Description

Roux-en-Y surgery is a relatively minimally invasive procedure - especially when performed using laparoscopic techniques.

In Roux-en-Y surgery, the stomach is divided into two, and a small "pouch", which has the effect of limiting the daily calorie intake to less than 1,000 calories, is formed while at the same time the majority of the stomach is sealed off. At the same time as part of the Roux-en-Y procedure a section of the small intestine is then divided and sewn to the newly created small stomach area. This process limits the body’s ability to absorb calories. This procedure can be performed either as a standard open or traditional surgery, or as a laparoscopic surgery.

What are the advantages of the Roux-en-Y gastric bypass?

Roux-en-Y offers the best balance between achieving weight loss and the potential risk of medical complications. On average, weight loss can average 80% of the excess body weight within one year of surgery.

The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with more restrictive surgical procedures.
Studies show that after 10 years, patients on average have only gained back 13 percent of the lost weight.

A year 2000 study of some 500 patients showed that 96% of a number of associated health conditions (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved by the Roux-en-Y surgery.

The new anatomical arrangement means that ingested food immediately comea into contact with the lining of the upper small intestine. It is believed that this causes the quick release of hormones that result in a feeling of "early satiety," a sense of satisfaction and a loss of hunger that would normally not be experienced for 30 to 60 minutes after the act of eating. Often the sense of "early satiety" is so quick that most gastric bypass patients are not hungry even before they start to eat. Many patients not only lose the physical sensation of hunger but also the mental compulsion to eat and the pre-occupation with food that has such a controlling power over them and has resulted in their problems managing their weight and diet.

Likewise, many gastric bypass patients discover that many foods taste quite differently after the roux-en-y surgery has been performed. Frequently, sweets taste just "too sweet" or "too strong". Some patients may still find sweets or chocolate palatable, but then simply lose the craving or desire for sweets which has so persecuted them previous to the surgery. Coincidentally, patients can often develop a stronger desire for vegetables, and even for foods which they previously actively disliked. Again, these effects are not really understood, but are presumed to be the result of changes in intestinal hormone balances.

What has been called the "Dumping Syndrome" occurs when patients consume excessive amounts of sweet and sugary foods such as milkshakes, chocolate, fudge, etc. Patients may then feel shaky, nervous, sweaty, or dizzy. Some patients also have headaches, painful abdominal cramps, or suffer bowel complaints such as diarrhea. The Dumping Syndrome is not dangerous, but it is uncomfortable, and most patients quickly learn their limits when eating these types of food. Most roux-en-y surgeons believe that the Dumping Syndrome helps reinforce better eating habits in post surgical patients.
Good candidates for this procedure

Someone around 75 pounds overweight with major obesity-related health problem or problems such as type 2 diabetes, heart disease or sleep apnea or someone more than 100 pounds overweight but without any other complications may also be a good candidate for this type of surgery.

How is a laparoscopic procedure performed?

Laparoscopic (minimally invasive) surgery involves making a number (often 5) of very small incisions rather than in open surgery, in which one large incision is made. Once the patient, who has been given general anesthesia, is asleep/unconscious, a harmless gas is introduced into the abdomen to move the organs so that the surgeon can work in a larger space and is able to see more when a tiny camera (the laparoscope of the procedure) is inserted into one incision through a narrow hollow tube (called a trocar).

This micro technique enables the surgeon to view images of the surgery site (the inside of the abdomen) on a video screen. Through other trocars that have been inserted into the remaining small incisions, the surgeons first introduce and then manipulate long narrow surgical instruments that allow performance of exactly the same procedures that take place in traditional single incision open surgeries.

The benefits of this laparoscopic technique is faster recovery after the operation, reduced likelihood of infection and shorter hospital stays. Patients also report faster return to normal activity. Some long-term problems, such as incisional hernias, may also occur less frequently. One disadvantage of laparoscopy is that sometimes, because of difficulty in visualization, the operation must be converted to an open procedure in order to complete the operation safely. Another disadvantage is that the incidence of leakage from the surgical staple lines may be more common in the postoperative period.