Roux-en-Y (RYGBP) is currently the most evolved form of gastric bypass surgery. It has become the most commonly performed weight loss surgery in the United States.
The Roux-Y procedure is designed to bypass the majority of the stomach, and is a restrictive procedure. First a portion of the upper stomach is separated and is formed into a small pouch. The pouch is tailored so that it typically holds between five and ten tablespoons. A limb of the small intestine is then connected to the small stomach pouch in order to have food pass through the remaining gastro-intestinal tract. The length of the small intestine which is diverted will alter the intestines ability to absorb and process nutrients. In this way, the procedure incorporates a degree of malabsorption as well.
RYGBP deliberately creates a component of malabsorption, or the impaired absorption of nutrients from food by the intestines. The bypassing of the intestine leaves the body unable to absorb some, but certainly not all, necessary elements as calcium and iron. Although this risk is minimal in most patients, impaired uptake of nutrients may result in osteoporosis and anemia. Therefore, lifelong mineral supplementation is mandatory. The amount of intestine bypassed by RYGBP is not enough to create malabsorption for protein or other macronutrients.
In special circumstances, some surgeons incorporate a greater degree of malabsorption in order to increase the amount of weight-loss by the patient. This modified procedure is sometimes referred to as distal gastric bypass. Distal gastric bypass can induce more severe nutritional complications than the proximal RYGBP, and is only offered to select patients where the benefits outweigh the potential risks.
RYGBP also produces what is referred to as the dumping syndrome. Dumping occurs when undigested food from the stomach fills the lower intestine too quickly after eating. Dumping can create symptoms such as lightheadedness, diarrhea, and heart palpitations can occur after eating foods with high concentrations of sugar. In some cases patients can remain sensitive to sweet foods for their entire lives however most patients lose this sensitivity over time. Patients will control the dumping syndrome by eating smaller food portions and more frequently.
RYGBP is very complex and after surgery, patients may experience a range of behavioral changes. Due to the smaller stomach, most patients are hungry less and feel full much sooner after eating, a condition known as early satiety. Many patients say that they now enjoy healthier foods and that they have lost their previous improper diet habits. The reason for this is that the brain may now be receiving different neural signals produced in the gastrointestinal tract. These new signals combined with alterations of many hormones are a result of the new diet that the patient is forced to adhere to.
Many studies have shown that RYGBP has resulted in long-term weight loss and has improved many obesity-related illnesses. RYGBP may improve or cure hypertension, sleep apnea, arthritis, liver disease, venous stasis disease, bladder incontinence, high cholesterol, sleep apnea and many other disorders associated with morbid obesity.
Laparoscopic Gastric Bypass
Traditionally, the RYGBP procedure created some postoperative complications, most commonly wound infection and hernia. Both of these complications are related to the skin incision used by surgeons. A surgical incision can be considered to as a controlled injury, where the trauma of a surgical incision is directly related to the length of the incision. In patients with significant obesity, larger incisions are required to provide the surgeon with adequate access. In other words, obese patients require larger incisions, which place them at higher risk of wound infection and hernias. Therefore, the laparoscopic approach to RYGBP was developed in order to minimize the complications from the large wounds of open surgery.
Laparoscopic RYGBP is usually performed through several small incisions in the abdomen. These incisions are individually 15 millimeters or less, typically about an eighth of an inch apiece. The abdomen is distended with carbon dioxide, a process known as “pneumoperitoneum,” to provide the surgeon space to manipulate the intestines and stomach with minimal risk of injury. The internal procedure is no different between laparoscopic and open RYGBP, only the abdominal access has changed.
One would predict that the long term weight-loss results of both the laparoscopic and RYGBP procedures should not be any different. This procedure can be very beneficial in terms of reducing trauma and postoperative problems. Laparoscopic RYGBP is not for everyone; candidacy depends on a number of factors, most importantly whether the patient has had previous intra-abdominal surgery.
Although the laparoscopic approach can minimize the postoperative complications that arise from the standard RYGBP, there can be more precautions prior to surgery. Patients with previous bariatric surgery, previous abdominal injuries or an extremely high body mass index may not be recommended to have the laparoscopic procedure. Laparoscopic RYGBP is much more specialized and therefore a patient must seek a surgeon that is specifically trained in the operation.
