by dividing it with gastric staples. Doing this creates a small stomach or gastric pouch (called a “gastrojejunostomy”) at the upper part of the stomach. Next the small intestine is divided into two parts – the Roux limb and the biliopancreatic limb. The Roux limb is brought up and connected to the newly created pouch so the pouch can empty food contents into the bowel. The end result of the altered digestive tract is that the lower stomach and part of the small intestine is bypassed. “Roux-en-Y” refers to the Y-shaped appearance of the altered small intestine after the bypass is performed.

Benefits

  1. Post surgery pain reduced, as well as recovery time and time off work compared to an open procedure.
  2. Procedure often described as the “gold standard” for weight loss surgery.
  3. After two years, average weight loss is 70-80% of excess weight.
  4. Hypertension and diabetes are clinically reversed or improved in over 90% of patients
  5. Dumping can occur with foods high in fat and sugar which can help modify eating behavior.
  6. Nearly no risk of incisional hernias after the operation (20% of open operations will have this problem).

Risks

  1. Sometimes leaks can occur from the pouch and from where the intestines are hooked back up together.
  2. Risk of death from surgery is 0.5%
  3. Vitamin and iron deficiencies can occur
  4. With no proper diet and exercise, after 10-15 months, 10-30% of the weight lost can be regained.

Open Gastric Bypass Roux-en-Y

With the Roux-en-Y gastric bypass procedure, traditional surgical methods are utilized rather than the newer, laparoscope-assisted (or minimally invasive surgery) methods, which involve smaller incisions and the use of a camera and video monitor. It is important to understand that newer does not mean better for every patient. The decision for open versus laparoscopic gastric bypass surgery is oftentimes made between the patient and the surgeon after thorough explanation and careful consideration. Each method has its own benefits and risks. Some patients may be offered the open gastric bypass surgery due to a high BMI or because of previous abdominal surgery.

Surgical alterations and results of laparoscopic and open gastric bypass surgery are basically the same, only the access to the inside of the body is different. The stomach size is reduced and the small intestine is divided and re-routed the same in both operations. The result is that the lower stomach and part of the small intestine is bypassed. Roux-en-Y” refers to the Y-shaped appearance of the altered small intestine after the bypass is performed.

Benefits

  1. Often described as the “gold standard” for weight loss surgery.
  2. After two years, average weight loss is documented to be around 70-80% of excess weight.
  3. Hypertension and diabetes are clinically reversed or improved in over 90% of patients.
  4. Dumping can occur with foods high in fat and sugar which can help modify eating behavior

Risks

  1. Leaks can occur in the areas where the surgeon has cut the bowel (3%).
  2. The risk of death from surgery is documented between 0.5 – 1%
  3. Fluid can drain from the incision, known as a seroma. Wound infection is also a possibility.
  4. Vitamin/mineral and iron deficiencies can occur.
  5. Without attention to new eating behaviors and exercise, after 12-18 months, 10-30% of the weight lost can be regained.
  6. Hernia can occur around the incision.

Extensive Gastric Bypass (Biliopancreatic Diversion)

In some cases a bariatric surgeon may suggest an open BPD instead of a laparoscopic procedure for obesity patients. This typically depends on the patient’s BMI and co-morbidities. Additionally, a larger incision might be necessary if a laparoscopic BPD cannot be accomplished using small incisions. BPD or biliopancreatic diversion is also known as the Scopinaro procedure. This is a malabsorptive procedure that involves removal of the lower part of the stomach and attachment of the intestine directly to the stomach. A large portion of the small intestine is re-routed as well. During this operation, a larger part of the stomach is removed than in the BPD-DS procedure, and calorie and nutrient absorption is more dramatically curtailed. Weight loss initially occurs primarily because the patient is eating smaller quantities of food. Long-term weight loss is maintained because all the calories are not fully absorbed. Weight loss is up to 8o% of excess weight lost 10 years after surgery. Although, this weight loss is accompanied by a much greater risk of malnutrition and loose, fatty stools.

Benefits

  1. The procedure offers the max weight loss which can be maintained for the long-term.
  2. Patients typically can eat more normally because the capacity of the stomach is greater than with a gastric bypass surgery.
  3. Dumping syndrome is uncommon with this type of surgery.
  4. In comparison to BPD/DS, pancreatitis is less likely to occur.

Risks

  1. Leaks and infection can come about from where the intestines are re-routed or where part of the stomach is removed.
  2. Sometimes a narrowing can occur where the duodenum is connected to the intestine.
  3. Sometimes a wound infection can occur in the incision which may require further therapy.
  4. Protein malnutrition occurs in around 2-10% of the time which can require hospitalization
  5. Vitamin, calcium and iron deficiencies can also occur.
  6. Some patients experience 5-10 bowel movements initially after the surgery and 3-6 per day for the rest of their lives.
  7. In some cases, a hernia may develop in the incision site that will require more surgery to repair.
  8. The procedure is non-reversible

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