Combined Restrictive & Malabsorptive Procedure

Gastric Bypass Roux-en-Y

According to the American Society for Bariatric Surgery and the NIH, Roux-en-Y gastric bypass, commonly known as gastric bypass surgery, 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. In this procedure, stapling creates a small (15cc to 20cc) stomach pouch. The remainder of the stomach is not removed, but it 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 for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine, creating 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

The average excess weight loss after gastric bypass surgery is generally higher in a compliant patient than with purely restrictive procedures such as gastric banding and sleeve gastrectomy.

One year after gastric bypass surgery, weight loss can average 77% of excess body weight.
Studies show that after 10 to 14 years, 50% to 60% of excess weight loss has been maintained by some patients.

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.

Risks

Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.

Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements. Such as supplementing with calcium and vitamin D. Something most people should be doing anyway.

Chronic anemia due to vitamin B12 deficiency may occur. The problem can usually be managed with vitamin B12 pills or injections.

A condition known as “dumping syndrome” can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after gastric bypass surgery. In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15cc to 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.

Learn more about your Houston gastric bypass surgery options by requesting an appointment with Dr. Thomas!