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Laparoscopic Roux-y-gastric bypass (LRYGB)
Laparoscopic Adjustable Gastric Band (LAGB)
Laparoscopic Mini-gastric bypass (LMGB)
Laparoscopic Sleeve Gastrectomy (LSG)
Laparoscopic Greater Curvature Plication (LGCP)
Biliopancreatic Diversion (BPD)
Revisional Bariatric Surgery
Endoscopic Gastric Balloon
Laparoscopic Roux-y-gastric bypass (LRYGB)
The Roux-y-gastric bypass (RYGB) is one of the oldest operations performed for the treatment of morbid obesity. It was started in the United States in the late 1960s after surgeons observed weight loss following operations done for peptic ulcer disease. It is the most popular bariatric operation in the United States. It is done laparoscopically using small “key hole” incisions in most cases.
The steps of the operation include:
Dividing the stomach into 2 parts: A small “pouch” measuring around 30ml and the rest of the stomach that will no longer be in contact with food. The division is accomplished by staplers (see link to staplers)
The next step is to divide the small intestine again with staplers and bring the intestine to the pouch and create a connection between the pouch and the small intestine (anastomosis). The intestine carrying the juices from the stomach, liver (bile) and pancreas is connected to the intestine about 100 to 150 cm away from the pouch (see diagram). This way all the digestive juices mix with the ingested food and absorption of calories should be normal.
Weight loss starts immediately after the operation and continues up to 12 to 18-months after surgery. At this time the average weight loss is 70% of the extra weight which is the weight before the operation minus the ideal weight. Take for example a young woman who weighs 120 kgs and is 156 cm tall. The patient’s ideal weight is 50 kgs so her extra weight is 70 kgs. Therefore at one year, we expect her to lose 70% x 70 kgs or 49 kgs so her weight at one year should be around 70 kgs.After the second year most patients regain a little bit of weight so the weight loss at 10 and 15 years is around 50-60% of the extra weight. So our patient’s weight should range between 70 and 85 kgs.
More importantly, gastric bypass has been shown to be the most effective treatment for diabetes and many obesity related health problems such as high blood pressure and sleep apnea. Most patients feel better and healthier. In fact several studies have demonstrated that patients who undergo gastric bypass live longer and develop less cancer than other obese patients who don’t receive bariatric surgery.
Risks and Side Effects
Immediate serious risks following RYGB occur in 5% of patients and include the risk of deep vein thrombosis (blood clots), pulmonary embolus, leak and deep abdominal infection, bleeding and intestinal blockage. Most will appear within the first few days. Some of these complications are best managed with early re-operation. The risk of death is less than 0.3% in experienced bariatric surgical centers such as ours.
Long term side effects include temporary hair loss, occasional fatigue, anemia, vitamin deficiency, gallstones and loose skin. That is why it is important to maintain regular follow-up and perform blood tests at least twice a year.
Dumping syndrome is a known side effect of the gastric bypass and consists of a set of symptoms that appear after eating high caloric food. These symptoms include fatigue, dizziness, near fainting, fast heartbeat, cold sweats and are related to low blood sugar in the blood. It is paradoxical but eating sugary foods will stimulate the pancreas to release large amounts of insulin which in turn lower the blood sugar. Dumping syndrome is preventable by avoiding high calorie foods and relying more on vegetables and proteins.
Life after the Lap RYGB
The average operation takes about 90 minutes and the average stay in the hospital is around 2 days. The phases of diet include clear fluids for three days, thick fluids for five days and soft food for one week. Thereafter food intake becomes normal. Most patients return to work within 10 days of the operation and resume exercise three weeks later.
Long-term commitment to healthy eating habits and regular activity are important to guarantee the success of the operation.