Roux-en-Y bypass
Dr. Thoman has now performed over 200 laparoscopic gastric bypass procedures at Santa Barbara Cottage Hospital with no major complications, no leaks and no deaths. He has also developed a “fast track” protocol resulting in over 90% of patients discharged the morning after surgery.
We know that when people are more than 100 pounds over their ideal body weight, they suffer psychologically, socially and physically. Their risk for hypertension, diabetes, coronary artery disease, lung disease, arthritis, cancer, gallbladder disease, shortness of breath, chronic back pain, sleep disorders, fluid retention and early death are increased. We also know that if we can treat patients successfully, we reduce the risk and severity of their problems, along with improving their quality of life and overall life expectancy. The prospect of having an operation to solve this problem is a big step, but with modern minimally invasive techniques, usually the benefit of surgery significantly outweighs the risk involved. It is only after all of the reasonable measures at weight reduction have failed that surgery is a reasonable consideration.
There have been many operations done over the past forty years to assist patients in controlling their weight. Some have proven to be more effective than others, and some have more side effects. Today in the United States, the two most commonly performed surgeries are the Roux-en-Y gastric bypass and FDA approved adjustable silicon LapBand®. At SBMIS we offer exclusively minimally invasive laparoscopic bariatric surgical procedures. Not only do we offer the laparoscopic Roux-en-Y gastric bypass, but we are also offering the only FDA approved laparoscopic adjustable silicon band, the LapBand®.
The gastric bypass operation has been performed with minor variations since 1968. Over 800,000 LapBands have been placed worldwide since 1993, and over 100,000 in the United States since FDA approval in June of 2001. Both procedures have been shown to be effective in controlling morbid obesity in the long term.
The operations are designed to limit the amount of food you eat. The laparoscopic Roux en Y gastric bypass is done through small incisions and a tiny video camera. The stomach is divided into a small two ounce pouch (A). The pouch is only about 5-10% the size of the "old stomach" and holds less food. The pouch (B) is about the size of a golf ball as opposed to a normal stomach which is about the size of a foot ball. The pouch is designed to be permanent, although it is reversible laparoscopically. No part of the stomach is removed while doing the operation, but the majority of food ingested "bypasses" the majority of the stomach.
When food enters the pouch, it must have a way to leave. An opening (anastomosis) is made from the pouch to the small intestine (C). In the bypass procedure, a special intestinal connection, called a Roux-en-Y, is created (C & D).
The LapBand® is a small adjustable silicone ring placed around the top of the stomach to functionally create a small golf ball sized pouch. The stomach is not cut or divided as in a bypass. The ring is attached to a port deep underneath the skin that can be accessed in the office to adjust the size of the ring depending on your amount of desired weight loss. Like the laparoscopic gastric bypass, it is completely reversible laparoscopically. It is the safest and only adjustable bariatric surgical procedure available today.
The three mechanisms by which patients lose weight after these minimally invasive bariatric procedures:
1) The pouch is very small and only holds a tiny portion of food.
2) The size of the opening, called the stoma, allows food to empty only slowly from the pouch.
3) Many patients experience a permanent decrease or loss in appetite.
4) A frequent side effect of the gastric bypass (not the LapBand) is called "dumping" and occurs whenever a patient ingests foods high in sugar or fats. Symptoms such as flushing, nausea, pain, and/or diarrhea can occur and can be a real deterrent to making the wrong food choices. The normal amount of sugar in what is not considered desserts or snack food will generally not cause unpleasant symptoms.
WEIGHT LOSS AFTER GASTRIC BYPASS
Your weight loss begins immediately after the operation. The majority of bypass patients will continue to lose weight for approximately 12-18 months. Weight loss with the LapBand® is more gradual and can occur for years. The amount of weight a patient will lose every month will vary depending upon the height and weight prior to surgery. A reasonable explanation is to expect to lose 50% of your excess body weight and many patients will get to within 30-40 pounds of their ideal body weight. In general, for many bypass patients, the weight loss is complete within 12 months and may plateau unless you institute an exercise program. The percent of weight loss among different patients varies and depends upon a number of factors such as exercise, food choices and daily caloric requirements.