Roux-en-Y Gastric Bypass
Roux-en-Y Gastric Bypass Surgery
The Roux-en-Y Gastric Bypass (RYGB) was first performed in the 1960s and has significantly evolved to improve its efficacy and to minimise the risk of complications such as excessive malabsorption). It has long been regarded as the ‘gold standard’ weight loss surgery and is performed laparoscopically (keyhole surgery). It is also the most effective operation for the treatment of gastro-oesophageal reflux disease (GORD).
During the procedure I divide the stomach with staples to create a very narrow new stomach, often referred to as the pouch. I then proceed to join the small intestine onto the end of the new gastric pouch. The new pouch holds approximately 150mls.
Food and liquid passes from the new stomach directly into the small bowel – and bypasses most of the stomach and the first part of the small bowel.
Food does not enter the divided, or ‘remnant’ stomach as it is detached from the new small pouch. Unlike the sleeve gastrectomy this remnant stomach is not removed. Although the alimentary tract is re-configured during the surgery, no part of it is removed – thus the operation is potentially reversible.
Similar to the sleeve gastrectomy the gastric bypass results in weight loss secondary to its metabolic and restrictive effects. However the gastric bypass offers more potent metabolic effects than the sleeve gastrectomy and also provides a small element of fat malabsorption which enhances weight loss.
The stomach produces a number of different hormones (e.g. ghrelin) which signal the brain as well as the digestive tract. After surgery these hormonal levels change and thus the messages to the brain and the body alter. These changes result in a significant decrease in appetite, promote the feeling of fullness and change glucose metabolism, amongst many other metabolic effects.
The new stomach pouch is significantly smaller and is easily filled.
One of the potential long term effects following both the sleeve gastrectomy and gastric bypass is stomach stretching, or dilatation. The use of a fixed gastric rings around the new small stomach can help prevent this dilatation in years to come. This technique is not new and banded gastric bypasses have been performed since the 1990s. Banded gastric bypasses have been shown to offer improved weight loss at 10 years compared with the non-banded bypass.
Our team approach includes dietitian and psychological support to help you achieve your weight loss goals. Please contact us if you would like to make an appointment to discuss your weight loss surgical options with me.
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