This operation is an adaption of the traditional Roux-en-Y Gastric Bypass (RYGB).
There is less operative risk involved as only one anastomosis (or bowel join) is performed rather than two, as performed in the RYGB.
Although more high-risk than the sleeve gastrectomy, it has a more acceptable long-term complication when compared to the RYGB and avoids such problems as internal herniation of abdominal organs.
This operation may lead to more weight loss than the sleeve gastrectomy, with approximately 75 to 85 percent excess weight loss reported due to malabsorption of nutrients. Accordingly, more intense post-operative surveillance is required long-term to avoid the complications of malnutrition.
Once a general anaesthetic has been administered, five key-hole ports are inserted into the patient’s abdomen. After confirming no hiatus hernia is present, the operation begins by dividing the lesser omentum (a strip of fat between the stomach and liver), allowing a stapler cutting device to be placed across the lesser curve of the stomach. This helps to create the new gastric pouch which is then stapled and divided away from the rest of the stomach over a calibration tube in order to ensure that the correct size is obtained.
While the remainder of the stomach is not removed in this procedure, it is now disconnected from the main of passage of food.
The first 200cm of small intestine is measured and bypassed, at which point the bowel is pulled up to the new small gastric pouch and joined to it using a combination of the stapler and laparoscopic sutures. A double of layer of sutures are placed in order to prevent a leak.
In the newly created gastrointestinal circuit, food passes from the oesophagus to the pouch, then through the join to the intestine where it meets bile and pancreatic juice. It then only has a small amount of intestine to travel where absorption can occur before it reaches the colon. The first 200 cm of bowel is bypassed.
All wounds are closed, with buried dissolvable sutures and local anaesthetic injected to numb the port sites. Photo documentation is taken throughout the case in order to show our patients step-by-step how their procedure went.
As the stomach is now much smaller, a person’s appetite is significantly reduced and portion size greatly diminished. In addition, bypassing 200cm of small intestine means not as many calories are able to be absorbed in the short amount of intestine that the food travels down before reaching the colon. This leads to substantial weight loss over a 12 to 18-month period, over which time an average of 75 to 85 percent of excess weight is loss. For some patient, this reaches 100 percent.
A full blood panel is required every 6 months for the rest of the patient’s life, as early detection of nutrient deficiencies is essential with gastric bypass surgery. Rapid decline in Vitamin D, Calcium, Vitamin B12 and iron stores can lead to anemia, osteoporosis and loss of sensation in the hands and feet.
Our allied health program will advise you in adapting your eating technique and the supplement requirements in order to get the most out of your gastric bypass and achieve long-term lifestyle change.