Laparoscopic Roux-en-Y Gastric Bypass
Why is Gastric Bypass the Most
Popular Weight Loss Operation in the United States?
The Roux-en-Y (pronounced "roo-on-why")
gastric bypass is currently the most commonly performed
weight loss operation in the United States. Roughly
70% of American weight loss surgeons use it as their
primary weight loss operation. It has been around for
over 30 years and has been demonstrated over and over
to provide an excellent balance of weight loss and manageable
side effects. For these reasons, the gastric bypass
is considered by many surgeons and patients alike to
represent the best alternative in weight loss surgery.
operation can be performed either laparoscopically,
through 5 very small incisions in the abdominal wall,
or open, through a traditional midline abdominal incision.
In general, we prefer the laparoscopic approach at Mount
Sinai because of decreased pain, faster recovery, quicker
return to normal activities, and a lower incidence of
incision-related problems like infection or hernia.
In the Roux-en-Y gastric bypass procedure,
a surgical stapler is used to separate the upper portion
of the stomach from the lower portion. The upper portion,
only 1 to 2 tablespoons in size, is referred to as the
"pouch," and is the only part of your stomach
that food enters into. This pouch is then connected
to a limb of small intestine called the "Roux limb."
The alimentary limb is the branch of the "Y"
through which food passes. The biliopancreatic limb
contains the digestive juices (bile and pancreatic juice).
Food finally mixes with the digestive juices in the
"common channel", the part of small intestine
downstream from the Y connection.
How Does the
Gastric Bypass Work?
The gastric bypass operation
help you to lose weight by 4 different mechanisms:
- Restriction: The stomach pouch
is only 15 to 30 mL in size -- that's just 1 or
2 tablespoons! The pouch fills up very quickly after
eating only a small amount of food, and provides
a sensation of fullness. Thus, the small pouch places
a physical restriction on the amount of food you
are able to eat (or want to eat) at one sitting.
- Malabsorption: While not primarily
a malabsorptive operation, the gastric bypass does
decrease absorption of some nutrients. Because of
this, it will be necessary to talk vitamin and mineral
supplements after the operation.
- "Dumping Syndrome"
This occurs if you eat concentrated sweets or carbohydrates
after the operation. While everyone experiences
dumping a little differently, patients may feed
hot and sweaty, cold and clammy, or like they're
going to faint. Dumping syndrome is an intentional
side effect of the operation! It has been called
the "postop police officer" since it strongly
discourages sweet eating. It is important to remember
that most people do not experience dumping on a
regular basis, since they very quickly learn to
avoid the sweet foods that cause it.
- Hormonal Changes: Ghrelin is
a hormone produced by the stomach that causes you
to feel hungry at mealtimes. Some recent research
suggests that gastric bypass may substantially reduce
ghrelin levels, resulting in decreased feelings