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Gastric Bypass Surgery
The Roux-en-Y Gastric Bypass
is generally considered to be the best surgical procedure
for the treatment of morbid obesity.
Through gastric bypass, weight loss is achieved
by reducing the functional portion of the stomach to a pouch
one ounce or less in size, and by creating a stoma, a small
opening between the stomach and the intestine. The small
size of the stomach pouch causes the patient to have a
sensation of fullness after eating only a small portion of
food. The small stoma delays stomach emptying, making the
sensation of fullness last longer. These are called the
"restrictive components" of the procedure. The limb of
intestine coming down from the small pouch is called the
Roux limb. The limb of intestine coming down from the
bypassed portion of the stomach can be called the Biliary or
Bypassed limb. The remaining portion of the intestine is
called the Common Channel.
DESCRIPTION OF ROUX-EN-Y GASTRIC BYPASS
After gastric bypass,
food does not pass down the
bypassed limb, only the Roux limb and the Common Channel.
The longer the bypassed limb, the less the length of
intestine actively working to absorb nutrients from the food
that is eaten. Digestive juices that normally help absorb
nutrients from the food enter the bypassed limb from the
larger portion of the stomach, the liver, and the pancreas,
and pass down the bypassed limb to the Common Channel. These
juices do not mix with the food while it is passing down the
Roux limb. The longer the Roux limb, the longer the portion
of intestine trying to absorb nutrients without the benefit
of these digestive juices. Both of these changes result in
less absorption of nutrients and contribute to weight loss,
and are called the Malabsorptive components of the
procedure.
Exactly how the
gastric bypass is
done for an individual patient depends on their individual
anatomy, their general health status, whatever changes they
may have from prior surgeries, and what they hope to be
achieve from the operation. The stomach compartments can be
completely divided from each other or simply partitioned,
the small stomach pouch and the intestinal limbs may be
connected to each other with either staples or sutures, a
small band may be placed around the stomach pouch, and the
two intestinal limbs may be made longer or shorter.
Gastric bypass patients will be on a clear liquid diet for the first few
days immediately following surgery, and then advance to a
pureed diet. These foods will be very soft, so as to pass
through the small, newly formed pouch and stoma. One of the
main issues during this period will be adequate fluid
intake, and dehydration can be a problem for patients
recovering from this surgery. We will ask patients to take
in at least 32 ounces of liquid a day before leaving the
hospital.
Approximately one month after gastric
bypass surgery the patients can
expect to advance to a transitional diet. They begin to take
more regular table foods, but will often still go back to
eating the pureed foods that they have tolerated well. They
will still be learning how to eat right, including chewing
food carefully, learning to drink most of their liquids
between rather than with meals, and learning that eating the
wrong foods, such as sweets or fatty foods, can make them
ill.
Most gastric bypass patients experience rapid weight loss during this
period. They are often thrilled to see the weight coming
off, sometimes at the rate of 20 pounds a month, but it is
not an easy time. Patients feel the loss of calories taken
in, and are sometimes low in energy. Their small pouch will
make them uncomfortable when they eat too much or too fast.
They may have diarrhea, which can usually be controlled by
avoiding certain foods or by taking medication. They may
experience hair loss, though the hair usually begins to grow
back within a few months.
At 6
months after gastric bypass, the patients will probably be on their long-term
maintenance diet, which is more or less what and how they
will eat for the rest of their lives. The maintenance diet
for the most part consists of regular table foods, but in
small portions. Most patients describe their meals as child
sized, and they often do not finish what they are served.
The patients generally become comfortable eating these small
meals, and almost always say the loss of the ability to
enjoy large meals or certain foods is more than compensated
for by being able to successfully control their weight.
Patients may expect to lose approximately 70% of their
excessive body weight during the first 2 years following
surgery. An approximately 10% weight regain is sometimes
seen between years 2 and 5, perhaps because the small pouch
increases several ounces in size, and perhaps because the
patients learn how to take in extra calories without making
themselves sick.
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