Roux-en-Y Gastric Bypass

Operation

In the gastric bypass procedure, a 15-20cc stomach pouch is constructed (usual stomach approximately 1500cc or greater). The remainder of the stomach is separated from the new stomach pouch and stapled closed. This part of the stomach is not removed. The new stomach pouch is then connected to the small intestine. This is done by dividing the intestine approximately 40cm from the stomach and attaching the distal part to the stomach pouch. The proximal part of the divided intestine is then connected to the side of the intestine that was previously attached to the pouch. The roux limb is that part of the intestine between the stomach pouch and the connection to the proximal small intestine.

The difference between short limb (or proximal) and long limb (or distal) gastric bypass is the length of the roux limb. Long limb gastric bypass results in more malabsorption than short limb gastric bypass.

(click here to watch a short animation of the Roux-en-Y Bypass procedure)*

*Requires

Surgical Technique

Laparoscopic vs Open

Laparoscopic	Open
Small incisions Less pain, shorter hospital stay Surgeon uses thin, long instruments Reduces complications of Hernia and Wound Infection	Large incision Longer hospital stay Surgeon handles the organs

The most significant recent advance in bariatric surgery is the technique of laparoscopy. Using laparoscopy, Roux-en-Y gastric bypass can be done with five small incisions rather that one large incision. Otherwise the laparoscopic procedure is the same as the open procedure. The laparoscopic approach results in less pain, quicker recovery, shorter hospital stay, less scarring, and quicker return to normal activity (Ref. 3). Complications related to the incision, such as infections and hernias, are nearly eliminated with the laparoscopic approach (Ref. 3).  Both Gastric Bypass surgery and LAP-BAND® surgery can be done laparoscopically. 

Researchers have demonstrated the difficulty of learning laparoscopic gastric bypass (Ref. 4). They found that complication rates and operative times are much higher during a surgeon's first 75 laparoscopic gastric bypasses (Ref. 4). Complication rates and operative times stabilize at low rates beyond 75 procedures. The importance of this is that an experienced laparoscopic gastric bypass surgeon is essential for good outcomes. Dr. Owens and Dr. Hajduczek have combined experience of well over 1000 laparoscopic bariatric procedures, operations, and bypasses (including laparoscopic revisions).