ROUX-EN-Y Gastric Bypass- FAQ

Roux-en-Y Gastric Bypass: A Combined Approach

The Roux-en-Y Gastric Bypass procedure combines restrictive and malabsorptve procedures and is the most popular technique, comprising 75% of bariatric surgical procedures. During the Roux-en-Y procedure, stapling is used to create a small supper-stomach pouch that restricts the amount of food able to be consumed. A portion of small bowel is bypassed, thus delaying food from mixing with digestive juices to avoid complete calorie absorption. In most cases, patients report an early sense of fullness, combined with a sense of satisfaction, that reduces the desire to eat.

Gastric bypass patients typically lose 60% of excess weight in the first year following surgery. Many health problems (back pain, sleep apnea, high blood pressure, type 2 diabetes, and depression) improve or are resolved following surgery.

A comprehensive clinical review of bariatric surgery data showed that patients (22,094 patients) who underwent a bariatric surgical procedure experienced compete resolution or improvement of their co-morbid conditions, including type 2 diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea.

Laparoscopic or Open Incision?

Weight loss surgery is performed in one of two ways. A laparoscopic procedure is performed by making several small incisions in the abdominal wall. A tiny video camera is inserted through one incision, letting the surgeon view the procedure on a video monitor. Small instruments, used to perform the surgery, are placed in the other incisions. No other incisions are necessary to complete the procedure. For this reason, laparoscopic surgeries are considered "minimally invasive" as compared to open surgeries. Patients who undergo laparoscopic gastric bypass surgery report experiencing less pain and the ability to breathe easier following surgery than patients who undergo an open procedure.

An open surgery involves a single vertical incision down the center of the abdominal wall. Although the size of the incision varies from surgeon to surgeon, it must be large enough to allow the surgeon to view the stomach and perform the procedure. Open surgery generally requires a longer hospital stay than laparoscopic surgery.

What Happens if the Operation Cannot be Performed or Completed by the Laparoscopic Method?

In a small number of patients, the laparoscopic method does not work effectively. Factors that may increase the possibility of choosing or converting to the open procedure may include:

• Obesity
• A history of prior abdominal surgery causing dense scar tissue
• Inability to visualize organs
• Bleeding problems during the operation

The decision to perform an open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open (conventional) procedure is strictly based on patient safety.

What are the Results of Weight Loss Surgery?

As the field of bariatric surgery continues to grow and develop, clinical outcomes have improved and numerous benefits have been noted. In contrast to usual morbid obesity treatments, at least two-thirds of patients who undergo gastric bypass surgery are able to keep off at least 50% of their excess weight for 10 years or longer. Weight loss surgery has been shown to influence dramatic improvement in life expectancy. Co-morbidities such as sleep apnea and hypertension are reduced, if not eliminated, following surgery.

Surgical treatment, although not without risk, is the most effective long-term treatment for extreme obesity when all other therapies have failed, and is likely to be used more widely given that the number of Americans with BMI > 40 has nearly tripled in the last decade. The actual weight a patient will lose is dependant on the patient's age, weight before surgery, overall health, ability to exercise, and adherence to dietary guidelines.

What Risks are Involved in Weight Loss Surgery?

As with any surgical procedure, weight loss surgery may present risks. Please consult with a physician to discuss which treatment is right for you. It is important that you discuss with your surgeon the specific risks for someone with your conditions and undergoing your specific procedure.

Potential Postsurgical Compications:

One or all of the collowing conditions and complications are possible following all types of weight loss surgery procedures discussed in the booklet, as well as for all types of gastric surgical procedures.

Potentially Serious Complications:

• Surgical: Perforation of stomach/intestine or leakage, causing peritonitis or abcess. Internal bleeding requiring transfusion. Severe wound infection - opening of the wound - incisional hernia. Spleen injury requiring removal/other organ injury. Gastric outlet or bowel obstruction.
• Pulmonary: Pneumonia-atelectasis (collapse of lung-tissue)-fluid in chest. Respiratory insufficiency-pulmonary edema (fluid in lungs). Blood clots in legs/lungs (embolism).
• Cardiovascular: Myocardial infarction (heart attack)-congestive heart failure. Arrhythmias (irregular heartbeats). Stroke (cerebrovascular accident, CVA).
• Kidney & Liver Failure: Acute kidney failure. LIver failure-hepatitis (may progress to cirrhosis).
• Psychosocial: Anorexia nervosa-bulimia. Postoperative depression-dysfunctional social problems. Psychosis.
• Death
• Other Complications (may become serious):
  • Minor wound or skin infection/scarring, deformity, loose skin.
  • Urinary Tract Infection.
  • Allergic reactions to drugs or medications.
  • Vomiting or nausea/inability to eat certain foods/improper eating.
  • Inflammation of the esophagus (esophagitis)-acid reflux (heartburn).
  • Low sodium, potassium, or blood sugar-low blood pressure.
  • Problems with the outlet of the stomach (narrowing or stretching).
  • Anemia-metabolic deficiency (iron, vitamins, minerals)-temporary hair loss.
  • Constipation-diarrhea-bloating-cramping-malodorous stool or gas.
  • Development of gallstones or gallbladder disease.
  • Stomach or outlet ulcers (peptic ulcer).
  • Staple-line disruption-weight gain-failure to lose satisfactory weight.
  • Penetration of foreign material (e.g., band, ring) inside of stomach.
  • Intolerance torefined sugars (dumping), with nausea, sweating, weakness.

Important Considerations

Surgery should not be considered until you and your doctor have evaluated all other options, The proper approach to weight loss surgery requires careful consideration and discussion of the following with your doctor:

• Weight loss surgery is in no way to be considered as cosmetic surgery. The procedures do not involve the removal of fatty tissue. by cutting or suction.
• A decision to elect surgical treatment requires an assessment of the benefits and risks to the patient and the meticulous performance of the appropriate surgical procedure.
• The weight loss surgical procedures are not reversible.
• The success of weight loss surgery is dependant on long-term lifestyle changes in diet and exercise.
• Problems may arise after surgery that may require reoperation.

Important Considerations

The decision to have surgery should be made only after careful consideration and consultation with an experienced bariatric surgeon or a knowledgeable family physician.

• Before being approved for bariatric surgery, it is likely you must:
• Demonstrate serious motivation for weight loss.
• Have a clear understanding of the surgical risks.
• Be prepared to make a lifelong commitment to strict dietary, exercise, and medical guidelines.

To begin the journey that could transform your health, first talk to your primary care physician. Ask about free information sessions for people living with morbid obesity who are considering the surgery, These sessions usually are conducted by an experienced bariatric surgeon who can thoroughly explain the procedure and answer your questions.

For more information, consult your physician or visit www.BariatricEdge.com.