What Is Gastric Bypass Surgery?

Gastric bypass surgery is a permanent gastric-restrictive procedure. The most common procedure performed in the United States is the Roux-en-Y gastric bypass, in which a stomach pouch is created. During Roux-en-Y gastric bypass, the stomach is divided just below the esophagus to create two separate stomach compartments. The small intestine is surgically divided to create a “Roux-en-Y” and none of the intestine is removed.

The lower stomach is closed and heals permanently, but it still continues to produce digestive fluids, secretions, and enzymes. Digestive secretions will flow through the first section of intestine and combine with food for normal digestion and absorption.

The second section is connected to the newly created stomach pouch. The point of connection is called an anastomosis. The stomach to intestine anastomosis is small, so that solid foods will stay in the stomach longer. This causes a sensation of fullness before the food slowly empties into the intestine through the newly reconstructed opening. Because appetite is reduced, the drive to eat more than the body needs is finally eliminated.

The two sections of the small intestine are rejoined to form a common limb. The anastomosis of intestine to intestine is wide so food can pass easily. At the point of this anastomosis, digestion occurs normally since pancreatic enzymes and bile from the first section has traveled down the Roux limb.

Here at Bay Bariatrics, we perform both the laparoscopic Roux-en-Y gastric bypass and the open Roux-en-Y gastric bypass. These surgeries are the same, with the exception of the incision. During open Roux-en-Y gastric bypass, a large incision is made in the abdomen, while the laparoscopic method requires several small incisions. The laparoscopic surgery is performed with small instruments, and a camera is used to guide the surgeon. Not all patients are candidates for the laparoscopic method, so you will need to discuss your options with Dr. Tersigni.

There are several benefits to laparoscopic Roux-en-Y gastric bypass, including:

• Less time in the hospital
• Quicker recovery time
• Less time off work
• Less post-operative pain
• Reduced risk of hernias and wound infections
• Smaller scars

How Does The Gastric Bypass Surgery Work?

The surgery accomplishes its goal in two ways: First, it reduces the size of the stomach. Second, it bypasses a portion of the small intestine.

An individual’s stomach has the ability to hold a great deal of food, about two to three quarts in capacity. This allows a higher caloric intake than can be expended in energy per day. These extra calories are then stored as fat. The gastric bypass surgery uses about 3 percent of the stomach, creating a one-ounce size pouch. This allows you to achieve a feeling of being full while eating smaller portions. The result is a decrease in caloric intake, which in turn results in weight loss. Eventually the one-ounce pouch grows to hold about five-and-one-half ounces. This allows for three small meals a day without further weight loss.

Bypassing a portion of the small intestine also helps in creating weight loss. Most fat that is eaten is absorbed in the small intestine. Bypassing a portion of the small intestine decreases absorption of fat, therefore creating further weight loss. Because the small intestine also absorbs protein, many patients will be protein deficient the first year. It is therefore extremely important that patients follow the dietary regime which includes an intake if at least 50 grams of protein a day.

Is Gastric Bypass Surgery Right For You?

The primary goal of Dr. Tersigni and his staff at the Bay Bariatrics is to improve your health. We want you to achieve excellent results and meet your goal of better health and quality of life through significant weight reduction. We also want you to make an informed decision about taking this step by being aware of the responsibilities, possible complications, and benefits of surgery. Should you elect to have gastric bypass surgery, you will receive dietary, exercise, and behavior modification guidelines to assist you. The tools and support are designed to help you achieve success and experience the “rebirth” of losing weight and maintaining your long-term goals.

Before you make a decision about bypass surgery, we also suggest discussing the pros and cons with a family member, friend, or former patient. Attending a support group meeting is a good way to meet others who have had the procedure, and they can give you a first-hand account of what to expect. Meetings are held monthly at North Bend Medical Center on the third Tuesday at 7:00 p.m. in the conference room on the second floor. It is important that you learn everything you can so that you have a realistic view of the surgery and lifestyle changes you will need to make.

If you have any further questions, please write them down and bring your list with you to your consultation appointment, and we will do our best to answer all of your questions.

Additional Procedures

In addition to laparoscopic Roux-en-Y gastric bypass and open Roux-en-Y gastric bypass, Bay Bariatrics offers the following bariatric procedures:

• Laparoscopic Adjustable Band
• Open Biliopancreatic Diversion
• Open Duodenal Switch
• Revision Bariatric Surgery

Laparoscopic Adjustable Band

Laparoscopic adjustable band is the simplest form of weight loss surgery because it does not alter the body’s anatomy. During laparoscopic adjustable band surgery, a band is wrapped around the stomach to create a small pouch in the upper part of the stomach. The band turns the stomach into an hourglass shape and leaves a narrow passage from the pouch to the lower section of the stomach. The food you eat fills the pouch then empties slowly through the narrow passage created by the band, similar to sand gliding through an hourglass. This reduces the amount of food you can eat at one time while keeping the normal progression of digestion.

The band causes you to experience a feeling of being full after eating a small amount of food. The feeling of fullness should last for several hours, which reduces the desire to eat between meals.

There are several advantages of laparoscopic adjustable band surgery, including:

• This method is less invasive than other methods. Because the stomach is not cut, stapled, or opened, there is less risk of infection and less pain after surgery.
• Shorter hospitalization
• This surgery can be individualized to your own weight loss needs by expanding or deflating the band
• This type of weight loss surgery can be easily adjusted or even reversed
• Because the procedure is done laparoscopically, there are smaller scars and shorter healing times

Open Biliopancreatic Diversion

During open biliopancreatic diversion, a portion of your stomach will be removed and connected to the lower section of the small intestine, restricting food intake and reducing acid output. The small intestine is then divided to create limbs. The "alimentary limb" is attached to the stomach pouch. All of the food moves through this segment, but not much is absorbed. The "biliopancreatic limb," which is connected to the side of the intestine, is where the bile and pancreatic juices move through. Digestive juices are then supplied to the portion of the intestine called the "common limb." Biliopancreatic diversion allows for less absorption of ingested food inside the intestine. This will help you feel full more quickly and reduce the amount of food (and calories) you consume. Dr. Tersigni performs this procedure with the open method, meaning a large incision will be made in your abdomen.

Open Duodenal Switch

During the open duodenal switch procedure, three-quarters of the stomach is removed. The duodenum (the first part of the intestine) is disconnected and replaced with another part of the small bowel (the jejunum). This restricts food intake and limits the amount of calories that are absorbed.

Revision Bariatric Surgery

Dr. Tersigni performs revision surgery for those patients who have had complications or unsatisfactory weight loss. Revision surgery is associated with more risks than general bariatric surgery, so it is important to discuss your options with Dr. Tersigni before making the decision to have revision surgery.

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