Guy Slater - Laparoscopic Roux en-Y Gastric Bypass and mini-gastric bypass

LRYGB: Who is it for?

Because it forces dietary change on patients, gastric bypass is still the most reliable weight loss operation. It is also the most effective operation for patients with metabolic illnesses. A typical patient would be:

Higher BMIs; BMI >45 kg/m²
Older, with low basal metabolic rate
Inactive, sedentary, with low calorie expenditure
Suffering from severe metabolic illness: Poorly controlled T2DM, BP, cholesterol etc
Lacking dietary discipline and know they are unlikely to change
Sweet tooth: unable to not eat chocolate, sweets, ice-cream etc

LRYGB: The Procedure & Recovery

Laparoscopic (Keyhole) surgery: 5 or 6 small incisions
General Anaesthetic
Two night hospital stay
Two week recovery time
A small gastric pouch, 20ml in volume, is formed from the upper stomach
The first 2m of the small bowel, are re-configured into a 'Y' shape (Roux en-Y)
One arm of the 'Y', joins the small gastric pouch to the small bowel
Ingested food no longer enters the stomach or duodenum, which is bypassed.

LRYGB: Mechanism of Action

Reduced appetite and early fullness

Food bypassing the stomach causes a change in gut appetite controlling hormones
Patients become less hungry, sometimes disinterested in food
Patients feel full sooner

Reduced portion size

In the short term patients eat a few mouthfuls of food
In the longer-term, patients will eat a child sized portion

Dumping

Dumping is a patient response to eating sugar or high fat containing foods
Anxiety, sweating, abdominal cramps, nausea, diarrhoea and overwhelming tiredness
Can be a useful deterrrent for patients, who find it hard not to eat sugar

LRYGB: Weight loss & impact on metabolic illness

LRYGB is the most reliable operation, for weight loss. It forces dietary change on patients

A person who is ten stone over their ideal weight, can expect to lose 7 to 8 stone and sometimes more. The weight loss will result in:

Remission or much better control of type 2 diabetes mellitus
Remission of gastro-oesophageal reflux
Improved blood pressure control
Remission of Obstructive Sleep apnoea
Improved mobility and a better quality of life

LRYGB: Diet and Lifestyle

LRYGB does restrict a patient's diet and lifestyle

More textured foods, such as red meat maybe difficult to eat
Foods that swell, such as pasta and rice, may be difficult to eat
Eating out, can sometimes be challenging, if the menu is restrictive
Sugar containing foods, cause dumping

Alcohol is absorbed, much more rapidly

Patients become drunk very quickly
Alcohol dependency, can be an issue
This limits partying; patients can become very 'cheap dates'

Smoking is prohibited, because it can cause life-threatening ulcers

LRYGB: Maintenance and Aftercare

Two years aftercare is essential

For support, with the recommended diet, moving from pureed to solid foods
To learn how to eat with the bypass, to ensure the best long-term outcome
To learn how to prioritise protein, to ensure the only weight lost, is fat

Severe vitamin and mineral deficiencies can occur, these are prevented by

Taking mulit-vitamins, as recommended
Additional Iron if needed. Vitamin B₁₂injections or a spray if needed
Regular specific blood tests looking for mineral or vitamin deficiency annually

LRYGB: Risks and complications

The risks of LRYGB are low, if an experienced surgeon performs the surgery.

Death

Is a risk with any major operation, but with LRYGB overall is below 1:1000

Peritonitis (severe intra-abdominal infection) can occur if one of the joins leaks

This is uncommon, risk below 1:200
Will usually occur in the first 48 hours after surgery, while in hospital
Would need further surgery and a prolonged hospital stay to fix it.

Bleeding can occur

1 in 100 patients bleed after the surgery
Mostly this is minor bleeding and may not need further intervention
It might be necessary to re-operate to control any bleeding
Very occasionally a blood transfusion, will be needed.