Roux-en-Y, Gastric Bypass
Definition: A small stomach pouch is created by stapling part of the stomach together, or through a method known as vertical banding. This is what limits how much food one can eat. Subsequently, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass through the duodenum as through the first portion of the jejunum. This effectively causes reduced caloric and nutrient absorption in the body.
Is it right for me?
Surgery is generally considered when your body mass index is 40 or higher or you have a life-threatening or disabling condition related to your weight.
Surgery: This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).
Risks: The main health danger of any bypass surgery is the operation itself. As a major medical procedure performed under general anesthetic, it carries a range of serious health risks. Aside from this, probably the most common health problem experienced by roux patients is nutritional deficiency. The RYGBP operation causes food to bypass the gastric fundus, body, antrum, all the duodenum and most/all of the proximal jejunum. As a result, patients are at risk of developing iron deficiency, vitamin B12 deficiency, as well as inadequate intake of vitamin D and calcium. Because of this, life long supplements of multivitamins, vitamin B12 iron and calcium are mandatory in order to maintain a healthy intake of vitamins and minerals.
Results: Typically, roux patients lose roughly 70 percent of their initial excess body weight during the first 24 months after surgery. Occasionally, patients experience a weight regain of about 10 percent between years 2 and 5. Bariatric experts attribute this to two factors. First, the functional capacity of the small pouch increases in volume to accomodate more food. Second, roux patients learn how to take in extra calories without incurring symptoms of dumping syndrome and making themselves sick. Symptoms include nausea, sweating, faintness, and diarrhea after eating, as well as the inability to process sweet foods without becoming extremely weak.
Recovery time: This surgery usually involves a 4- to 6-day hospital stay (2 to 3 days for a laparoscopic approach). Most people can return to their normal activities within 3 to 5 weeks.
Extensive gastric bypass (biliopancreatic diversion)
Definition: BPD interrupts the normal process of digestion by removing 2/3 of the stomach. The small pouch that remains bypasses the duodenum and jejunum and is connected to the lower portion of the small intestine. By reducing the size of the stomach to create a quicker sense of fullness, an individual can eat less and thus consume fewer calories. Less food and less calories result in achieving fast weight loss.
Is it right for me?
The best candidates for this surgery are people who have a BMI over 40, have tried other weight-loss techniques without sustained success and who are at risk for other health problems due to being overweight.
Surgery: This depends on the experience of the surgeon and if it is being done as an open or closed (keyhole) procedure. Open gastric bypass operations usually take 90-120 minutes, but laparoscopic bypasses may take up to twice as long to perform. Anesthesia is always consistent with this procedure. Since it’s a somewhat-invasive surgery, general anesthesia is administered.
Risks: Complications related to this procedure include severe diarrhea, abdominal bloating and protein malnutrition.
Results: This operation results in one of the best weight loss outcomes (90% of excess weight loss at five years) as it provides the highest degree of malabsorption. Studies patients have achieved excess weight loss of 74% at one year, 78% at two years, 81% at three years, 84% at four years and 91% at five years.
Recovery time: For open operations, most patients are discharged on the third or fourth post-operative day. Patients who have the laparoscopic procedure can go home on the second or third post-operative day.
Duodenal Switch (DS)
Definition: The duodenal switch (DS) is a modification of the BPD designed to prevent ulcers, increase the amount of gastric restriction, minimize the incidence of dumping syndrome, and reduce the severity of protein-calorie malnutrition. The DS works through an element of gastric restriction as well as malabsorption. Anatomically, the main difference between the DS and the BPD is the shape of the stomach - the malabsorptive component is essentially identical to that of the BPD. Compared to the BPD, the DS leaves a much smaller stomach that creates a feeling of restriction.
Is it right for me?
If you have a body mass index greater than 40 and are between the ages of 18 and 65, you may be a candidate for duodenal switch.
Surgery: The biliopancreatic diversion with duodenal switch operation can be performed either using the laparoscopic technique or by using the open technique. Instead of cutting the stomach horizontally and removing the lower half (such as with the BPD), the DS cuts the stomach vertically and leaves a tube of stomach that empties into a very short (2-4 cm) segment of duodenum. This surgery, sometimes referred to as a mini bypass, is typically performed in a hospital or a surgery center using general anesthesia. Most surgeries are performed. In some cases, the surgery will require a larger, traditional incision (open surgery). A surgery that begins laparoscopically may also be converted to an open procedure if and when the surgeon determines it is necessary.
Risks: As a general rule, the greater the magnitude of the surgery, and the less healthy the patient, the higher the risk of surgery. In the spectrum of weight-loss operations, Duodenal Switch is the most aggressive, and, therefore, has the highest potential for complications. These potential complications include leaks, blood clots forming in the legs, blood clots traveling to the lungs (otherwise known as pulmonary embolus), infections, abscesses, bowel obstruction, pneumonia, and problems with healing of the incision. Other possible complications include kidney failure, injury to the spleen, and bleeding. Some patients may need to spend extra time in the ICU as a result of these complications, or if their underlying health is marginal to begin with.
Results: A theoretical benefit of the DS is an improvement in absorption of iron and calcium in comparison to the BPD. Biliopancreatic diversion surgery has excellent results, with the average patient losing 70 to 80% of his excess weight in the two years that follow the procedure. However, patients who choose this type of surgery are at much higher risk for nutritional deficiencies than with other types of weight loss surgery. Nutritional supplements, including vitamins and minerals, will be necessary for the lifetime of the patient.
Recovery time: Every person's recovery is different. Most people require about 3 to 4 weeks for recovery from their surgery. Even if the operation is performed laparoscopically, with small incisions on the outside, the operation is a big one on the inside.
