Roux-En-Y Gastric Bypass Case Study

There seem to be an increasing application of Roen-en-Y gastric bypass today by some surgeons. This is a restrictive procedure that has minimal mal-absorption issues and it makes part of an array of bariatric surgeries. However, the most commonly used procedure is biliopancreatic diversion or Scopinaro, which have been used for more than two decades and are popular in with many surgeons more so in the developing countries. This process is intended to inhibit absorption of fat in a bid to trigger massive weight loss in patients who are morbidly obese. It restricts gastric thereby diverting bile and pancreatic fluids to the distal ileum (Consensus Development Conference Panel, 1991). This procedure therefore exposes a limited area of small bowel for the absorption of nutrients that need biliary and pancreatic fluids. The procedure and its variations are still common as indicated above including; biliopancreatic diversion with duodenal switch, which also result in malabsorption. It is however noted that most patients who undergo this procedure also experience severe protein and fat related malabsorption problems.

Weight loss or bariatric surgery, as defined by the American Society for Metabolic and Bariatric Surgery, is a surgery that “works by changing the anatomy of your gastrointestinal tract” or by “causing different physiologic changes in your body that change your energy balance and fat metabolism.” Weight loss surgery ultimately changes a person’s desire

In Bijal P. Trivedi’s report, “The Bypass Cure” she details the history of gastric bypass surgery, its effect on type 2 diabetes, and the how one doctor is using his understanding of modern gastric bypass applications to save the life’s of his patients. The patient, Nancy Rubio was nearly twice the normal weight of a person her height. Her weight had slowly increased throughout her life, due to her unhealthy diet and having two kids. She eventually developed type two diabetes, which then led to other health issues, such as arthritic knee pain, high blood pressure, cholesterol and blood sugar. Fearing for her life, Rubio opted to receive a modern version of the Roux-en-Y. The Roux-en-Y involves reducing the lining of the stomach to a small pouch, which reduces the patient’s appetite and eating. The pouch is then connected to the lower section of the intestine. Do the nature of the surgery Rubio will lose weight very fast, but miraculously have her type 2 diabetes become remitted or possibly abolished.

There are four 4 procedures as of today but two are most popular such as the Roux-en-Y gastric bypass(found on 1892 by Dr. Cesar Roux) and the Gastric sleeve (found on 1988 by Doug Hess ). Both make the stomach smaller. The bypass also reroutes the small intestine. A simpler procedure, the Gastric band (was discovered in the early 1980’s and was actually put into use in the

1. Roux-en-Y gastric bypass is a special procedure used to treat morbid obesity. Describe in detail the Roux-en-Y procedure. The Roux-en-Y procedure is a laparoscopic form of gastric surgery that uses trocars to manipulate the stomach. The patient must be positioned supine with their arms extended outward or in the lithotomy position. This is dependent on where the trocars are positioned. The surgeon uses monitors to see inside the abdominal cavity and places the trocars a fist length away from each other. Four 10mm trocars and two 5mm trocars are used for this surgery. Gastric ligaments are “pulled down at the angle of His” (Ayloo, 2014). The gastric pouch is then created by “creating a window in the lesser sac” (Ayloo, 2014). The stapler is then used to “transect the stomach horizontally and then vertically at the angle of His”.

Malabsorptive techniques decrease the intestinal absorptive area, preventing the meal running through the whole digestive tract, since there is an internal bypass. The pattern of this surgery is the bilio-pancreatic bypass (BPD) by Scopinaro with or without duodenal switch (Fig. 5) (Velhote et al., 2007).

Laparoscopic vertical banded gastroplasty or VBG, is an elective surgical procedure in which the stomach is partitioned with staples and with a plastic clamp to limit the amount of food the stomach can hold at one time.

This procedure involves stapling the stomach into two parts, so as to leave a small opening for food to pass from the upper stomach part to the lower one. The vertical banded gastroplasty is the most popular version of this type of surgery and is performed by vertically stapling the upper stomach near the oesophagus to create a small pouch along the inner curve of the stomach. The opening from the pouch to the rest of the stomach is restricted by a polypropylene mesh band or Silastic® ring band, which consequently causes a delay in the emptying of food from the pouch, causing a feeling of

The Roux-en-Y Gastric Bypass is the most common Gastric Bypass Surgery. The stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle of the portion of small intestine, bypassing the rest of the stomach and upper portion of the small intestine. This procedure requires a four to six day stay in the hospital or two to three days for the laparoscopic procedure. It is possible to return to normal activity three to five weeks after the

Bariatric is the field of medicine that manages obesity and the disease that accompanies it. Obesity is a chronic disease associated with the three leading causes of death in the United States: cardiovascular disease, type 2 diabetes mellitus, and cancer. (McCance 1477). Successful interventions fare needed to help improve obesity, which affects more than one-third (34.9% or 78.6 million) of US adults. (CDC 1). Drug therapy and bariatric surgery are used as adjuncts to diet and exercise in the treatment for obese patients with a BMI greater than 30. (Burchum 998).

Rationale: Gastric bypass operative procedures are a group of techniques that divides the stomach into a small upper pouch and a much larger lower pouch, then rearranges the small intestine so that it connects with both. There are a number of techniques to reconnect the intestine, but all lead to a considerable reduction in the volume of the stomach, also accompanied by an altered physiological response to food. Despite media advertising, these procedures are major surgeries that are usually only prescribed to treat morbid obesity, type-2 diabetes, serious hypertension or sleep apnea. Typically, 15% of patients have negative complications, and .5% dies within six months of surgery due to post-operative complications (USDHHS, 2009).

Sleeve gastrectomy is a weight loss procedure where the stomach is made smaller by surgical removal to form a slim “sleeve.” Patients can eat only small amounts of food, resulting in weight loss. A sleeve gastrectomy is often followed by duodenal switch surgery or a gastric bypass.

A surgeon uses liposuction to loosen the fat in the small area to be treated. After the fat has been loosened and partially removed with liposuction, a small incision is made below the belly button and the abdominal muscles are repaired. After the reparation, any excess skin is removed and the remaining skin is stretched and stitched into place. This procedure is also designed for generally healthy individuals who have stubborn fat and an abundance of skin on their lower

Most patients who have this done have a BMI of 30-40, 40 being the max due to being morbidly obese. In a study discussed in the Journal of the American Medical Association, “ The average patient started with a BMI of nearly 47-about 345 pounds for a 6 foot tall man or 280 pounds for a 5 foot 5 inch woman. By the end of the studies, most of which lasted less than two years, the average gastric-bypass patient had a BMI of 30; the average gastric-band patient, 36” (“Consumers Union”). The National Institutes of health states, “ Patients be either morbidly obese, which is defined as having a body mass index of 40 or more, or that they have significant health problem related to obesity, such as diabetes, heart disease or Hypertension of sleep apnea. In addition, these guidelines state that surgery should be a last resort, only after other methods of weight reduction have failed” (“Hall”).

Healthy weight management is more than a diet; weight management is a lifestyle that aims to regulate caloric intake and expenditure in accordance to the amount of physical activity that occurs daily. The goal of weight management is to keep an individual’s body fat content to a healthy minimum, which is important for maintaining overall health and lowering risks of health threats throughout the lifespan. To measure healthy body fat rates, a Body Mass Index (BMI) is calculated by dividing the weight of the individual by their height squared. Healthy BMI for an individual changes over time in accordance to their height;