Roux-En-Y Gastric Bypass
Roux-en-Y gastric bypass surgery is performed to help severely obese patients lose significant amounts of weight. The surgeon uses suture-like staples to separate a portion of the top of the stomach and create a pouch which is then connected directly to a section of the small intestine called the Roux limb. The name of this procedure derives from the surgical connection to the Roux limb and from the Y-shaped junction between stomach and small intestine.
Candidates for Roux-en-Y
While Roux-en-Y bypass surgery is an effective obesity solution for many patients, it is not right for everyone. There are several qualifications that a patient must meet to be considered a good candidate for this surgery. Many of these qualifications are medically required for patients seeking insurance coverage for their procedure. Most candidates for this procedure must be considered morbidly obese with a body mass index, or BMI, of 40 or higher. There may be exceptions made for individuals with a BMI of 35 or higher and a serious obesity-related medical condition. In order for a surgeon to consider performing Roux-en-Y gastric bypass, the patient should:
- Be between the ages of 18 and 65
- Have been obese for at least 5 years
- Have tried other methods of weight loss with little to no success
In addition, the patient must be committed to making lifestyle changes relative to diet and exercise.
Benefits of Roux-en-Y
Along with the significant weight loss results this procedure often provides, Roux-en-Y bypass surgery may increase the patient’s longevity and quality of life, making it easier to perform everyday functions.
Roux-en-Y bypass also helps to improve many obesity-related health conditions, such as hypertension, heart disease, gastroesophageal reflux (GERD), or type 2 diabetes.
The Roux-en-Y Bypass Surgery Procedure
During Roux-en-Y bypass, the surgeon decreases the size of the stomach by creating a small pouch, then attaches the pouch to the small intestine below the duodenum. Creation of the smaller stomach pouch restricts the amount of food that can be consumed at one sitting. In addition, the bypass technique limits the body’s ability to absorb much of the food’s caloric content. This combination of malabsorptive and restrictive techniques makes the Roux-en-Y procedure one of the most successful gastric bypass surgeries.
Risks of Roux-en-Y
Although Roux-en-Y bypass offers an unmatchable weight-loss solution for many obese patients, there are certain risks associated with this type of surgery. These risks may include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Post-surgical infection
- Damage to adjacent organs
- Breathing problems
- Hernia at the incision site
In addition, risks particular to Roux-en-Y bypass may include:
- Gastric leaking
- Pouch stretching
- Gastric dumping syndrome
- Nutritional deficiency
In almost all cases, these risks are outweighed by the medical advantages of weight loss.
Recovery from Roux-en-Y
Recovery from Roux-en-Y bypass is usually relatively smooth. While some discomfort is to be expected during the immediate aftermath of the procedure, patients should begin to experience beneficial results in a short time. After spending a few weeks on a liquid diet, patients can begin gradually reintroducing soft and then ordinary foods. They are instructed to eat small meals at regular intervals and to avoid heavy lifting for several months.
Patients who undergo Roux-en-Y bypass must be willing to make lifestyle changes to achieve and maintain weight loss and to prevent complications from the surgery. With determination, good nutrition and regular exercise, the results can be dramatic. Most patients lose about one to two pounds per week and reach a stable weight 18 to 24 months after surgery. After gastric bypass surgery, patients must follow a program including:
- Regular exercise
- Careful nutrition
- Vitamin and mineral supplementation
After any bariatric procedure, counseling or psychotherapy is usually recommended to assist patients in adjusting to lifestyle changes and maintaining weight loss.
A sleeve gastrectomy, sometimes known as a gastric reduction or a vertical gastroplasty, is a restrictive form of bariatric surgery that effectively shrinks the stomach to approximately 15 percent of its original size. During the procedure, the surgeon sutures the stomach into the shape of a tube, or sleeve. Sleeve gastrectomy is commonly performed on severely obese patients who are not healthy enough to undergo a successful gastric bypass, biliopancreatic diversion or similar weight loss surgery.
