Laparoscopic Gastric Bypass Roux-en-Y (RNY)
 This
version of the gastric bypass (RNY) is performed
laparoscopically, as opposed to open surgical
techniques. Laparoscopic surgical techniques
were first reported in the early 1980's,
and primarily performed for gynecological
procedures and appendectomies. It soon became
known as "band-aid" surgery.
The benefits of performing the procedure
laparoscopically versus open is that there
are usually 4-5 very small incisions made
which causes much less pain and very little
scarring than the open which can run 7 inches
or longer. Patients are able to move around
with less discomfort than the open operation,
spend less time in the hospital (2 days
versus 4-5 days with open) and can return
to work usually within 1-2 weeks versus
2+ weeks with the open procedure. Of course,
not all patients are candidates for the
laparoscopic procedure and would need to
be first evaluated by the surgeon.
The risks of performing the surgery laparoscopically
are comparable to the standard operation
- when done by an experienced and skilled
laparoscopic surgeon.
This operation is considered a restrictive
procedure and is achieved by creating a
small pouch (holds approximately 1-2 ounces
of food - about the size of a shot glass)
from which the rest of the stomach is permanently
separated. The small intestine (jejunum)
is cut, below the stomach, and is re-arranged
so as to provide an outlet to the small
stomach, maintaining the flow of digestive
juices at the same time. The lower part
of the stomach is bypassed and food enters
the second part of the small bowel within
approximately 10 minutes of beginning the
meal.
The operation works by reducing food intake
thus reducing the feeling of hunger. There
is very little interference with normal
absorption of food. The procedure is an
excellent tool for maintaining long term
weight control, without the hunger and cravings
usually associated with small portions,
or with dieting. Expected weight loss of
80-100% of excess body weight is achievable
for most patients with successful long term
maintenance with adherence to behavioral
modification.
After undergoing the gastric bypass procedure,
patients may incur dumping syndrome. This
is caused when the patient consumes foods
containing sugar or fat (ice cream or Hershey's
kisses are examples) and it leaves the stomach
pouch into the small intestine (jejunum).
The small intestine cannot handle concentrated
calories any more. This portion of the intestine
will react and the patient may have palpitations
(fast heart rate), a clammy feeling, queasiness
and nausea, sometimes vomiting and sometimes
diarrhea. The patient will usually feel
weak and must lie down for 30 or more minutes.
Dumping syndrome is not dangerous but it
feels horrible, and is a significant component
of the weight loss equation.
From a medical standpoint, recovery is fairly
rapid. Patients leave the hospital within
2 days after laparoscopic surgery. Patients
are usually able to walk and move around
reasonably comfortably as well as take care
of themselves at home. Patients are given
discharge instructions and seen back in
the office around one week after surgery
for staple or drain removals. If patients
are doing well at the first follow-up appointment,
they can commence driving, doing any physical
activity they feel they are able to do and
also return to work.
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