What is Laparoscopic Gastric Bypass Roux-en-Y? How the Gastric Bypass Roux-en-Y is performed Advantages of Gastric Bypass Roux-en-Y Risks and Concerns of Gastric Bypass Roux-en-Y Laparoscopic (Minimally Invasive) Surgery The Benefits of Laparoscopic Surgery include Make sure you visit the Overview of Surgical Procedures

Laparoscopic Gastric Bypass Roux-en-Y
(This is one of the procedures offered by Dr. Fermelia.) This is done laparoscopically (small incisions and TV cameras and is considered "minimally invasive"Surgery.  Read about laparoscopic surgery below

According to the American Society for Bariatric Surgery and the National Institutes of Health, Gastric Bypass Roux-en-Y is the current “gold standard” procedure for weight loss surgery. Gastric Bypass Roux-en-Y is a tried and true operation to which all other weight loss procedures should be compared. It is one of the most frequently performed weight loss procedures in the United States. Gastric Bypass Roux-en-Y is considered by most weight loss surgeons including Dr. Fermelia, to be the preferred surgical procedure for the treatment of Morbid Obesity in most patients.

How the RYGB is performed

We create a small (15 to 20cc – 4 to 6 ounces) upper stomach pouch with a laparoscopic stapling device, which divides the stomach and seals both sides with three rows of tiny staples. The remainder of the stomach is not removed, but is stapled shut and divided from the upper stomach pouch. The newly formed lower larger stomach pouch is bypassed. The lower large stomach empties, as it always has, into the duodenum (the first part of the small intestine) and drains with the other digestive juices to mix with the food downstream. The small intestine is divided for the purpose of constructing a connection with the newly formed upper small stomach pouch. The other end is connected into the side of the enzymatic limb of the intestine creating the "Y" shape that gives the technique its name.

The Gastric Bypass Roux-en-Y operation can be divided into these steps:

• Creation of a small upper stomach pouch, leaving lower part of stomach in place.
  
  
• Creation of a Y-connection in the small bowel
  
  • One end is connected to the new smaller stomach pouch.
    
    
• One end of the Y provides a limited small bowel bypass of the lower part of the stomach and first part of the small intestine

Advantages of Gastric Bypass Roux-en-Y

• Gastric Bypass is laparoscopically.
  • Recovery time is short: typically 2 to 3 days in the hospital, and depending on individual factors, 10 -14 days to return to full activity
    
    
• Weight loss is excellent early on and in the long term:
  • Predictable Weight Loss. Patients commonly lose 60 % of the excess body weight in the first six months,and average 70% of excess body weight after one year, and maintain at 60% for years following surgery. Long term average weight loss with the Sleeve (estimated 50 to 55%), approaching the RYGB (estimated 55 to 65%), yet better than the Gastric Band (40 to 50%). Weight loss with the Sleeve and the RYGB is much more predictable than gastric bands. ⁷ Weight loss is more variable with the gastric bands.
    
    
• Rate of Weight Loss. The rate of weight loss with the RYGB (and the Sleeve to a degree) is relatively faster, where the weight loss with gastric banding is most often long and slow. Metabolic rates after Gastric Bypass Roux-en-Y remain higher in comparison to other gastric restrictive procedures, which combats the natural slowing of metabolic rates that occur with decreased calorie intake. This compounds early weight loss in Gastric Bypass Roux-en-Y.
  
  
• Metabolic Problems. Although patients have to be compliant on certain principles, the chances of severe metabolic complications are low, Gastric Bypass Roux-en-Y has a better long term risk profile compared to malabsorptive procedures.
  
  
• Diabetes type II. Patients with diabetes are advised that the best procedure for them is RYGB, due to the known metabolic / hormonal changes that occur with bypassing the first part of the small intestine. Diabetes has been proven to get better with the weight loss and calorie restriction. Weight loss related improvement to diabetes is achieved with the Sleeve and the gastric band, however there are definite advantages to the RYGB in the remission of diabetes type II.
  
  
• Proven. It is a proven, well-studied procedure. Many surgeons refer to Gastric Bypass Roux en Y to be the gold standard by which to measure other procedures. It is a very safe procedure that provides a very nice risk to benefit ratio.
  
  
• Resolution of comorbidities. Improvement in obesity related comorbidities is proven in this procedure.
  
