• The Procedure
• Benefits
• Risks
• Contraindications

The Procedure

The laparoscopic RY gastric bypass is performed by introducing a laparoscope which is connected to a video camera, through small abdominal incisions, giving us a magnified view of the internal organs on a television monitor. The entire operation is performed "inside" the abdomen after gas has been inserted to expand it. Special stapling instruments are used to create a new small <10 ml stomach pouch. The remainder of the stomach is not removed (99%), but is completely stapled shut and divided from the new small stomach pouch. The outlet from this newly formed small stomach is connected to the small intestine so that food empties directly into the lower portion of the intestine bypassing the stomach. This is done by dividing the small intestine just beyond the ligament of Treitz 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 remaining small intestine creating the "Y" shape that gives the technique its name.  The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat. The laparoscopic technique is identical to the open procedure. What is unique to our technique is the use of hand-sewing the gastrojejunostomy, as opposed to using stapling instruments. This allows for the creation of a very small gastric pouch. The end result on the outside is shown at left. 
Click the figure below to see an animation of the proceedure.

Benefits

Our most recent statistics show that the Isolated Gastric Bypass operation as performed at our institution, with your help and compliance with post-operative instructions, will allow a patient to lose 70-80% of their excess weight and keep this weight from coming back in the future. This means if you weigh 250 lbs and should weigh 150 lbs according to your height and body frame, you will lose an average of 70-80 lbs with the operation. Some patients lose all their excess weight, while others who do not follow instructions will lose less.

In addition to this weight loss, if you have any of these conditions, they will improve or resolve after the surgery:

• Diabetes
• Hypertension
• Sleep apnea
• Dyslipidaemia
• Asthma
• Low back pain and vertebral disk disease
• Weight-bearing osteoarthritis of the hips, knees, ankles, and feet
• Skin fold dermatitis
• Urinary stress incontinence
• Gastroesophageal reflux

Finally, the health benefits gained with weight loss surgery can reduce your risk of death by as much as 89% compared to staying morbidly obese. For more details click "It's not just weight loss. It's health gain".

Risks

These benefits do not come without risks, however. The worst that can happen is that you die from the operation. The mortality risk is dependent of the Body Mass Index, the sex, the associated comorbidity, and the expereince of the bariatric surgeon and the bariatric team.

General 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.
• A 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 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 15-30cc.
• 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.

Specific Risks based on our own experience with over 2000 gastric bypasses:

Contraindications

• Extremes of age
• History of pulmonary embolus or pulmonary disease requiring oxygen therapy
• Extremely limited mobility
• Untreated psychiatric disorders and substance abuse or narcotic dependency
• Endocrine disorders such as Cushing's Syndrome and Prader Willi Syndrome
• Psychological instability
  • Drug or alcohol abuse
  • Inability to cope with the changes in diet and life modification after surgery
  • Refusal to be assessed by psychologist or psychiatrist

Complex medical conditions increase the risk of surgery and are considered on a patient-by-patient basis.