ROUX-EN-Y GASTRIC BYPASS
By Dr. Norman Samuels, Fort Lauderdale, Florida, USA

Modern obesity surgery involves operations on the stomach, which are designed to permanently reduce food intake and thus result in loss of weight. These operations tend to produce a feeling of fullness or satiety so that the individual will have much less appetite and feel full with very much less food. The two (2) operations most commonly done, and approved by the National Institute of Health (USA) in a consensus statement issued in 1991, are the Vertical banded Gastroplasty and the Roux-en-Y. Gastric Bypass. Other operations are also performed less commonly. 

The Vertical Banded Gastroplasty (VBG) is purely restrictive, meaning that it is an operation simple in concept, which produces a small pouch within the stomach with a banded opening leading into the remainder of the stomach. Solid food makes the person feel full, whereas liquids tend to pass through much more easily. Unfortunately, this operation does not produce as much weight loss as the Gastric Bypass, there tends to be a late weight gain and a common problem is vomiting because food does not pass easily through this small opening and therefore backs up. In addition, it has been found that another possible complication is a disruption or opening up of the staple line, so that food empties into the main stomach without passing through the banded opening. 

Because of the above, I no longer recommend VBG. The Roux-en-Y. Gastric Bypass also is performed by making a small pouch in the upper part of the stomach. To this a section of small intestine is joined and the food passes directly from the small pouch into this intestine. The remainder of the stomach empties through the small intestine into the intestine that has been joined to the stomach. The excluded stomach contains acid and gastric juice only, and this together with bile passes down the small bowel joining the food and thus helping to digest it. The excluded and unused portion of stomach remains unchanged, because it has a normal blood supply. 

Because of the risk of the staple line breaking down I divide the stomach so that the pouch is totally separate from the stomach and I also place a portion of the small intestine between the two portions of stomach to separate them. There is a band placed around the stomach as well. This band is much wider than the usual vertical banded gastroplasty band and therefore does not tend to cause vomiting. It does however produce a smaller pouch above the band and controls the opening out of this pouch in case the opening into the intestine should enlarge. Because of all the above, weight loss is much better with the Roux-en-Y. Gastric Bypass and people can eat much more normally with very little likelihood of vomiting. The quality of life is excellent and there is a good chance of reaching and staying at your ideal weight. Average weight loss with the Gastric Bypass is approximately 70% of the excess weight.

In addition, sugar passing through into the small intestine tends to produce a feeling of nausea or pain, and because of this, eating sugar is greatly discouraged and thus also helps in weight loss.

Because of the band being placed, this is considered to be a double operation combining  the features of Gastric Bypass and Vertical Banded Gastroplasty.

The diet I recommend following Gastric Bypass is a common sense diet without weighing or measuring foods. You should eat three small meals a day without drinking with meals as the pouch will not hod liquid and solid at the same time. All liquids should be calorie free. Essentially your diet dhould be protein, meaning meat, fish, egg or fat free cheese as well as fresh fruit, green vegetables and salads. Fat and sugar should be avoided and starch should be mainly in the form of fruit or vegetables.

It is possible following the Gastric Bypass to develop a lactose intolerance. This means milk or milk products such as cheese may cause diarrhea. This is not very common, but can easily be managed by avoiding these foods or using Lactaid. Following a Gastric Bypass certain nutrients are not absorbed as well. In particular, these may be fat soluble vitamins, such as vitamin A, D and K, iron, calcium and vitamin B12. Because of this you should take a multivitamin with minerals as well as extra iron, and calcium in the form of Tums following this surgery. These should be taken permanently.

You should be aware that any surgery may have complications, and this is major surgery. Specific complications will be discussed further with you, but it is possible that death may result and the risk of death is approximately 1 in 300. You should therefore carefully weigh the benefits versus the risks. You should consider whether you have any alternative way to lose weight. Usually, if you are 100 lbs or more overweight, it is impossible to lose weight and keep it off by any means. If you do not have surgery you will probably continue to gain weight and develop other complications of obesity, which may seriously affect your health and may shorten your life. The decision to undergo the surgery should not be taken lightly as it is intended to be permanent and for life. The changes which it can produce in your life are generally very positive, but you should fully consider all the implications.

You should be aware that certain medications may cause bleeding during surgery and should not be taken after surgery, because they may cause ulcers. These medication, if taken, should be stopped at least 2 weeks before surgery. They are Aspirin, Motrin (Ibuprofen), Aleve and any other non-steroidal anti-inflammatory drugs such as Indocin, Clinoril, Naprosyn, and many others.

In addition, Cortisone, Hydro-Cortisone, Prednisone and other Steroids also interfere with healing. Tylenol and prescription drugs such as Darvocet are safe to take for pain relief. Please discuss any other medications you may be taking with me prior to surgery.

One final comment. Many people have heard of the old intestinal bypass or jejuno-ileal bypass and should be aware that this operation is obsolete because it caused serious problems including diarrhea.  The Gastric Bypass is not the same as this old operation and ordinarily will not cause diarrhea. Nor does it cause the serious problems that the old intestinal bypass did cause. See side effects for further information on possible complications.

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