Gastric Bypass

Roux en Y (RNY) or gastric bypass is a restrictive procedure that staples off an approximate 1/2 – 1 ounce stomach pouch at the upper portion of the stomach.

A section of small bowel is then attached to the pouch via a small opening, which is to simulate the pyloric valve. Narrowing and or blockages can take place at this small opening. Ulceration can also happen at the area where the small bowel and the stomach tissue are attached.

The pyloric valve is bypassed in this procedure. Because of the small pouch size vomiting can take place if food is not properly chewed or food is eaten too fast or too large a volume. Dumping syndrome is also takes place when consuming high sugar containing food.

Advantages:
a) It is the surgery that obtains better weight loss results near the 85-90% of loss of the excess of weight within 12-18 months since the surgery.

b) It allows the patients to eat practically in a normal way, with a minim or null probability of feeling nauseous, vomits or a food stuck sensation technically called dysphagia,

c) This surgery diminishes the diseases associated with the obesity, because of the obtained weight loss, that even allows cutting off the medication need.

d) If this surgery is taken by laparoscopic procedure, the advantages of this mean itself are added, with less pain and faster recovery.

e) It has been proved that this procedure maintains the lost of weight by more than 15 years, even if patients eat greater caloric content foods, this surgery assures its results by the second mechanism, the one of bad intestinal absorption which would be in charge of not gaining weight.This is, without a doubt, the most important and fundamental goal of obesity surgery.

f) It improves more than the 85% of the surgery-performed patients. Risks:
a) Because stomach resections and intestinal connections are done, the probability of intestinal content leaks is possible in the first days since the operation. This is called fistula and can happen in approximately in 1 to 2% of the cases.

b) Also longer recover time in the hospital is required, around four days, because it is necessary to pay special attention to fistula problems and other complications.

c) It requires taking vitamins and calcium supplements permanently after the surgery. In case of not doing it, long term complications by the lack of these nutrients can happen. In addition, it can require of periodic supplements of B12 vitamin and iron.

d) The probability of diarrhea after the surgery is from 1 to 3%, and nevertheless, it can be corrected with diet and medicines adjustments. Generally, if this problem appears, it would be within the first 6 months. If diarrhea gets so severe it could require another surgery to correct the lengths of the intestine, which makes this surgery partially reversible.
e) Excretions and gases can have an intensely fetid scent, and can be controlled with diet adjustments.

f) It is recommended to visit the doctor three to four times during the first year, with controlled examinations. Then once a year, it will be sufficient to watch the possible lack of vitamins or minerals.
While restrictive procedures could reduce stomach capacity temporarily, they couldn’t always prevent the stoma from stretching out over time. The question for researchers became: how do we help patients maintain the weight loss?
Surgeons returned to the concept of malabsorption. As the BPD had proven, restricting the absorption of nutrients and calories provided lasting weight control, despite stomach pouch expansion. But many doctors and patients hesitated about BPD, given the potential for serious nutritional complications. The perfect middle-ground seemed to be another hybrid procedure combining restriction and malabsorption called the gastric bypass, developed by Dr. Edward Mason all the way back in 1966.

History.
It’s an interesting sidebar to note that Dr. Mason is the only surgeon to devise two different and well-received procedures for the treatment of obesity. You’ll remember that he introduced the VBG as well, almost two decades after he invented the gastric bypass procedure. Considered the “Father of Bariatric Surgery,” he also founded the American Society for Bariatric Surgery (ASBS) in 1976.

An important step in the growth of gastric bypass surgery came in 1993, when private practitioners Dr. Alan Wittgrove and Dr. Wesley Clark of San Diego, California, co-developed a less-invasive, laparoscopic method of performing the procedure. Instead of making one large incision in the abdomen, they made several small incisions and operated remotely using long, slender instruments and a narrow-shafted camera to visualize the operative field. Patients experienced less pain and scarring, and the overall hospital stay and recovery time were shortened. Today, about half of all patients meet the criteria for the laparoscopic approach.

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