Sleeve gastrectomy enables rapid weight loss with fewer complications than the more conventional weight loss surgeries, but its effectiveness is not as predictable since it does not involve a malabsorptive component. The patient’s intake of food will be lessened and hunger will be decreased, but any calories are ingested will be absorbed during digestion. It may be performed as the first part of a two-part bariatric procedure. In certain cases, after some major weight loss has taken place, the patient may undergo a duodenal switch bypass procedure to promote further weight loss. Sleeve gastrectomy is one of the newer bariatric procedures. Since it has less of a track record than some other bariatric operations, it may not be covered by insurance.
Candidates for Sleeve Gastrectomy
Candidates for a sleeve gastrectomy must be prescreened to make sure the procedure is appropriate for them. Patients are typically good candidates for this procedure if they:
- Have a history of morbid obesity for several years
- Have demonstrated an inability to lose weight with diet, exercise or medication
- Have no medical or psychological conditions that preclude bariatric surgery
- Are between 18 and 65 years of age
In addition,candidates must be highly motivated to make the necessary lifestyle changes after the surgery, for their weight loss program to be successful.
Benefits of a Sleeve Gastrectomy
Like many bariatric procedures, a sleeve gastrectomy is performed laparoscopically, so the surgery is minimally invasive, resulting in smaller scars, less blood loss, less pain, and a shorter recovery period. There are a number of benefits particular to the sleeve gastrectomy as compared to other, more complex, bariatric surgeries. These include:
- No Malabsorptive Complications
- No Gastric Dumping Syndrome
- Less Hunger
- No Foreign Bands or Tubes Remain in the Body
Many weight-related medical problems are resolved after gastric sleeve gastrectomy. These may include hypertension, type 2 diabetes. high cholesterol, severe sleep apnea, heart disease and asthma. If necessary for additional weight loss, a sleeve gastrectomy can also be modified at a later date. In some cases, where weight loss resulting from the sleeve gastronomy is not sufficient, a revision surgery, such as a gastric bypass or the placement of a gastric band, may be performed.
The Sleeve Gastrectomy Procedure
The actual sleeve gastrectomy procedure is quite simple. The surgeon uses miniature tools, entering the abdomen through a small incision and stapling the stomach into the shape of a tube. This greatly reduces the stomach’s capacity. Once the created “sleeve” is examined to ensure that there is no leakage or bleeding, excess stomach tissue is removed. The removal of this stomach tissue also removes part of the stomach, the fundus, where ghrelin, the hunger hormone, is produced and secreted, decreasing the patient’s desire to eat.
Because sleeve gastrectomy does not alter the digestive process itself as do bariatric bypasses, no malabsorption occurs and supplemental nutrition is usually unnecessary.
Risks and Complications Associated With a Sleeve Gastrectomy
Weight-loss surgery may increase the risk for gallstones. The doctor may recommend a cholecystectomy, a surgery to remove the gallbladder, at the same time the sleeve gastrectomy is performed. Other risks of this procedure may include:
- Inflammation of the stomach
- Heartburn, or stomach ulcers
- Gastric leakage
- Scarring in the abdomen
Vomiting may sometimes occur in individuals who have had a sleeve gastrectomy, when they eat more than the stomach pouch can hold.
Recovery from a Sleeve Gastrectomy
Recovery from a sleeve gastrectomy is fairly routine. Because this procedure is less invasive than some other types of bariatric surgery, recovery tends to occur more quickly. Generally, patients remain in the hospital for a day or two, during which they ingest a liquid diet. Once they go home, they can begin to gradually reintroduce soft and then more solid foods. Doctors instructions should be followed carefully. Although a sleeve gastrectomy can be an effective tool in the struggle for weight loss, there will still be serious work for the patient to accomplish. Without serious, ongoing changes to the patient’s diet and exercise regimen, the positive effects of the surgery will not be long-lasting.
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