Weight Loss Surgery

Weight Loss Surgery - Roux-en-Y Gastric Bypass

Roux-en-Y Gastric Bypass

Gastric bypass surgery was developed as a tool to help morbidly obese people lose weight, and reduce or eliminate the related medical conditions associated with obesity. At the Midwest Institute of Advanced Laparoscopic Surgery, Dr. Glascock performs the Roux-en-Y gastric bypass surgery, the premier method of gastric bypass surgery. With this type of surgery, the stomach is permanently divided to create a small pouch. This causes restriction in food intake. Next, a section of the small intestine is attached to the pouch to allow food to bypass most of the stomach and the first several feet of small intestines. This causes reduced caloric and nutrient absorption. The Roux-en-Y gastric bypass (RnYGB) procedure works in two main ways.

  1. First, the size of the stomach is reduced so it will only accommodate a few ounces of food. With the small size of the stomach, people feel full quickly and tend to eat less.
  2. Second, food is rerouted, bypassing several feet of small intestine, reducing the amount of calories absorbed.

Sweets tend to be avoided due to feeling ill after high calorie meals (called dumping syndrome).

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What are the risks of the surgery?

No surgical procedure is without risks. Risks for minimally invasive weight loss surgery are similar to other major abdominal surgeries. The risks, as well as the benefits of surgery, are discussed in detail with each individual patient. In general, complications resulting from severe obesity in the long-term are greater than the risk of surgery. The overall complication rate is small, at less than five to 10 percent. The major surgical risks include, but are not limited to:

  • Leaking at the newly created stomach (two to three percent)
  • Wound infections (five percent)
  • Narrowing of the connection between the stomach and small intestine
  • Blood clots (three percent )
  • Vitamin deficiency (iron, B12 and calcium)
  • Other infections (five percent)

The risk of death following the operation is small, but does exist, as it does with all types of major surgery.

What to expect from your first appointment

Prior to your arrival at the office, you will be asked to complete a demographic information sheet and a detailed questionnaire about your weight history and current medical condition. After watching the video, we will discuss and clarify your medical history, conduct a physical examination, and go into a detailed discussion about bariatric surgery specific to your situation. The doctor will determine if you are a reasonable candidate for gastric bypass. The remainder of the discussion will be to ensure that you are as informed as possible about the procedure and its ramifications. The doctor will also discuss the benefits and risks of the procedure.

Pre-operative appointment

You will see the doctor approximately two weeks prior to surgery after pre-op evaluations are completed. The doctor will review all medical data and make sure that planned testing has been done, and will answer any questions that you may have. Instructions for possible medication changes will be discussed preceding the surgery.

What to expect in the hospital

Your operation will be performed on the day of your admission. The procedure takes approximately three hours. Advantages of the laparoscopic approach include reduced postoperative pain, shorter hospital stay (two to three days), and a faster return to work (two to three weeks). You will be given explicit instructions on what and how much to eat. Pain is usually mild and controlled easily by medication. Nurses, dietitians, radiologists, and staff surgeons will all be monitoring your care closely.

What to expect right after my surgery

The day after your surgery you will be expected to sit up and walk around. At first you will be restricted as to what types of foods and how much food you can eat. Your physical activities will also be conservative. Within three to four weeks after your surgery your physical activities should be close to normal levels.

Weight loss results following surgery

Typically for the first year and up to two years you will lose about 15 to 25 pounds per month, depending on your beginning weight. After this time your weight will stabilize. The average patient loses about 70 to 85 percent of his/her excess weight. About 35 to 40 percent of patients will reach their ideal body weight range. Regaining lost weight after surgery may occur in a small percentage of patients. The doctor will review your weight, diet and overall health during follow-up appointments.

How well you maintain your diet and exercise regime will determine the stability of your weight. Our staff will monitor your weight frequently and provide important dietary and exercise counseling. In addition to the weight loss, you will also improve your overall health, noticing an elimination of many weight-related illnesses such as sleep apnea, diabetes, high blood pressure, and hypercholesterol. Nearly all patients report a significant improvement in their quality of life after surgery.

 
Anatomy
Small 1 ounce pouch (20-30 cc) connected to the small intestine. Food and digestive juices are separated for 3-5 ft.

Mechanism

  • Significantly restricts the volume of food that can be consumed.
  • Mild malabsorption
  • "Dumping Syndrome" when sugar or fats are eaten

Weight Loss
(United States Average Statistical Loss at 10 Years)

  • 70% loss of excess weight
  • More failures (loss of < 50% excess weight) than some other surgeries

Long Term Dietary Modifications
(Excessive carbohydrate/high calorie intake will defeat all procedures)

  • Patients must consume less than 800 calories per day in first 12-18 months; 1000-1200 thereafter; 3 small high protein meals per day
  • Must avoid sugar and fats to prevent "dumping syndrome"
  • Vitamin deficiency/protein - deficiency usually preventable with supplements

Nutritional Supplements Needed
(Lifetime)

  • Multivitamin
  • Vitamin B12
  • Calcium
  • Iron (menstruating women)

Potential Problems

  • Dumping Syndrome
  • Stricture
  • Ulcers
  • Bowel Obstruction s Dumping
  • Anemia
  • Vitamin/Mineral deficiencies (Iron, Vitamin B12, folate)
  • Leak
Hospital Stay
2-3 days
Time Off Work
2-3 weeks
Operating Time
2 hours
Our Recommendations
Most effective for patients with a BMI of 35-55 kg/m2 and those with a "sweet-tooth". Virtually all insurance companies will authorize this procedure.