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Combined Restrictive & Malabsorptive Procedure - Gastric Bypass Roux-en-Y
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. 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. The length of
either segment of the intestine can be increased to produce lower or
higher levels of malabsorption.
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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