Covenant Weight Management Center
Bariatric Surgery

"If people are morbidly obese, there's something they can do about it."
- Dr. Stephen Boyce, Covenant Weight Management Center director

Bariatric Surgery, also known as Gastric Bypass, Overview
Roux en Y Gastric Bypass (Open or Laparoscopic) is considered to be the "gold standard" of all bariatric surgical procedures because the gastric bypass is a time-tested operation (dating back to the late 1960's).

Significantly more information is available about the long-term results of the Roux en-Y Gastric Bypass (as compared to other available procedures) because its results have been documented for over 20 years.

Digestion
During normal digestion, food moves down into the stomach from the esophagus. While in the stomach, the food is broken down by gastric juices. This process takes about twenty to thirty minutes, after which the stomach contents move to the first segment of small intestine. Most of the iron and calcium in the foods we eat is absorbed at this time.

The remaining segments of the small intestine complete the absorption of almost all calories and nutrients. The remaining food particles that cannot be digested in the small intestines are stored in the large intestine until eliminated.

The Roux en-Y operation provides a restrictive and malabsorptive method to weight loss because the stomach and small intestines are reconfigured. First, a "mini stomach" is created by permanently dividing the stomach, creating a stomach pouch that can hold about 2-3 bites of food. The intestine is then cut approximately one and one half feet beyond the stomach and is attached to the pouch to provide an outlet for the food. This aids in weight loss in that you cannot eat as much and you absorb fewer nutrients and calories.

Instead of food staying in the stomach for the "normal" twenty to thirty minutes, it now stays in the "mini pouch" for about ten minutes, then moves on to the small intestine. The pouch maintains a sensation of fullness for a longer period of time.

Digestive juices are still produced in the lower part of the stomach and are released into the intestines where they help the food digest. Nutrients and calories can still be absorbed, but the food is not as thoroughly digested so a greater portion moves into the large intestine to be released.

The Roux en-Y Gastric Bypass Surgery may be performed "open" or "laparoscopically". When performed as an "open" procedure, a midline incision on the abdomen is made extending from just under the diaphragm to a spot close to the belly button. A stapling device is used to create the "mini pouch".

The "laparoscopic" approach, also known as "minimally invasive surgery" follows the same guidelines internally, however this surgery is done using 5-6 small keyhole incisions. A camera is inserted into one of the incisions, to aid the surgeon for guidance. Several small instruments are inserted into the other incisions to perform the surgery.

Roux en-Y Gastric Bypass Candidates

The Roux en-Y Gastric Bypass is not right for everyone. Here are some of the things we will consider when evaluating your candidacy for obesity surgery.

Indications
The Roux en-Y Gastric Bypass may be right for you if:

• Your BMI is 40 or higher or you weigh at least twice your ideal weight or you weigh at least 100 pounds more than your ideal weight. (BMI is calculated by dividing body weight (lbs.) by height in inches squared (in2) and multiplying that amount by 704.5).

• If you do not meet the BMI or weight criteria, you still may be considered for surgery if your BMI is between 35 - 40 and you are suffering from 2 or more of the following co-morbidities:
  • Diabetes Mellitus (Adult Onset)
  • Hypertension
  • Sleep Apnea
  • Osteoarthritis of knees, hips, and/ spine (lumbar region)
  • GERD
  • Urinary Incontinence
  • CAD
  • Asthma
  • Hyperlipidemia
  • Pedal Edema
  • Hypothyroidism
  • CHF
  • Cardiomegaly related to Obesity
  • Polycystic Ovarian Syndrome
  • Hiatal Hernia

• If you have documented failure at medically supervised weight reduction programs for at least 6 months

• Demonstrates motivation and commitment for long-term lifestyle changes related to weight loss, diet, and exercise

• Obesity is not caused by other disease or medications

• No cigarette smoking for at least 3 months

Contraindications

• Inflammatory disease of the gastrointestinal tract (i.e., ulcers, severe esophagitis, or Crohn's disease)
• Severe heart or lung disease
• Bleeding in the esophagus or stomach
• Portal Hypertension
• Anatomical structures of the esophagus, stomach, or intestines are abnormal
• Intra-operative gastric injury
• Cirrhosis
• Chronic Pancreatitis
• Pregnancy
• Infections
• Chronic, long-term use of steroids (i.e., prednisone)
• Illicit drug use
• If diabetic, poorly controlled blood sugar
• Autoimmune connective tissue disease (i.e., systemic lupus erythematosus or scleroderma)
• Unable or unwilling to follow the dietary rules associated with surgery

Your Motivation

While the Roux en-Y Gastric Bypass is an effective treatment for morbid obesity, the pounds do not come off by themselves. The RYGB is an aid to support you in achieving lasting results by limiting food intake, reducing appetite and slowing digestion. However, your motivation and commitment to adopt a new lifestyle are extremely important for long-term weight loss. New eating habits must be adhered to for the rest of your life. Exercise is an equally important component of a changed lifestyle.