Laparoscopic Roux-en-Y Gastric Bypass Surgery
 In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. "Restrictive" refers to a decrease in the size of the stomach so the patient feels full after eating a small amount of food. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.
The Gold Standard of Weight Loss Surgery
According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States.
During the Roux-en-Y procedure, the doctors at L.A. Bariatric Center section off a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the stomach pouch.
The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption. This is done by dividing the small intestine just beyond the duodenum and bringing it up to connect to the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine. This creates the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.
Advantages of Roux-en-Y Gastric Bypass Surgery
- Roux-en-Y procedure provides greater average excess weight loss than with purely restrictive procedures.
- One year after Roux-en-Y surgery, weight loss can average 77% of excess body weight.
- Studies show that after 10 to 14 years, some patients maintain 50-60% of excess body weight loss.
- A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved after the Roux-en-Y procedure.
Risks of Surgery
- Poor absorption of iron and calcium, which can in turn result in the lowering of total body iron and a predisposition to iron deficiency anemia.*
- Potential for heightened bone calcium loss.*
- Metabolic bone disease.*
- Vitamin B12 deficiency leading to chronic anemia.**
- "Dumping syndrome," the rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed.
- In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or initially left larger than 15-30cc.
- 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.
* All of these deficiencies can be managed through proper diet and vitamin supplements.
** This problem can usually be managed with Vitamin B12 pills or injections.
The Myriad Benefits of Laparoscopic (Minimally Invasive) Surgery
For the last decade, laparoscopic procedures have been used in a variety of general surgeries. Many people mistakenly believe that these techniques are still "experimental." In fact, laparoscopy has become the predominant technique in some areas of surgery and has been used for weight loss surgery for several years. Although few bariatric surgeons perform laparoscopic weight loss surgeries, more are offering patients this less invasive surgical option whenever possible.
 When a laparoscopic operation is performed, a small video camera is inserted into the abdomen. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them better visualization and access to key anatomical structures.
The camera and surgical instruments are inserted through small incisions made in the abdominal wall. This approach is considered less invasive because it replaces the need for one long incision to open the abdomen. A recent study shows that patients having had laparoscopic weight loss surgery experience less pain after surgery, resulting in easier breathing and lung function and higher overall oxygen levels. Other realized benefits with laparoscopy have been fewer wound complications such as infection or hernia, and patients returning more quickly to pre-surgical levels of activity.
 Laparoscopic procedures for weight loss surgery employ the same principles as their "open" counterparts and produce similar excess weight loss. Not all patients are candidates for this approach, just as all bariatric surgeons are not trained in the advanced techniques required to perform this less invasive method. The American Society for Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.
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