Overview

Roux-en-Y Gastric Bypass Weight-Loss Surgery

Roux-en-Y Gastric Bypass Surgery

There are two components to the procedure. First, a small stomach pouch is created by dividing the top of the stomach from the rest of the stomach, typically using staples. Similar to most bariatric procedures, the newly created stomach pouch being considerably smaller facilitates significantly smaller meals, which translates into less calories consumed.

Next, the surgeon cuts your small intestine and attaches the lower part of it directly to the small stomach pouch. Food then bypasses most of the stomach and the upper part of your small intestine so your body absorbs fewer calories. The surgeon connects the bypassed section further down to the lower part of the small intestine, so that digestive juices from the stomach can eventually mix with food.
Because there is a section of the stomach and small intestine that no longer has food going through it, there is less absorption of calories and nutrients. This bypass changes gut hormones and gut bacteria which reverses one of the primary mechanisms by which obesity induces diabetes. This change may also affect appetite and metabolism.
A Gastric Bypass is difficult to reverse, although an experienced surgeon may do it if medically necessary.

Of the individuals that are overweight by 50 pounds or more, 90% fail to control weight through exercise and diet. This is not due to laziness or a lack of willpower, but to an increased metabolism that processes nutrients and minerals at a faster rate. These individuals will gain more calories than before when eating the same meals. When a change in lifestyle is insufficient, weight loss surgery becomes the most viable solution. However, a successful operation often requires an additional surgery to finalize improvements to health and weight.

Post-bariatric surgery is a very important part of rehabilitation and success. Follow up surgeries are typically performed about 12 to 18 months after surgery, when the patient has adapted to lifestyle changes, and weight loss has slowed down or even begin to reverse. By then, the body has likely compensated for the shift in diet by increasing the absorption of calories consumed. Often times, this happens prior to the patient achieving their desired results, and independent of anything the patient may have done wrong. This is why revisional surgery is often necessary to fine tune and solidify a patient’s overall progress. Failure to get a revisional surgery can lead to; difficulty maintaining dietary guidelines, minimized results, or even weeks of dieting undone. Some possible indications that it’s time for a revision include; incapacity to attain desired body mass, unexpected changes despite maintaining the same diet, slowed weight loss prior to achieving satisfactory IBM, greatly increased appetite, greater capacity to eat than expected, and more.

Furthermore, a revision may be necessary if there is cause for concern as described below.

When you come into our office, we will evaluate any developments since your previous weight loss surgery. We will take diagnostics, conduct X-rays, and run tests to determine the current state of your anatomy. Our surgeons will also consider other conditions that may affect your bariatric revision and will take into account your progress and goals. Your success is important to us.

A surgical revision is generally recommended to maintain improvements, but may even be necessary if symptoms or incidents become reason for concern. Here are a few possible revisions to help you get back on track:

  • Correction or Reversal of a Roux-en-Y Gastric Bypass:
    Intestines can continue to grow following surgery and the composition of bacteria, hormones and nerves can change over time. If you experience metabolic changes that cause your intestines to absorb more calories, promoting weight gain, our surgeons can conduct a revision to your Roux-en-Y, including further adaptations to the stomach or intestines. Additionally, a more serious condition such as internal leakage or erosion could require surgery. Although difficult, all or part of this procedure can be reversed if necessary.
  • Usage of an Adjustable Gastric Band, a Vertical Banded Gastroplasty, or a Vertical Sleeve Gastrectomy:
    If you still experience trouble losing weight and our doctors notice an enlarged pouch, it may be possible to use a band or a sleeve gastrectomy to enhance results.
  • Conversion to a Biliopancreatic Diversion:
    It may also be possible to turn your previous procedure into a Biliopancreatic Diversion by removing part of the stomach, thus absorbing less calories. This may be even more effective if the pouch has expanded or if a fistula between the pouch and old stomach exists.

Generally, our surgeons can perform revision surgery laparoscopically. This is a minimally invasive surgery that uses small incisions with the aid of a camera to operate. This technology helps avoid large incisitions in your body that would make day-to-day life activities more difficult and take longer to heal. Our physicians use only the best technology to revise your bariatric surgery.

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