Gastric bypass surgery is the primary surgical procedure done at the Weight and Wellness Center. For some severely obese people, gastric restrictive surgery may offer the best long-term solution.
The Roux-en-Y (RNY) is considered 'the Gold Standard' for Gastric Bypass surgery. During this operation, the surgeon separates the stomach into two sections with a special stapling device. This creates a small working section on top, called a pouch, connected to the esophagus. This pouch will become the new stomach and is constructed to contain only 1 ounce of food (picture a hard-boiled egg).
The rest of the stomach, the larger 'left over' bottom section, is completely disconnected from the pouch and remains where it normally is but no nutrients ever enter it. It is alive and healthy and still secretes acids and other gastric juices, which flow into the intestines to aid in digestion and it makes intrinsic factor, necessary to absorb Vitamin B12. It also contributes to hormone balance and motility of the intestines in ways that are not entirely known. In some cases it may shrink a bit and its lining (the mucosa) may contract, but for the most part it remains unchanged.
The new pouch is then stapled to a segment of the intestine so that the food travels from the mouth, down the esophagus through the pouch directly into the intestine, bypassing the majority of the 'left over' bottom section. Inside this new connection between the pouch and the intestine, a small 'hole' or 'tunnel' is created for the food to pass through. This 'hole' is called a stoma and is deliberately made very small in diameter (picture a drinking straw) to slow down the movement of food from the pouch out into the intestine.
The staples used on the stomach and the intestines are very tiny in comparison to the staples you normally use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI nor will they set off airport metal detectors.
The RNY gastric bypass surgery is a very successful operation for weight control and tens of thousands are performed yearly in the U.S.A. Patients eat smaller amounts of food, feel fuller sooner, have less of an appetite and, with the laparoscopic approach, suffer less pain and run a lower risk of developing hernias .
How weight loss is achieved with the RNY
The operation produces a number of changes in how your body digests food. These changes, in combination with an overall plan of diet and exercise, can help you lose a significant amount of weight in several ways:
- You now have a smaller stomach. The small "pouch" created during the operation is your new stomach. It can only hold about 3 ounces of food or liquid at a time. (Normally, the stomach can hold up to 50 ounces.) A much smaller stomach means it takes a much smaller amount of food to make you feel full.
- Slower digestion. Because of the small opening connecting the pouch to the intestines (the stoma), food moves through the system very slowly after it is eaten, making you feel full longer.
- Hormone changes. Your body makes hormones that contribute to your feeling full after a meal. The changes in the way food enters the intestines after surgery affects these hormones, which may also help you feel full for a longer period. Hormone changes are also responsible for the "dumping syndrome" - a side effect of surgery that is explained below, but that can also contribute to rapid weight loss in the months following surgery.