Roux-En-Y surgery can be performed in two ways. In an open procedure, a large incision is made in the stomach. In a laparoscopic procedure , doctors make three to six small incisions and use tiny instruments and a camera to perform the surgery.
The Roux-En-Y procedure has multiple advantages:
- Rapid weight loss . Patients lose an average of 77 percent of excess body weight a year after surgery.
- Proven long-term track record . Studies show that after 10 to 14 years, patients have still lost 60 percent of their excess weight.
- Reduced co-morbidities . The procedure has been shown to significantly reduce other conditions related to obesity, including high blood pressure , Type II diabetes and sleep apnea.
- Reduced desire to eat . Patients often report that they get fuller, faster – and are still satisfied. So they're less likely to eat too much.
Complications include vitamin and mineral deficiencies, especially iron, calcium, and B12; chronic anemia; osteoporosis due to reduced calcium absorption; “dumping syndrome,” which occurs when foods high in sugar or fat enter the small intestine and cause cramps, nausea, vomiting, bloating, sweating and a racing heart; gallstones and hernia; and potential leakage of the connection between the pouch and the intestine.
Adjustable Gastric Banding
This procedure is designed to restrict and reduce your food intake without interfering with the body's normal digestive process. A hollow silicon band is placed around the upper part of your stomach, creating a small pouch and a narrow passage into the stomach. The pouch can only hold a small amount of food, usually just an ounce initially; the narrow passage slows the emptying of food into the rest of the stomach, causing you to feel fuller for a longer period of time.
The diameter of the band can be adjusted to increase or decrease the amount of food that enters the stomach. This is done by inflating or deflating the band with a salt water solution introduced through an access port placed under the skin near your breastbone. Adjustable gastric banding can be performed in two ways:
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In an open procedure, a large
incision is made in the stomach. |
In a laparoscopic procedure, doctors make three to six small incisions and use tiny instruments and a camera to perform the surgery. |
Adjustable gastric banding is safe and effective, with advantages that include:
- Proven success. Patients who underwent the procedure lost about 50 percent of their excess body weight within two years, and the typical weight loss after three years was more than 36 percent. In some cases, patients lost up to 87 percent of excess weight.
- Reversibility. Unlike some other bariatric procedures, the surgery can be reversed.
- Normal digestion and absorption. The procedure does not affect how the body digests food and absorbs vitamins, minerals and other nutrients.
- Less impact on the anatomy. Adjustable gastric banding does not require the opening or removal of any part of the stomach or intestines.
- Shorter recovery periods. Because there is less impact on the internal organs, patients recover more quickly.
Among the potential complications associated with adjustable gastric banding are tearing in the stomach or gastric perforation, which could require another operation; leakage or twisting of the access port; nausea and vomiting; slippage of the band; obstruction of the passage between the pouch and the stomach; and enlargement of the pouch.
Bariatric Revisions
Bariatric (or weight loss) surgery has been performed for many years. Unfortunately, unlike the gastric bypass and adjustable gastric banding, a number of operations were performed with only short-term success or significant complications. Some examples of these operations include VBG (vertical banded gastroplasty) and nonadjustable gastric bands.
Our surgeons at Memorial Hermann-Texas Medical Center perform revisions, either open or laparoscopically, on those individuals who are having complications from their previous weight loss surgery. Indications for revisions are:
- Persistent nausea
- Persistent vomiting
- Pain
- Severe recurrent or persistent morbid obesity with major obesity-related comorbidities
Laparoscopic Surgery
In the laparoscopic approach, surgeons make a series of three to six tiny incisions in the abdominal wall rather than the larger breastbone-to-navel incision required in the open approach.
A small camera and tiny surgical instruments are then inserted. This enables doctors to operate while viewing the procedure on a separate video monitor that provides a magnified view of the abdominal area.
Laparoscopic procedures can be used in Roux-En-Y and adjustable gastric banding, among others. While the long-term results of laparoscopic surgery are comparable to those of the open approach, not everyone is a candidate for the operation. Your doctors will decide which approach is best for you.
The laparoscopic approach offers significant advantages over open surgery:
- Less post-operative pain . Studies show that patients experience less pain after laparoscopic surgery, resulting in easier breathing and higher oxygen levels.
- Fewer complications . The laparoscopic approach minimizes infections, incisional hernias, adhesions, bowel obstruction, and the potential that a surgically closed wound will burst open.
- Better cosmetic appearance . The tiny incisions are less noticeable after they have healed.
- Shorter hospital stays . Laparoscopic Roux-En-Y typically only requires two days in the hospital; adjustable gastric banding often requires just an overnight stay.
- Faster recovery . You may be able to return to your everyday activities in as little as 10 to 14 days.
As with open procedures, there are some risks associated with the laparoscopic approach. However, they tend to reflect the complications associated with the kind of surgery you have (Roux-En-Y, adjustable gastric banding) rather than how it is performed.
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