Gastric Bypass Surgery: Facts About Roux-en-Y
There are several options available for morbidly obese people looking into bariatric surgery. But after doing nearly 1400 gastric bypass operations using something called the Roux-en-Y procedure, surgeon Gus J. Slotman has settled into a successful groove.
He began his explanation of the procedure by explaining why he performs "open" surgery (via an incision of 4-to-5 inches starting slightly below the rib cage) as opposed to laparoscopic surgery using about five smaller incisions serving as portal for surgical instruments.
"I don't do laparoscopic because it has a 1 to 4 percent leak rate carrying a 50 percent mortality from infection in that minority of cases," he said. "Laparoscopically you have to cut the stomach into two different pieces and in my opinion that is just two additional pieces that can leak."
Instead of cutting, Dr. Slotman uses four rows of overlapping staples to section off a small piece of the upper stomach, a pouch that has a capacity of about a tablespoon. It can stretch comfortably to hold two ounces of food and that amount of food creates a "full stomach" feel. This is the "restrictive" component of gastric bypass surgery.
The "bypass" part of the operation occurs when Dr. Slotman, at a point about 18-24 inches below the beginning of the small intestine, divides the intestine. He then moves the lower piece of the small intestine up to connect with the new stomach pouch.
Bypassing most of the original stomach and two to five feet of the small intestine does not cause significant malabsorption of nutrients from food. However, vitamins and iron are taken into the body through this now bypassed first part of the intestine. Therefore, gastric bypass patients must take multivitamins with iron every day.
After the stomach pouch and the stoma, or opening into the intestine, have been created, the upper part of the small intestine is reconnected to the small intestine that receives the food and is going downstream. Why? So the stomach and pancreatic juices and bile salts that normally travel down this upper intestine can be available for processing the food in the intestine.
Dr. Slotman stresses to patients that gastric bypass is a tool that cannot be reversed and, if used properly, will enable them to control their weight. "But if you don't follow instructions you can hurt yourself with malnutrition and with leaks and if you eat too much, the staples I use to divide the stomach can break and cause severe bleeding ulcers."
The chances of a successful life-after-surgery are increased by a patient support system during which the surgery is detailed and the patient is provided extensive pre-operative preparation. For example, when visiting Our Lady of Lourdes Medical Center for pre-admission testing, the patient tours the floor where he or she will stay post-op and speaks with nurses and other counselors. The pre-admission session includes an introduction to Peggy Huddleston's "Prepare for Surgery" program, available to all surgery patients.
The support can continue for a lifetime if the patient perseveres, said Dr. Slotman, who tries to keep every patient returning for regular checkups. He also asks each patient to pose for "before and after" patient photos, some of which he and the staff keep in the office for inspiration.
To locate a Lourdes Health System bariatric surgeon by phone, call 1-888-LOURDES.
