Gastric
Bypass, Roux en-Y: The Gastric
Bypass, Roux en-Y is considered the "gold
standard" of modern obesity
surgery, the benchmark to which other
operations are compared, for evaluation
of their quality and effectiveness.
This
operation achieves its effects by creating
a very small stomach pouch (thumb-sized,
actually), from which the rest of the
stomach is permanently divided and
separated. The small intestine is cut
about 18 inches below the stomach,
and is re-arranged so as to provide
an outlet to the small stomach, while
maintaining the flow of digestive juices
at the same time. The lower part of
the stomach is bypassed, and food enters
the second part of the small bowel
within about 10 minutes of beginning
the meal. Click
here to view an animation of the procedure.
There
is very little interference with normal
absorption of food - the operation
works by reducing food intake, and
reducing the feeling of hunger. The
result is a very early sense of fullness,
followed by a very profound sense of
satisfaction. Even though the portion
size may be small, there is no hunger,
and no feeling of having been deprived:
when truly satisfied, you feel indifferent
to even the choicest of foods. Patients
continue to enjoy eating - but they
enjoy eating a lot less.
The
Gastric Bypass provides an excellent
tool for gaining long-term control
of weight, without the hunger or craving
usually associated with small portions,
or with dieting. Weight loss of 80
- 100% of excess body weight is achievable
for most patients, and long-term maintenance
of weight loss is very successful,
but does require adherence to a simple
and straightforward behavioral regimen.
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Laparoscopic
Gastric Bypass, Roux en-Y
The
techniques for performing the Gastric
Bypass by laparoscopy, or limited access,
was first performed in 1993. This operation
duplicates the anatomy and physiology
of the standard, open procedure. 
Laparoscopic
surgery first became available around
1990, when small, light-weight, high-resolution
video cameras were developed, allowing
surgeons to "see" into the
abdomen using a pencil-thin optical
telescope, and to project the picture
from the video camera on a TV monitor
at the head of the operating table.
The surgeon must develop skills in
operating by this new method, without
being able to feel tissue directly,
and by learning to determine where
instruments are by seeing them on TV.
The
benefits of the laparoscopic approach
come from the very small incisions
which are necessary, which cause much
less pain, and very little scarring.
Patients are able to get up and walk
within hours after surgery, can breath
easier, and move without discomfort.
Bowel activity usually is not affected,
as it is with an open incision. Most
persons find they can return to normal
activities within 10 –
12 days,
or even sooner.The risks of surgery
performed laparoscopically are
comparable to those the standard operation – when
done by an experienced and skilled laparoscopic
surgeon. Some bariatric surgeons have
been unable to master the techniques
of advanced laparoscopic surgery, and
therefore do not offer this method – or
may even try to claim that it is less
effective – which is not true. With
the Gastric Bypass procedures, using
the laparoscopic technique, results have
been equal to, or better than, those
obtained with the open operation, but
with major reduction of discomfort and
disability, and excellent cosmetic results
as an additional benefit.
Of
500 patients who have undergone laparoscopic
surgery, weight loss averages over
80% of excess body weight, one year
after surgery, and has been maintained
over 80% for over 5 years. Over 95%
of all health problems (comorbidities)
associated with their obesity have
been resolved following surgery. Patients
enjoy a normal-style diet, and are
satisfied to eat smaller portions.
