ROUX-Y GASTRIC BYPASS

 

 

            This bariatric (weight-loss) procedure (gastric bypass) was first developed in the 1960’s by Drs. Mason and Ito (based on weight loss observed after gastrectomy for ulcer disease).  The procedure has been modified since then to create a smaller gastric (stomach) pouch and a Roux-Y reconstruction (referring to the way the intestine is reconnected to the stomach pouch) to prevent reflux of bile into the pouch.  Weight loss after this operation is rapid and quite predictable, with most of the excess weight lost in the first 6 months and the rest up to 18 months after surgery, at which time weight stabilizes at a new level.  The average percentage excess body weight loss (%EWL) after two years is 60-70% (excess weight is one’s own weight minus one’s ideal body weight, found in a Metropolitan Life Insurance Table).  Maintenance of at least 50% EWL five years after gastric bypass occurs in about 85% of patients. (Fig. 1 shows my results compared to combined results of all Center of Excellence programs)    

 

            The operation works by restricting how much a person can eat at one time (portion size) and by decreasing appetite or inducing early satiety (fullness).  A small gastric pouch is created which holds only 3-4 ounces of food, and an intestinal bypass is created which alters certain gastrointestinal hormone levels creating signals to the brain (hypothalamic appetite control and” pleasure” centers) to decrease appetite, increase metabolism of fat, and provide a greater sense of well-being.  Roux-Y gastric bypass leads to such significant alterations in these gut hormone levels, insulin sensitivity, and glucose serum levels that type II diabetes can be completely resolved or remitted (off all medication) in 84% of patients very quickly.  Hypercholesterolemia, hyperlipidemia, and dyslipidemia are significantly improved, or completely resolved or remitted in 97% of patients; hypertension (high blood pressure) completely resolved or remitted in 62% (up to 80% improved).  In addition, 85.7% of patients with obstructive sleep apnea can become asymptomatic and off CPAP or BIPAP, and over 90% of patients resolve symptoms of reflux or GERD.  These data come from metaanalysis of data from multiple studies of patients after gastric bypass with long term follow-up (greater than 5 years).

 

            There can, of course, be complications associated with this procedure, both short and long term, but the risks are relatively small compared to the benefit to be gained.  (Figure 2 shows the percentages of various complications occurring in my patients as compared to percentages from national Centers of Excellence).  The following are long term issues related to the Roux-Y gastric bypass, not seen with purely restrictive procedures:

 

            *Anemia (related to iron, vit. B12, or folate deficiency), Osteoporosis (thin bones related to calcium and

              vit. D deficiencies), and vitamin (especially B) deficiencies can occur and require lifetime commitment 

              to daily (or twice daily) multivitamin, calcium citrate (1200-1500 mg.) with vit. D, vitamin B12, and

              sometimes iron supplementation.

            *The lower stomach pouch, duodenum and upper jejunum cannot be visualized using x-ray or

              endoscopy.

            *The “dumping syndrome” can occur after eating foods with high sugar or fat content leading   

              to nausea, vomiting, sweating, faintness, shaking, fast heart rate, diarrhea, and cramps.

            *Ulcers can occur in the pouch and at the opening of the pouch into the intestine more commonly than

              can occur in the normal stomach and may require long term use of Proton-Pump Inhibitors (acid

              blockers).

 

            The Roux-Y gastric bypass is the gold-standard operation for weight loss and correction of health issues related to obesity, especially type II diabetes, leading to long-term improvement in health, longevity, and quality-of-life.  It is usually preferable to restrictive bariatric procedures for patients with BMI’s > 55, especially in the presence of type II diabetes.  As noted previously, I perform all bariatric procedures laparoscopically, and many Roux-Y gastric bypass procedures using the da Vinci robot (link to “Laparoscopic Approach” and “da Vinci Robotic Approach”).  Other questions regarding the Roux-Y gastric bypass can be answered by attending a free information session.

 

 

       

                           

                            Fig. 1 (Our or my data based on 500 patients)

 

 

 

 

                           

                             Fig. 2