Gastric Bypass Surgery: The Procedure
Gastric Bypass Surgery takes on average about two hours to complete and there are three basic steps involved.
The first step is the division of the stomach into two parts; a smaller upper portion called the proximal pouch, and a larger lower portion called the distal pouch. The proximal pouch, which will serve as the "new stomach", is significantly smaller than the original stomach (approximately 40 cc or about the size of an egg). It is created from the more muscular side of the stomach so that it will stretch less overtime and remain relatively small.
The second step is dividing the jejunum (the second section of the small intestines) approximately 50 cm beyond its origin and creating what doctors refer to as the "Roux Limb." The "Roux Limb" is brought up behind the distal pouch (larger portion of the stomach) and joined ("anastamosed") to the bottom portion of the proximal pouch. This new junction allows food entering the mouth to travel from the esophagus, into the proximal pouch and then, bypassing the larger portion of the stomach, directly into the jejunum. The larger portion of the stomach, now called the gastric remnant, is left inside the body for three reasons:
1) removing it would make the procedure riskier.
2) If the patient wants to reverse the operation the gastric remnant can be "hooked back up."
3) the secretions from it continue to assist the digestion of proteins, fats and carbohydrates.
The third and final step involves reconnecting the bowel (the first 50 cm of the duodenum and the jejunum called the "common limb" or "biliopancreatic limb") to the "Roux limb" in order to allow the juices of the stomach, pancreas, and liver to assist in digestion.
When the operation is complete, the newly configured digestive system allows food to bypass the distal pouch (larger portion of the stomach), the duodenum and a portion of the jejunum so that digestion can not occur in these areas. Instead, digestion occurs only where the "common limb" joins with the "Roux limb". Then, once the food enters the colon the body no longer has an opportunity to digest it. Since much of the food enters the colon undigested the patient losses weight.
When the operation is a success it provides an excellent means of long term weight control for people with serious obesity. Studies show that in the first two years after a successful gastric bypass, a patient will lose on average 2/3 to 3/4 of their excess weight.
Although some of this lost weight returns, studies indicate that 5 to 15 years after the operation, the patient will still tend to have 50% less of the additional weight. Many obesity related problems such as hypertension, diabetes, and sleep apnea generally improve dramatically with this weight loss. Patients who have undergone successful surgery generally report their quality of life has greatly improved and that they no longer experience the discomfort of the food cravings associated with dieting.
Unfortunately many people who do not need the surgery have the procedure as a quick fix for weight loss. The use of this risky procedure for people simply looking to lose weight has resulted in many unnecessary complications and deaths.
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