Roux en Y gastric bypass

Definition

Definition of By – Pass Gastric en Y . Laparoscopic Roux-en-Y gastric bypass (RYGB) 

  • Why choose the By-pass in 7 points

  • The gastric by-pass is the intervention of reference (standard gold) as regards morbid obesity
    1 the gastric By-pass is the bariatic surgery most effective in terms of result on the weight loss
    2 After gasticablation  of a band (rate dent of the by-pass is lower compared to the sleeve)
    3 After failure of a sleeve gastrectomy (rate dent of the  by-pas is lower comprared to the sleeve)
    4 after sleeve gastrectomy of the super obèse IMC above 50kg/ m2
    5 for the obèse patient who suffers from a RGO (by-pass = better treatment of the backward flow report to the sleeve)
    6 for the obèse patient with diabetes (by-pass better treatment of the diabetes )
    7 for the obèse patient with rather anarchistic food disorders like nibbling and drinking large quantities of sodas (dumping syndrome)

 

 It is about an intervention of major surgery with risks and side-effects.

It obliges you with deep changes in your practices of life.

  • Important
  • Before choosing gastric Gastric By-pass, it is important to understand what that implies and which are the changes of life which you will have to make.

  • Definition By – Pass Gastric en Y. Laparoscopic Roux-en-Y gastric bypass (RYGB) 

  • Gastric By-pass consists in creating a small gastric pocket in which the food arrives. This pocket has a very reduced capacity.
  • It is connected directly to the jejunum (handle in there): the food passes in the intestine by shorting-circuit most of the stomach, the duodenum and the jejunum.
  • The By-pass allows the reduction of the caloric intake and also of the absorption of the nutritive substances. It is about a surgery for mixed purpose: restriction and malabsorption.

Laparoscopic gastric bypass

 

The weight loss is explained by 4 mechanisms

  • Small of the gastric pocket (30-50 DC).
  • Malabsorption whose importance varies according to the length of the excluded jejunum.
  • Reduction of the rate of the hormone ghréline.
  • Dumping syndrome associated with ingestion with sweetened food (Malayan, diarrhoeas, sudation).
  • At the obese patient with rather anarchistic food with sweetened nibbling and concept of assumption of great quantities of sodas (“dumping syndrome “).
 Définition by pass gastrique par laparoscopie Dr Vincenzo Salsano Montpellier dernière mise à jours Novembre 2016
 
 

Advantages and disadvantages

Advantages and disadvantages

 

Advantages of By-Pass

  • Important weight loss.
  • Fast improvement of quality of life.
  • Food comfort is better than with the gastroplastie (rare vomiting).

Evaluated results with long terms

  • Ponderal loss 5-10 years from distance.
  • 60-70% (% excess of lost weight).
  • Remission of the diabetes.
  • Control of other pathologies related to obesity.
Disadvantages of By-Pass
  • Surgery technically more difficult = operational time remains short in a “expert operator “.
  • Risk of vitamin deficiencies = reduction in the digestion of the “liposoluble” vitamins (vitamins A, D, E K), of the vitamin B12 and certain nutrients and oligo elements.

Complications

Complications

The diffuclty of this surgical procedure is in the performance of two laparoscopic intestinal sutures (anastomosis).

Mortality is 0 to 1%.

Immediate post-operative complications

  • Fistulas (leaking from the suture line) : 1 to 3%
  • Hemorragies : 1%.

 

Late complications

  • Anastomotic ulcer : 4 %.
  • Gastro jejunal anastomosis stenosis : 2%.
  • Internal hernia (intestinal occlusion) : 2,5 %.
  • Gallbladder stone.

 

Metabolic Complications

  • Nutritional deficiencies.
  • Hypoglycemia after the meal (dumping syndrome).

Results

Results of Gastric By-Pass

The percentage of loss of the excess of weight obtained in the medium term is important (%EWL = 90%) and is maintained stable at five years with a low rate of side-effects (10-15%).

 

  • With your small pocket of stomach (volume of 50cc), you will eat modest amounts with each meal.
  • To eat too much or too quickly can cause vomiting or an intense pain.
    The quantity of food which you will be able to consume will increase gradually but remain always weak.
  • The long-term weight loss after the gastric by-pass depends on your commitment. It is necessary to maintain the changes of your dietary habits and to do physical exercise.
  • The improvements observed in the diabetes of the type II, arterial hypertension and the hypercholesterolemy can decrease your risks considerably to have a heart attack or a stroke.

The long-term final result will depend on the maintenance of a good hygiene of life, so much on the food level (the food with vegan trend is stated) that on that of the physical-activity