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Programs and services : Weight-Loss Surgery : FAQ : Surgery

Sanford Weight-Loss Surgery

Surgery

What is Roux-en-Y gastric bypass surgery?

In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach with surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine.

What does Roux-en-Y mean?

The Roux-en-Y (pronounced roo-in-Y) procedure is named partly after a 19th century French surgeon, Dr. Phillibart Roux, who initially introduced the idea of bypass surgery. After surgery, the stomach and intestine form a Y shape—one branch of the Y is the short intestinal limb and the other is formed by the duodenum. Refer to image above.

What's the difference between Roux-en-Y gastric bypass surgery and lap-banding?

In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach with surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. Gastric bypass surgery limits food intake as well as absorption of calories and nutrients.
  • Most patients lose 50—80 percent of their excess weight in about one year.
  • Surgery cannot be reversed.
  • Gastric bypass surgery is considered the gold standard of weight loss surgery.
Lap-banding is a restrictive surgical procedure in which an adjustable band is placed around the upper part of the stomach. The band divides the stomach into two parts, one smaller and one larger, causing patients to feel full faster. If the rate of weight loss is not what it should be, the band can be adjusted by a doctor.
  • Patients lose roughly 47 percent of their excess weight.
  • Surgery can be reversed.

Who qualifies for surgery?

Surgery candidates are people that are 100 pounds or more over their ideal weight with a BMI of 40 or higher, ages 18—65, are not drug or alcohol dependent and who are able to comply with post-surgery requirements.

How small is the stomach pouch after surgery?

The pouch is usually about one ounce or one to two tablespoons.

Can the pouch stretch?

Yes, but not significantly unless abused by frequent vomiting or overeating.

What happens to the stomach that's bypassed?

It remains attached to the neighboring organs. The acid and fluid secretions are significantly decreased. It doesn't have a function, but remains in the body.

What is the success rate of Roux-en-Y surgery?

It is 95 percent effective with greater than 80 percent of excess weight lost that is maintained for more than 10 years.

Are staples used in gastric bypass surgery?

Yes, staples are used for cutting the stomach and the small bowel. Clips are also used to control bleeding. However, it is not a gastric stapling procedure or "stomach stapling."

How long does the Roux-en-Y procedure take?

Approximately one hour. The short surgery time also decreases the time you spend under anesthesia, therefore decreasing the possibility of complications.

Does this surgery require a blood transfusion?

Typically not, but with any surgery there is a chance of having a transfusion if the need arises.

What are possible complications after surgery?

Possible complications include pre-operative, intra-operative, post-operative and late complications.

Pre-operative complications include but are not limited to anxiety attacks, mood swings, allergic reactions to pre-operative medications and problems with anesthesia. Intra-operative complications can include but are not limited to bleeding, injuries to various intra-abdominal structures or organs, hypotension, hypertension, cardiac arrhythmia, cardiac arrest, aspiration and death.

Post-operative complications include bleeding, infections, leaks, lung collapse, pneumonia, thrombophlebitis, blood clots to the lungs, nausea, vomiting, watery stools, difficulties breathing without a respirator, back pain, numbness, difficulties passing urine, outlet obstruction and bowel obstruction.

Long term related complications include but are not limited to hair loss, depression, gastro-gastric fistula, bowel obstruction, ventral hernias, cholelithiasis, alopecia (hair thinning), anorexia with excessive weight loss, inadequate weight loss, fat soluble vitamin A, D, and E deficiencies, Calcium, Iron, B 12, and folic acid deficiencies, osteoporosis and anemia. The nutrient deficiencies can either be prevented or corrected. There are occasional problems with certain types of food intolerance, resulting in dumping, diarrhea and hypoglycemic attacks.

What is the mortality rate?

One in 200 patients dies within the first 30 days after the operation from various causes. The most common cause is pulmonary embolism (blood clot in the lungs). This can be prevented by walking and moving around as much as possible following surgery to promote blood flow.

What is sleeve gastrectomy?

Sleeve gastrectomy is an innovative new weight loss surgery procedure that results in weight loss through restriction.

During surgery, a small portion of the stomach is stapled to make a tube or sleeve. The rest of the stomach (around 85 percent) is removed. This part of the surgery is not reversible. The procedure is usually performed laparoscopically, even in patients weighing more than 500 pounds.

Benefits:

  • The intestine is not bypassed in this procedure, reducing the possibility of vitamin and protein deficiency.
  • The pylorus is preserved, reducing the chance of dumping syndrome.
  • The simplicity of the procedure reduces risk of leaks.
  • This surgery is effective as a first-stage procedure for patients with high body mass indexes. Once weight is reduced to a level safe to perform gastric bypass or lap band surgery, the sleeve gastrectomy can be converted to one of those options.
  • This surgery reduces the stomach’s capacity but allows it to function normally.

Disadvantages:

  • Some patients experience inadequate weight loss compared to gastric bypass and lap band surgery.
  • Patients who have a high BMI before this procedure may require a second procedure down the road to help lose the rest of their excess weight.
  • About one third of patients who undergo a sleeve gastrectomy have a second surgery to increase the amount of weight lost.

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