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Gastric Bypass Surgery - Roux-en-Y Gastric Bypass - Weight Loss Surgery Procedures - Kansas City - IABS
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Weight Loss Surgery Procedures


Gastric Bypass Surgery - Roux-en-Y - "Stomach Stapling"


|   INTRODUCTION   |   AM I A CANDIDATE?   |   PROCEDURE   |
|   HOW DOES IT WORK?   |  ADVANTAGES   |   RISKS   |   MAKING THE DECISION   |
WLS PROGRAM   |   THE NEXT STEP   |   MEDICAL INSURANCE   |
Gastric Bypass Surgery - Roux-en-Y Gastric Bypass - Weight Loss Surgery - Kansas City - IABS

Introduction to the Gastric Bypass Surgery Procedure

The Roux-en-Y Gastric Bypass or “Stomach Stapling” remains the gold standard to which other weight loss operations are compared.  It is still the most frequently performed weight loss surgery procedure in the United States. The Gastric Bypass takes advantage of both restriction and malabsorption to work. The restrictive part of the procedure is the creation of the small stomach pouch with a very small outlet. The malabsorptive part of the procedure involves re-arranging the small intestine to reduce how much of the intestine is involved in absorbing the small amount of food that is eaten.

The entire procedure is performed laparoscopically. The small stomach pouch is created by stapling.  The pouch is created to be small – about 30cc in size. The remaining stomach is not removed, but simply stapled shut and separated from the stomach pouch.   The small intestine is then rearranged - one cut end of the bowel is connected to the pouch, while the other cut end, is reconnected to the small bowel about 100 to 150cm from the pouch. The result is a "Y" shaped re-connection that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

The operation restricts food intake very effectively, particularly during the first year, the time of maximum weight loss.  Ultimately a bypass patient will be able to eat about a cup of food per meal three times a day, experiencing prolonged satisfaction and fullness from that amount of food while losing weight.  Hunger and cravings are controlled, particularly if the patient is compliant.  This is a profound experience for many, being released from a prison of hunger.

The average expected weight loss with the RYGB procedure is around 70% of excess weight.  About 50% of the expected weight loss will be lost in the first 6 months after the operation. The remaining half is lost slower over the remaining half to one year. With good compliance an 80% to 90% chance of maintaining the weight loss long-term can be expected, and 80% to 90% of patients have at least improvement or resolution of their medical problems.

Proceeding with weight loss surgery is a very personal and often difficult decision.  Educating yourself about weight loss surgery is a very important first step.  Although the information presented here may be very helpful, patients have repeatedly told us that attending the weight loss surgery informational seminar helped the most.

For those of you who are not from Kansas, we treat many patients from out-of-state, and from all across the United States.  When contacting the office, please inform the staff that you are out-of-state and access our out-of-state link for more information on how we can help you with the preparatory process.

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Am I a Roux-En-Y Gastric Bypass Surgery Candidate?

To be a candidate for any type of weight loss surgery, the individual must be morbidly obese.  Below are tools you can use to determine if you are morbidly obese and potentially a candidate for the Roux-en-y Gastric Bypass. If you determine you are morbidly obese you are a candidate for the Roux-en-y Gastric Bypass.

There are several medically accepted criteria for defining morbid obesity. You are likely morbidly obese if you:

  • Are more than 100 lbs. over your ideal body weight, or have a Body Mass Index (BMI) of over 40
  • Have a BMI 35 or greater and are experiencing severe negative health effects o co-morbidities , such as high blood pressure, diabetes, etc. related to being severely overweight
  • Are unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
  • Have physical, psychological, social, or economic problems that could be significantly improved by weight loss

Morbid obesity is usually defined as being 100 pounds over the ideal body weight. A better way of defining morbid obesity is by using the Body Mass Index (BMI). BMI is a calculated number that takes weight and height into consideration. A person weighing 300 pounds that is 5ft tall will have a higher BMI than a person weighing 300 pounds but is 6ft tall.  A BMI above 40 indicates that a person is severely obese and therefore a candidate for surgery. Surgery may also be an option for people with a BMI between 35 and 40 who already suffer from cardiopulmonary problems or diabetes.

