Wednesday, August 19, 2009

Roux-en-Y Gastric Bypass Bariatric Surgery

When individuals start to consider weight loss surgery, they typically think of something commonly called "stomach stapling." However, the technical name for the most common bariatric surgical procedure is a Roux-en-Y gastric bypass procedure. The procedure is a significant operation requiring full anesthesia and a fellowship trained surgeon who is comfortable doing such bariatric procedures.


What is a Roux-en-Y Gastric Bypass?

The most common bariatric surgical procedure is a Roux-en-Y Gastric Bypass. The procedure can be performed as either an open abdominal procedure via a midline abdominal incision or as a laparoscopic procedure, in which several small incisions are made in the abdomen. Through one incision, a small fiberoptic camera is passed. Through the other incisions, ports are placed through which instruments are passed and the procedure performed. Bariatric surgery is increasingly being performed laparoscopically due to the decreased hospital time required for recovery, although the procedures do require more technical skill. Overall, laparoscopic surgery is equally effective as open surgery.

The procedure's aims are as follows. First, the stomach is divided into two parts: a small pouch through which food will pass, and a second pouch, which will not be used in digestion. Dividing the stomach in this manner creates the volume restriction that will allow patients to feel "full" or "satiated" early in a meal. Then, the small intestine is divided about 45 centimeters past the gastric outlet. There will now be one end connected to the second non-functional stomach pouch, and one free end. The free end will be connected (anastomosed) to the small stomach pouch, while the end connected to the nonfunctional pouch will be reconnected to the small intestine further down along the GI tract. The end connected to the new, smaller stomach is called the "Roux" limb since it is the route food will take. If you were to draw this out, you would now see that the small intestine now takes the shape of a Y as the two limbs join together, hence the name "Roux-en-Y".

Gastric Bypass Surgery
Roux-en-Y Gastric Bypass Surgery Diagram
(Source:
Wikipedia)

The term "stomach stapling" comes from the fact that in older versions of the operation, the stomach was not split into two pouches, but rather partitioned simply using staples, hence "stomach stapling." However, this is no longer recommended as the stomach occasionally would heal over the staples, defeating the purpose of the surgery.


Who should get a Roux-en-Y Gastric Bypass?

In general, patients who are morbidly obese who have failed other weight loss programs are candidates for weight loss surgery. The concept of 'morbid obesity' can be measured using a statistic called the "Body Mass Index" or BMI. Basically, this statistic normalizes one's weight based on one's height. Without it, one could not tell the difference between a 150lb man who was 5 feet tall versus one who was 150 lbs and 7 feet tall. Most BMIs fall between 18 and 50. A normal BMI is between 18 and 25, overweight 25 to 30, obese 30 and above, morbidly obese 40 and above. Anyone with a BMI over 40, or a BMI over 35 with other medical issues, is potentially a candidate for bariatric surgery.


Tips For A Successful Roux-en-Y Gastric Bypass Procedure

Research the procedure beforehand. Find out who will be performing the procedure and how much experience they have. Don't forget that you still need to follow healthy habits, such as eating right and exercising. Simply having the procedure alone will not change your life permanently. If you continue to eat high calorie foods, you will eventually gain back all the weight you lose in the first few months after the procedure. Remember, the procedure is an extreme effort to help you lose your weight, but at the end of the day, you are in control and in charge of your weight loss, not the surgeon's knife. Help the procedure help you.

Saturday, August 15, 2009

What Is Bariatric Surgery?

If you are reading this blog, odds are you are interested in weight loss. You want to take charge of your life and be in control of your body. You want to eat to live, not live to eat. Many of us have struggled with the demons of weight loss and gain. There are fad diets, new exercises, all kinds of plans. Eventually, after you had considered all these options non-medical options, you may have considered what professional medicine had to offer for you. Perhaps you have heard of medications like Alli (Orlistat), a weight loss aid that helps control appetite. Still, you heard of even more radical options being offered: weight loss surgery. Specifically, bariatric surgery. And you wanted to know more.


What is bariatric surgery?

