Laparoscopic Roux-en-Y Gastric Bypass

Dr. Michel Gagner has been an instrumental agent in the evolution of the Gastric Bypass (GB) procedure into what it has become today. His team performed the second GB while he was working at the Cleveland Clinic in "95, and was the first to perform a hand-assisted GB in "96. He brought forth multiple modifications that were adopted worldwide and have become standard: the use of an antecolic and antegastric limb in "96, the use of a split omentum in "96, and the use of trans-oral techniques. Dr. Gagner is also an experienced revisionist of the GB, being the first surgeon to convert both a gastric band and a VBG into a GB by laparoscopy in "96.

Gastric bypass combines gastric reduction and intestinal malabsorption to achieve weight loss. The procedure involves creating a small gastric pouch near the esophageal sphincter. The first part of the intestine is cut in two: the lower section (Roux limb) is attached to the newly-formed gastric pouch, and the upper section (Bilio-Pancreatic limb) is attached further down the Roux limb. Digestive juices from the excluded stomach and Bilio-Pancreatic limb flow into the Roux limb, thus constraining digestion and ingestion further down the intestinal pathway.

On average, the surgery takes one hour to complete; patients are discharged 1-2 days post-op, and return to work after 2-4 weeks.

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For more information:
International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)
ObesityHelp
NIH
WebMD

Advantages

  • Good weight loss
  • Good remission rate of diabetes
  • More long-term data

Disadvantages

  • Dumping syndrome (sweating, dizziness)
  • Hypoglycemia
  • Bowel obstructions
  • Lifelong need for vitamins and minerals
  • Increased rate of gastric ulcers

Risks

  • Ulcers, 5-15% in collective series
  • Bowel obstruction, 3-5% in collective series
  • Leakage, less than 1% in collective series
  • Bleeding, less than 1% in collective series

The process