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The Gastric Bypass Surgery Procedure

The Gastric Bypass operation is performed laparoscopicaly.  Five small incisions are required to perform the operation.  The first part of the operation is the creation of the small new stomach or “pouch”.  With modern stapling devices pouches are made as small as the size of your thumb.  The pouch is created from the very top portion of your stomach and it is completely separated from your old stomach.  The old stomach is not removed.  It remains a viable organ, but it does not see food anymore.  By leaving your old stomach inside, the bypass operation can be reversed if the need should arise.

Once the pouch is created the second step is to perform the bypass.  This means the intestine is rearranged to reduce the amount of intestine involved in absorbing food.  The point where the digestive enzymes mix with the food is changed.  The point is approximately 100 cm from the pouch.  To accomplish this the intestine is divided in one place and two connections need to be made to allow the digestive enzymes to meet with the food.

The name Roux-En-Y Gastric Bypass comes from the ultimate way the operation looks.  The bowels are arranged in a Y shape, and approximately 150cm of intestine are not involved or bypassed from food digestion and absorption.

Animated Gastric Bypass Video (1 min, 22 sec)

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For a QuickTime version, click here

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How Does the Roux-En-Y Gastric Bypass Surgery Work?

The bypass maintains the principles of restriction and malabsorption. The small pouch and narrow outlet restrict food intake and maintain satiety, while the re-arranging of the small intestines allows for less food to be absorbed. The combination of these two procedures results in additional weight loss compared to a restrictive operation alone, for example the Lap-Band.

The size of the pouch limits how much food you can eat, while the size of the outlet controls how quickly it can empty. The smaller the outlet the longer it will take for food to leave the pouch. The longer the pouch is full the longer you experience satiety and no hunger. Once the food exits the pouch into the small intestine the malabsorptive component begins.  By bypassing parts of the intestine, food is now delayed from mixing with the digestive enzymes. The food is now not digested completely and the food that is digested has less time to be absorbed because there is less bowel to absorb it.

The digestion of food starts later than normal, thus less food will be digested.  The point where the biliopancreatic limb is connected to the food conducting limb can vary to produce more or less malabsorption.  More bypassed bowel increases risk and side-effects.

Surgery alone will not ensure long-term success.   Surgery is a great tool, something to help patients do the work, to reach their health and weight loss goals.  The operation will help and to a degree force patients to change their eating habits for life.  Please access the RYGB Diet Guide to learn more about the nutritional and life style changes.

Gastric Bypass Surgery - Roux-en-Y Gastric Bypass - Weight Loss Surgery - Kansas City - IABS - difficulty scale

Live Gastric Bypass Video (7 min, 32 sec)

Please click the > button to view the video
For a QuickTime version, click here

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Advantages of the Gastric Bypass Surgery

The medical and emotional benefits of the gastric bypass procedure begin almost immediately after surgery, and the cosmetic benefits follow their wake. Over time the benefits of gastric bypass surgery may include:

  • significant sustained weight loss
  • blood sugar levels that become completely normal within 1 year of surgery
  • lower or normal blood pressure
  • lower or normal cholesterol levels
  • relief from sleep apnea, acid reflux and urinary stress incontinence
  • less arthritis pain and improved mobility
  • increased energy and ability to exercise
  • improved mood and self-esteem
  • arrested progression of heart disease
  • improvement of many lung conditions
  • exercise endurance

Gastric Bypass Surgery - Roux-en-Y Gastric Bypass - Weight Loss Surgery - Kansas City - IABS - laparoscopic benefits

With the bypass, patients lose around 2/3 of their excess weight within one and a half years. The average weight loss is 70 to 80% of excess weight. Half of that weight is lost in the first 6 months. In most patients, 85-90% are able to maintain their weight loss long term. Some weight regain is common, approximately 10-15% after 5 years.

The co-morbidities of clinically severe obesity begin to resolve before complete weight loss occurs. These include better control or cure of diabetes; lowered or normalized blood pressure and cholesterol; relief from sleep apnea, severe acid reflux, and urinary stress incontinence; eased lower back, knee and hip pain. Patients also report enhanced mobility. Many conditions, such as evolving heart disease, has been arrested or its progression significantly slowed.

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Risks of the Gastric Bypass Surgery

As with all surgery, there are risks. Patients considering surgery must weigh the risks and benefits of surgery against the severity of their obesity. The decision to proceed is based on the premise that the treatment should be less harmful than the disease being treated.   Complications can occur as with any type of surgery, please review Risks and Benefits of Surgery for a more detailed list.

