Laparoscopic Roux-En-Y Gastric Bypass

The Roux-En-Y Gastric bypass was one of the earliest successful operations for combating intractable morbid obesity. It was first developed in the last 1960’s and has undergone many improvements over the 50+ years. The biggest improvement has been the ability to perform this surgery laparoscopically. Dr. Scott Shikora, Director, Brigham and Women's Center for Metabolic and Bariatric Surgery (CMBS), performed the first successful laparoscopic gastric bypass in New England in 1998. He and his fellow surgeons at CMBS have cumulatively performed several thousand, one of the largest experiences in the region.

The gastric bypass procedure involves the creation of a very small stomach section (we call it the “Pouch”). This is accomplished by separating the top part of the stomach off of the rest of the stomach. The pouch is intentionally created to be very small, about the size of an egg or infant’s stomach. The intestine is then connected to the pouch so that the food eaten travels into the pouch and directly into the small intestine where it is digested and absorbed. After gastric bypass, food can no longer go into the big part of the stomach (the “Bypass”).

The gastric bypass has been shown to help patients achieve significant and sustainable weight loss by several actions. The small pouch can only hold a small amount of food so patients eat less. The bypass aspect stimulates hormones that reduce appetite and improve diabetes. It can also cause patients to feel sick when they eat rich foods like sweets and junk food; this is a phenomenon referred to as “Dumping Syndrome". Weight loss after gastric bypass is typically in the range of 65-75% of excess weight (approximately 30-40% of total body weight). With proper behavior and follow up, 75-80% of patients will maintain that weight loss indefinitely.

Like all major gastrointestinal operations, the gastric bypass does have risks associated with it. However, with experienced surgeons, those risks are dramatically less. Recently the risk of death from the procedure is less than 2 out of every thousand patients or about the same as gallbladder surgery. Potential complications include bleeding, leakage, blood clot, bowel obstruction, hernias, and vitamin deficiencies.

In addition to the weight loss, the gastric bypass has been praised for the improvement patients will see in their overall health. Patients whom are successful will benefit from improvements, and even remission or resolution, of many of their health conditions including type 2 diabetes, high blood pressure, severe heartburn, shortness of breath, and sleep apnea. What is most exciting is that many people with type 2 diabetes will be off their pills within 48 hours after their surgery. Therefore, patients with diabetes in particular should strongly consider having the bypass over the band.

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