Weight loss surgery is often called bariatric surgery. These surgeries are performed on the gastrointestinal tract of patients who are morbidly obese, typically those with Body Mass Index > 40 who have failed other weight loss regimens. The most common procedures are the gastric bypass (also known as a Roux-en-Y procedure) and gastric banding (sometimes referred to as "lap banding" because it is done laparoscopically). According to the Mayo Clinic:
Weight-loss (bariatric) surgery changes the anatomy of your digestive system to limit the amount of food you can eat and digest. The surgery aids in weight loss and lowers your risk of medical problems associated with obesity.

Gastric bypass is the favored bariatric surgery in the United States. Surgeons prefer this surgery because it's safer and has fewer complications than other available weight-loss surgeries. It can provide long-term, consistent weight loss if accompanied with ongoing behavior changes.

Gastric bypass isn't for everyone with obesity, however. It's a major procedure that poses significant risks and side effects and requires permanent changes in your lifestyle. Before deciding to go forward with the surgery, it's important to understand what's involved and what lifestyle changes you must make. In large part, the success of the surgery is up to you.
The key sentence from the Mayo clinic is: In large part, the success of the surgery is up to you.

What this means is that as a patient, it is your responsibility to educate yourself about how bariatric surgery works and what you can do before and after the procedure to ensure that it is a success. Remember, bariatric surgery is not a magical cure for obesity. In some ways, it is an extreme measure taken for people who are unable to lose weight by any other means. People can, and have, gained back all the weight they lost after bariatric surgery by not being full committed. The key is commitment.


How does bariatric surgery lead to weight loss?

In general, the procedures work by limiting either the amount of volume/space available for digestion within the GI tract, the amount of digestive/absorptive capacity of the GI tract, or both. Future posts will go into greater detail about particular procedures, but this is the basic principle underlying bariatric procedures. A simplified view of the gastrointestinal tract makes it clear why bariatric surgery is effective weight loss surgery.

After food enters the mouth, it begins the process of digestion. It travels down the esophagus to the stomach, where it undergoes further breakdown. The food then passes from the stomach into the small intestine, where it begins to be absorbed. A majority of nutrient absorption occurs here, prior to the food being expelled into the large intestine. The large bowel is primarily involved in absorbing water from food and then excreting the by-product.

By reducing the size of the stomach, bariatric surgery mechanically reduces how much one can take in as nutrition. By removing part of the small intestine, bariatric surgery can also decrease how much is absorbed into the body. After the procedure, food that used to be fully absorbed is now partially absorbed, with the leftover being excreted via the colon.

Stay tuned for future posts that go into detail about these procedures, the pros/cons, and the key information you need to make your surgery a success.

Tuesday, August 11, 2009

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Monday, August 10, 2009

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Sunday, August 9, 2009

Why Start A Blog About Weight Loss?

The post title is a question I have pondered for a while: Should I start a blog about weight loss? Specifically weight loss surgery?

On the one hand, I am not morbidly obese nor have I undergone weight loss surgery myself. However, on the other, I have struggled with weight issues for a long time. The most unique contribution I have though is, given my role in the medical field, I have actually been on the other end of the scalpel and seen weight loss surgeries from the operating room perspective. While I do not have the most experience and do not claim to have performed any surgeries myself, I have seen how the procedures are performed, what some of the various options are, and some of the potential complications. The most important thing for anyone serious about weight loss, and weight loss surgery in particular, is to go into the procedure knowing the benefits and risks very, very well. This site aims to help in that endeavor.


About Houston Weight Loss Surgery

The reason for Houston in the title is that this is where the majority of my experiences occurred. Houston is not only the 4th largest city in the U.S., but also its fattest. I do not have concrete data to back this up, but I believe that more bariatric surgeries occur per capita in Houston than any other city in the U.S., and perhaps the world. Given this, it is important to have an information source targeted specifically at the issues facing Houstonians interested in weight loss surgery. This blog will discuss how procedures are performed, the limited benefits, the possible risks and complications, as well as future options for persons interested in gastric surgeries for weight loss. This information is available in many disparate locations on the web, but the blog aims to collect them in one location in an easy to digest format for the casual reader. Suggestions for topics are more than welcome, as are questions. Welcome!