  
• No mechanical device to fail. Sleeve resection does not use an implantable device, such as Gastric Banding, which may be unacceptable for some patients. Gastric Bands can be plagued by short and long term mechanical complications (such as slip and erosion). Reoperation is much more common in Gastric Banding compared to RYGB.
  
  
• No gastric band fills. Fills are expensive, inconvenient and variable.

Risks and Concerns of Gastric Bypass Roux-en-Y

• Marginal Ulcers. The gastric bypass may lead to have peptic ulcers at the connection of the small stomach to the small intestine. This is called a marginal ulcer. The propensity of RYGB for ulcer is why we strongly recommend that gastric bypass patients DO NOT USE TOBACCO in any form for the rest of your life. Gastric bypass patients have to stay away from NSAIDS (Non Steroidal Anti Inflammatory Drugs) and steroids for the rest of their lives because of the risk of ulcer. Marginal ulcers are difficult to heal, can cause a lot of pain, can cause bleeding or a stricture (narrowing) of the pouch. Marginal ulcers can also perforate and have to be surgically repaired.
  
  
• Vitamins. Because the lower stomach and duodenum is where some vitamins such as Calcium, Iron, and vitamin B12 are absorbed, patient need to take appropriate vitamins and supplements. Proper vitamin supplementation and follow-up after this operation will avoid such concerns. Such concerns are greater with malabsorptive procedures and less with purely gastric restrictive procedures.
  
  
• Metabolic problems such as protein malnutrition and dehydration are greater with malabsorptive procedures and less with purely gastric restrictive procedures as compared to the Gastric Bypass Roux-en-Y. Protein malnutrition is extremely uncommon with Gastric Bypass.
  
  
• Dumping syndrome. A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or concentrated fats (especially in liquid or mushy form) are consumed. While generally not considered to be a serious risk to health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery. Because it can help patients avoid caloric food that may promote weight gain, we consider dumping to be a benefit of Gastric Bypass Roux-en-Y.
  
  
• Endoscopy / xray limitation of the bypassed GI tract. The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.
  
  
• Reversability. The gastric bypass is conceptually reversable, but revision is risky and difficult. You should assume that the Gastric bypass is not reversable.

Choosing Minimally Invasive Laparoscopic Surgery

If a shorter hospital stay, reduced discomfort and disability, and superior cosmetic results are important to your decision, the choice of Laparoscopic Gastric Bypass Roux-en-Y, Laparoscopic Gastric Sleeve Resection, or Laparoscopic Gastric Band are choices you should consider.

Laparoscopic (Minimally Invasive) Surgery

Laparoscopic surgery is a type of intra-abdominal surgery that uses tiny incisions and TV cameras to accomplish complex abdominal surgeries. It is called “minimally invasive” because of the small incisions. One of the obvious benefits of laparoscopic surgery compared to “open” or conventional surgery is that with smaller incisions, the recovery is faster and overall less painful.

For the last ten years or so, laparoscopic procedures have been used in a variety of abdominal surgeries. Laparoscopy has become the predominant technique in some areas of surgery and has been used for weight loss surgery for over a decade. Although many weight loss surgeons perform laparoscopic weight loss surgeries, not all surgeons offer the procedures laparoscopically. Dr. Fermelia, is pleased to offer most weight loss surgery patients a laparoscopic procedure. The American Society for Bariatric Surgery recommends that only surgeons who are experienced in both laparoscopic and open weight loss procedures should perform laparoscopic weight loss surgery. Dr. Fermelia, is experienced at the open procedure. During your initial consultation, Dr. Fermelia can tell you if you are a candidate for the laparoscopic procedures.

During a laparoscopic operation, the abdomen is gently inflated with carbon dioxide, which gives the surgeon a working space in the abdomen. A small video camera and the surgical instruments are inserted through small incisions made in the abdominal wall. The surgeon views the procedure on a video monitor. We believe that this technique actually provides better view than open surgery because of the magnification and the additional angles of view that are achieved by the camera. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen.

The Benefits of Laparoscopic Surgery include:

• Small incisions
• Substantially fewer hernias in the incision(s)
• Less pain and discomfort
• Less pain medication is needed
• Better mobility after the surgery
• Better ability to breathe after the surgery
• Reduced physiological stress on the body
• Shorter Hospital Recovery Time
• Quicker return to work and pre-surgical levels of activity

Make sure you visit the Overview of Surgical Procedures

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