Laparoscopic Roux-en-Y gastric bypass

• Laparoscopic Roux-en-Y gastric bypass
• Laparaoscopic gastric banding
• Laparoscopic sleeve gastrectomy

With the Surgical Obesity Service, the Roux-en-Y gastric bypass procedure is usually performed laparoscopically (i.e. keyhole surgery with a telescope); however in some cases it may be necessary to perform an open procedure. This type of bypass operation has proven to be an effective, consistent way of losing weight and keeping it off.

In this gastric bypass operation, the stomach is completely divided with a stapler to leave a pouch that initially measures only 25mls. The small bowel is divided and the divided end brought up and joined to the small stomach pouch. The other small bowel end is joined back on to the small bowel about a metre down from the stomach. Thus the whole stomach is bypassed apart from a tiny pouch. This operation works in two ways:

1. The small pouch creates a sense of fullness early so that only a small amount of food can be taken in at any sitting.
2. When undigested high fat or high sugar food passes into the small bowel, it causes significant symptoms ( nausea, sweaty, clammy and dizzy feelings called dumping), putting people off eating the wrong sort of foods.

When performed laparoscopically, most patients stay in hospital 3 nights and are back at work in two weeks.

Advantages:

Effective weight loss operation in most patients (although where patients end up is always dependent on how they use the tool they are given)

• More rapid weight loss than banding
• Dumping offers a useful deterrent to eating high calorie food and drinks
• Long track record- the operation has been around in various forms for 30 years
• There is nothing to break or erode

Disadvantages:

This procedure has a slightly higher serious complication rate than some of the other operations (i.e. gastric banding) because of the bowel joins. There is a need to take oral supplements of iron, vitamins and calcium for life, and some patients also need Vitamin B12 injections. Recovery time slightly longer than after banding

Risk information:

All surgery has risks, especially major surgery. Any stomach operation for obesity is considered major surgery, and therefore has significant risks associated with it.

People have died from having operations for morbid obesity - it happens rarely, but we can never take away the risk completely. If you are older and if you already have certain problems related to your obesity, your risk will rise. Being male, and having a BMI greater than 50 also increases the risk.

The two major events causing death in international series are:

• Pulmonary embolus- clots that form in the leg veins and then pass to the lungs
• Leakage of the joins between the stomach and the bowel, or the bowel and the bowel.

In addition, if you already have heart or breathing problems, these could be exacerbated by surgery.

Less serious complications can also occur:

• Narrowing at the join between the stomach & the bowel can occur in 5% of patients 4-6 weeks after surgery and requires a gastroscopy to dilate the join up again.
• Gallstones may develop in 16% of patients any time after surgery & may need removing by another lapaorscopic operation.
• Bleeding requiring transfusion
• Wound infections

Rarely, bowel can herniate through spaces created during the operation, causing obstruction Ulcers can occur at the join between the stomach and the small bowel.

These complications are all treatable & do not change the weight loss achieved.

Rapid and significant weight loss often results in excess skin folds. If these become an issue, they may require further plastic surgery to remove. We can recommend excellent plastic surgeons throughout New Zealand.

We do everything we can to keep complications to a minimum, as will be explained if you have a consultation. We keep a constant audit of our results- please ask for any further information you may require regarding complication rates.