When success is defined as “the most weight loss, kept off for the longest period of time,” the Roux-Y Gastric Bypass is among the operations that fulfill this goal without producing major malnutrition. For years it has been known that people who lose weight by restricting their diet undergo a significant reduction in their basal metabolic rate. Their body fights to keep from losing more weight. There is evidence that patients who undergo Gastric Bypass do not exhibit this major reduction in basal metabolism. It is as if their body does not recognize that they are losing weight. This removes one of the major barriers to weight loss associated with restriction of dietary intake. Gastric Bypass patients also exhibit a significant reduction in Ghrelin hormone, a hormone associated with hunger and weight gain. This hormone is elevated in people on a diet.
We are now performing this operation almost exclusively by the minimally invasive, Laparoscopic approach, and it has become the favored weight management operation in the U.S.
There are several ways to perform Gastric Bypass, but only one is illustrated here. Since there are many ways to complete the re-routing of the food path around the stomach, pancreas, and first portion of the intestine, the operations are similar. Just as there are minor variations in the operation performed by the open surgical approach, there are minor variations in the Laparoscopic approach.
Laparoscopy leaves smaller scars, produces less post-operative pain, and may also shorten recovery time. The major medical improvement from the Laparoscopic approach is the reduction of hernias in the incision. These have been reported to occur in nearly 20% of patients who undergo open Gastric Bypass surgery. It takes another laparoscopic procedure to repair these hernias when they occur.