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Gastric bypass Roux-en-y ::
The Roux-en Y works by decreasing food
intake, limiting the amount of food the stomach can hold by
closing off a significant portion of the stomach and delaying
the emptying of the stomach (gastric pouch).
ROUX-EN-Y GASTRIC BYPASS ::
In this operation the stomach is divided into two compartments
with several rows of titanium staples. The newly created
stomach pouch is measured at less than 30 cc's. The small
intestine is then divided in the proximal jejunum and the
lower end brought up and joined to the new small stomach
compartment. The pouch initially holds about 1 ounce of food
and expands to 2-3 ounces with time. The pouch's lower outlet
usually has a diameter of about 1/2-inch. The small outlet
delays the emptying of food from the pouch and causes a
feeling of fullness. After an operation, the person usually
can eat only 5 to 10 bites of food before feeling full. With
time, the capacity may increase to half to a whole cup of food
that may be consumed without discomfort or nausea. Food has to
be well chewed. For most people, the ability to eat a large
amount of food at one time is lost, and some of the food
consumed will not be absorbed due to the bypass segment of the
operation.
Many patients are interested in lighter and healthier foods.
Most patients report that their tastes change after surgery.
Many patients experience the "dumping syndrome" in which
foods; usually those high in fat and/or sugar are not well
tolerated. In the dumping syndrome stomach contents move too
rapidly through the small intestine. Symptoms include nausea,
weakness, sweating, faintness, and, occasionally, diarrhea
after eating these foods. Patients find that this negative
incentive helps them to eliminate high caloric foods and
sweets from their diets.
At Peachtree Surgical Specialists, the roux-en-y gastric
bypass is done through a small midline incision (mini-lap),
4-5 inches, and the incision is closed with sutures under the
skin (plastic surgery closure) in most cases.
Advantages :
The primary advantage of this restrictive procedure is that a
reduced amount of well-chewed food enters and passes through
the digestive tract in the usual order. That allows the
nutrients and vitamins (as well as the calories) to be fully
absorbed into the body.
Risks :
Postoperatively, stapling of the stomach carries with it the
risk of staple-line disruption that can result in leakage
and/or serious infection. This may require prolonged
hospitalization with antibiotic treatment and/or additional
operations.
Staple-line disruption may also, in the long-term and possibly
lead to weight gain. For these reasons, some surgeons divide
the staple-line wall of the pouch from the rest of the stomach
to reduce the risk of long-term staple-line disruption.
The band or ring applied may possibly lead to complications of
obstruction or perforation, requiring surgical intervention.
Characteristically, these procedures, while creating a sense
of fullness, do not provide the necessary feeling of
satisfaction that one has had "enough" to eat.
Because restrictive procedures rely solely on a small stomach
pouch to reduce food intake, there is the risk of the pouch
stretching or of the restricting band or ring at the pouch
outlet breaking or migrating, thus allowing patients to eat
more.
Approximately 40% of patients undergoing these procedures have
lost less than half their excess body weight.
As is the case with all weight loss surgeries, readmission to
a hospital may be required for fluid replacement or
nutritional support if there is excessive vomiting or adequate
food intake cannot be maintained.
The Fobi Pouch ::
What is the Fobi Pouch?
Invented by Dr. Mal Fobi, the Fobi Pouch bariatric operation
for obesity is a combination of stomach reduction and gastric
bypass. The Fobi Pouch procedure helps to keep patients from
regaining the weight, a complaint that many have had about the
traditional surgery. Some who have had traditional surgery
gain as much as 25% of their weight back. This procedure has
helped to eliminate many of the common fallacies about
bariatric surgery.
 In a traditional stomach bypass procedure, surgeons create a
smaller stomach by stapling off a large section. The new
stomach is called the "stomach pouch" because of its tiny
size (about a heaping tablespoon), Fobi explains. When food
is eaten, whatever doesn't fit into the pouch bypasses the
upper part of the intestines, and thus cannot be absorbed
into the body. Excess food goes straight through the
gastrointestinal system and is eliminated.
An issue with the traditional procedure is that the staples
can break down, causing the stomach to regain its original
shape -- and patients to start gaining weight again. Also,
the stomach opening that leads into the intestines, which in
surgery is made smaller to allow less food to pass through,
often stretches as the years go by.
The Fobi procedure has the same type of pouch construction
as the Roux-en-Y stomach bypass, but instead of staples, it
uses a silastic ring around distal end of the pouch to
simulate the pyloric valve and prevent stretching of the
opening between the pouch and the section of small
intestines.
Advantages :
Dr Fobi's statistics indicate that this gastric bypass
operation is 95 percent effective, with 40 percent of excess
weight loss maintained for at least five years. Side effects
similar to the other procedures can be expected, although the
rate of surgical complications appears to be lower.
According to many bariatric surgeons, the Fobi Pouch gastric
bypass reduces several of the more common causes of surgical
failure, like stomach-pouch stretching and leakage.
Risks :
There are occasional problems with frequent vomiting, diarrhea
and meat intolerance. Some patients report a tendency towards
constipation after surgery long-term.
As in the case of other gastric bypass procedures that reduces
digestion-time and nutrient absorption in the small intestine,
the Fobi Pouch operation may lead to
possible nutritional deficiencies. Possible long term
deficiencies involve fat soluble
vitamin deficiencies of Calcium, Iron, B12,
and Folic Acid. All of these can either be prevented or
corrected. Patients are placed on nutritional supplements for
the rest of their lives, and yearly monitoring is suggested.
Are you a candidate? ::
You may qualify for the Peachtree Surgical Specialists program
if:
You are 100 pounds or 100% over your ideal weight, or have a
Body Mass Index (BMI) of 40 or greater
Or, if:
Your BMI is between 35 and 40 and you
have one or more of the following obesity-related conditions:
Diabetes
High blood pressure (hypertension)
Heart problems (cardiovascular disease)
Sleep apnea
Degenerative joint disease
And if:
You've repeatedly tried - and failed - to lose excess weight
with diets, exercise, behavior modification, or weight-loss
drugs.
If you feel that you meet these criteria, contact Peachtree
Surgical Specialists to schedule a consultation with our
physician for a personal evaluation by
calling 404 265-3333.
If you qualify for bariatric surgery, you can benefit from
Peachtree Surgical Specialists commitment to comprehensive
treatment and care.
We've put together a highly experienced multidisciplinary
medical team and our dedicated facilities provide you comfort,
privacy, and the good feeling that quality medical care
provides.
Calculate BMI :
Knowing your Body Mass Index (BMI) helps you determine
if you may qualify for weight-loss surgery.
BMI is short for Body Mass Index, which is based on a ratio of
weight and height. Your BMI is one simple number. Once you
know yours, you can compare it to your ideal BMI and see if
you may be a candidate for bariatric surgery.
Bariatric surgery is the recommended solution to morbid
obesity. In general, obesity is defined as a BMI over 30 and
morbid obesity as over 35. Use the BMI Calculator to see where
you lie.
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