Laparoscopic Gastric Bypass (LGB)

The Roux-en-Y Gastric Bypass combines the benefit of limiting food intake by a restricting how much you eat with a delay in having the food mix with digestive juices in the small bowel. This delay has a beneficial effect on the GI tract hormones including ghrelin and insulin, plus helps to discourage poor food choices. The Roux-en-Y Gastric Bypass is also called proximal gastric bypass or RNY. It has been performed as an open surgery since 1966, and since 1993 as a laparoscopic operation. In the procedure, stapling creates a small (approximately 1 ounce) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and we divide it completely from the lower stomach. The outlet of this newly formed stomach pouch empties directly into a portion of the small bowel.  The connection between the pouch and the small intestine is called the anastomosis. This portion of small intestine is called the "Roux" limb and is usually 100 centimeters long. It is reattached near the beginning of the intestine to minimize the amount of bypassed small intestine and eliminate the risk of malnutrition. With a 100 centimeter Roux limb, a person will absorb all of the protein, calories and fat in their food. Although often mistaken for one, the Roux-en-Y Gastric Bypass is not a malabsorptive operation.

   The Laparoscopic Roux-en-Y gastric bypass combines excellent weight loss with minimal risk of future metabolic abnormalities. The following is a discussion of the advantages and risks of the laparoscopic gastric bypass (also called the LGB)

   Advantages:

1. Laparoscopic surgery uses smaller incisions which result in less post-operative pain, less wound infections and hernias, shorter hospital stay, faster recovery.
2. The average excess weight loss in the gastric bypass is generally higher than with a purely restrictive procedure such as the Adjustable Gastric Band.  In our personal experience, patients have lost 70% of their excess body weight at 1 year after surgery and 77% at 2 years after surgery. 
3. Studies of gastric bypass patients have shown that even 10 years after surgery, weight loss has been maintained by most patients. 
4. Most patients' medical conditions including diabetes, high blood pressure, sleep apnea, joint pain, and urinary stress incontinence are improved or completely resolved. 

   Risks of LGB:

   No matter how carefully your surgery is performed, there are always the possibilities of complications. The following table gives estimates for the risks associated with LGB based on national averages, the surgical literature, and our own experience.

Risks death, conversion, re-operation and failure after Lap Gastric Bypass

   Specific risks and complications include:

• Intestinal leak from the stomach or small intestine. In our current experience, the risk of leak in our hands is 1% or less.
• Pulmonary embolus. Blood clots (called deep vein thrombosis or DVT) can form in the veins during or after any surgery. If they break lose and go to your lungs.The risk of a serious blood clot is 1% or less.
• Bleeding which requires blood transfusion, conversion to open surgery, or even removal of the spleen. The risk of this complication is under 1%.

   Complications that can arise during long term follow-up, including:

• Narrowing at the anastomosis (risk of 5-10%). This is usually treated without an operation.
• Ulcers (risk of 2% or less)
• Pre-existing medical conditions such as kidney stones or gout may be exacerbated by the changes in diet after gastric bypass.

   Most other complications can be prevented by appropriate nutritional and medical follow-up, along with proper eating and drinking habits. These include minor vitamin and mineral deficiency, hair loss, constipation, and vomiting.