Laparoscopic Gastric Bypass

The gastric bypass was initially developed based on the weight loss observed among patients undergoing partial stomach removal for ulcers. The gastric bypass has been modified into its current form, using a Roux-en-Y limb of intestine (RYGBP). The “Roux-en-Y” connects a limb of intestine to a very small stomach pouch of the stomach, and the remaining stomach and first segment of small intestine are bypassed. Because the bypassed portion of intestine is where the majority of calcium and iron absorption takes place, anemia and osteoporosis are the most common long-term complications of the RYGBP. Therefore, lifelong mineral supplementation and follow up is mandatory.

The RYGBP has been proven in numerous studies to result in durable weight loss and an improvement in weight-related medical illnesses including diabetes mellitus of the adult onset type (so-called insulin resistant), hypertension, high cholesterol, arthritis, venous stasis disease, bladder incontinence, liver disease, certain types of headaches, heartburn, sleep apnea and many other disorders.

There are two reasons people lose weight with the bypass. One is partially due to alterations in several hormones (ghrelin, GIP, GLP, PYY) and neural signals produced in the GI tract that communicate with the hunger centers in the brain. Another mechanism for weight loss after the RYGBP is referred to as the dumping syndrome. Dumping may result in lightheadedness, flushing, heart palpitations, diarrhea and other symptoms early (within 10 to 30 minutes) after eating sweets or foods with a high concentration of sugar.

Advantages of RYGBP

• Better weight loss than after purely restrictive procedures
• Low incidence of protein-calorie malnutrition and diarrhea
• Rapid improvement or resolution of weight-related comorbidities
• Appetite reduction

Complications of RYGBP

Early

• Anastomotic Leak
• Pulmonary embolism
• Wound infection
• Gastrointestinal hemorrhage
• Respiratory insufficiency
• Mortality

Late

• Incisional hernia
• Bowel obstruction
• Internal hernia
• Stomal stenosis
• Micronutrient deficiencies
• Marginal ulcer