Below is a list of some specific complications that are unique to the Roux-en-Y Gastric Bypass procedure:

  • Perforation of stomach/intestine
  • Leakage from a connection or staple line causing infection
  • Spleen injury - requiring removal / other organ injury
  • Gastric pouch outlet narrowing/stretching
  • Small bowel obstruction
  • Blood clots in legs
  • Pulmonary embolism - blood clot to the lung
  • Inability to eat certain foods
  • Development of gallstones or gallbladder disease
  • Inflammation of pouch, pouch ulcer
  • Dumping syndrome - intolerance to refined sugar
  • Weight gain, failure to lose satisfactory weight
  • Instrumentation failure may or may not result in additional surgery
  • Pregnancy is not recommended during the first 1-1/2 years of active weight loss
  • Other potential complications not included can also happen
  • Anemia, vitamin/mineral deficiency, protein malnutrition, temporary hair loss:
    • Bypassing the duodenum can cause poor absorption of iron and calcium and result in lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids.
    • Women are already at risk for osteoporosis particularly after menopause, should be aware of the potential for heightened bone calcium loss. Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be easily prevented and managed through proper diet and vitamin supplements.
    • A chronic anemia due to Vitamin B12 deficiency may occur. The problem can usually be managed with Vitamin B12 pills or injections.
  • A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of sweet food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.
  • The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.

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Deciding on the Roux-En-Y Gastric Bypass Surgery

The decision about which operation is best for you is a complicated one. Although the information presented here may be helpful, you will be able to learn substantially more about the benefits and risks of the BPD-DS operation during you consultation with the bariatric surgeon or at our free weight loss surgery informational seminars, To arrange an appointment call (913) 322-7401,

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Weight Loss Surgery Program

Post-operative support can greatly help patients improve upon their weight loss success.  Our weight loss surgery program has a comprehensive post-operative support program.  We encourage patients to take advantage of the informational seminars, nutritional classes, behavior modification classes, and social support groups offered.  There is a lot of information we have introduced to you and want you to understand.  The support programs are designed to motivate you, as well as continue your education in the area of nutrition, behavior modification, and your weight loss operation.

Patients who have weight loss surgery must have lifelong medical follow-up.  Our surgeons want to meet with you on a regular basis particularly during the first and second year when rapid weight loss occurs.  Your primary care doctor is also a very important extension of your post-operative care.  As you start losing weight your medical problems will start improving and you may not require the same dose of your medications.  Together we monitor and adjust your need for medication. 

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The Next Step - Learn More About The Weight Loss Surgery

Proceeding with weight loss surgery is a very personal and often difficult decision.  Educating yourself about weight loss surgery is a very important first step.  Although the information presented here may be very helpful, patients have repeatedly told us, that attending the weight loss surgery informational seminars helped them the most.  At the seminar, you will be able to separate fact from fiction, meet the surgeons, ask questions, and hear testimonials from patients who have already undergone weight loss surgery. The patient testimonials are often the highlight of the seminar.  Individuals considering weight loss surgery enjoy talking to patients and getting first hand accounts of how the operations have worked for them and how it has changed their lives. 

The next step is to meet in consultation with the surgeon.  The visit has multiple purposes:  determine your health and operative risk, discuss which operation may be best for you, answer your specific questions and concerns, and start the preparatory process toward getting insurance pre-approval and scheduling your surgery.  You can save about 45 minutes of your time at the doctor’s office by filling out the New Patient Forms prior to coming for your doctor consultation.

While waiting for your insurance approval or obtaining your medical work-up, start reading the Preparatory Guide and the RYGB Diet Guide.  These will prepare you for your surgery as well as what to expect after your operation.  For further questions do not hesitate to contact the office at (913) 322-7401.

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About Medical Insurance Coverage

To determine if your insurance policy covers obesity (or "weight loss") surgery, please refer to the policy information that all insured people receive after they have paid their first premium, or if they have chosen a plan offered by their employer. Some policies will automatically exclude bariatric surgery. Others may have certain criteria about which bariatric procedures they cover, and how much of the costs they cover.  At the time of the seminar our office staff is present and can help you read and interpret your policy information if you have it with you.  After your consultation with the surgeon our office obtains pre-authorization for you from your insurance company. 

For more information about insurance coverage for obesity surgery, please access About Medical Insurance Coverage.

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