In recent years, better clinical
understanding of procedures combining restrictive and malabsorptive approaches
has increased the choices of effective weight loss surgery for thousands of
patients. By adding malabsorption, food is delayed in mixing with bile and
pancreatic juices that aid in the absorption of nutrients. The result is an
early sense of fullness, combined with a sense of satisfaction that reduces the
desire to eat.
According to the American Society for Bariatric
Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the
current gold standard procedure for weight loss surgery. It is one of the most
frequently performed weight loss procedures in the United States.
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combined
restrictive and MALABSORPTIVE PROCEDURE
laparoscopic roux-en-y gastric bypass
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In this
procedure, stapling creates a small (15 to 20cc) stomach
pouch. The remainder of the stomach is not removed, but
is completely stapled shut and divided from the stomach
pouch. The outlet from this newly formed pouch empties
directly into the lower portion of the jejunum, thus
bypassing calorie absorption. This is done by dividing
the small intestine just beyond the duodenum for the
purpose of bringing it up and constructing a connection
with the newly formed stomach pouch. The other end is
connected into the side of the Roux limb of the
intestine creating the "Y" shape that gives the
technique its name.
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The length
of either segment of the intestine can be increased to
produce lower or higher levels of malabsorption.
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Advantages
- The average excess weight
loss after the Roux-en-Y procedure is
generally higher in a compliant patient than
with purely restrictive procedures.
- One year after surgery,
weight loss can average 77% of excess body
weight.
- Studies show that after
10 to 14 years, 50-60% of excess body weight
loss has been maintained by some patients.
- A 2000 study of 500
patients showed that 96% of certain
associated health conditions studied (back
pain, sleep apnea, high blood pressure,
diabetes and depression) were improved or
resolved
Risks
- Because the duodenum is
bypassed, poor absorption of iron and
calcium can result in the lowering of total
body iron and a predisposition to iron
deficiency anemia. This is a particular
concern for patients who experience chronic
blood loss during excessive menstrual flow
or bleeding hemorrhoids. Women, already at
risk for osteoporosis that can occur after
menopause, should be aware of the potential
for heightened bone calcium loss.
- Bypassing the duodenum
has caused metabolic bone disease in some
patients, resulting in bone pain, loss of
height, humped back and fractures of the
ribs and hip bones. All of the deficiencies
mentioned above, however, can be managed
through proper diet and vitamin supplements.
- A chronic anemia due to
Vitamin B12 deficiency may occur. The
problem can usually be managed with Vitamin
B12 pills or injections.
- A condition known as
"dumping syndrome " can occur as the result
of rapid emptying of stomach contents into
the small intestine. This is sometimes
triggered when too much sugar or large
amounts of food are consumed. While
generally not considered to be a serious
risk to your health, the results can be
extremely unpleasant and can include nausea,
weakness, sweating, faintness and, on
occasion, diarrhea after eating. Some
patients are unable to eat any form of
sweets after surgery.
- In some cases, the
effectiveness of the procedure may be
reduced if the stomach pouch is stretched
and/or if it is initially left larger than
15-30cc.
- The bypassed portion of
the stomach, duodenum and segments of the
small intestine cannot be easily visualized
using X-ray or endoscopy if problems such as
ulcers, bleeding or malignancy should occur.
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