Laparoscopic Roux-En-Y Gastric Bypass (REYGB)
The Roux-en-Y gastric bypass procedure is usually performed laparoscopically (i.e. keyhole surgery with a telescope) by our service. However, in some cases it may be necessary to perform an open procedure through a large cut in the abdomen, usually if you have had an open operation before. This REY bypass operation has proven to be an effective, consistent way of losing weight and keeping it off, but to achieve these results it requires lifelong changes to lifestyle and eating.
The bypass is considered the “gold standard” of weight loss surgery. A small stomach pouch is created, restricting the amount of food that can be eaten initially, but long term, the operation also works by switching off the desire to eat. Initial weight loss at 1 year of 87% of excess weight is the average weight loss in our practice. Patients generally spend 2 nights in hospital.
Laparoscopic Sleeve Gastrectomy
Sleeve Gastrectomy was originally developed as the first stage of a two stage malabsorptive procedure in high-risk patients. Surgeons found that if they removed three-quarters of the stomach, left the patients to lose weight, then came back and finished the operation, the death rate was much lower. However, some patients did quite well even without the second procedure, although the majority did have some weight regain long term.
In this operation, 2/3 of the stomach is removed laparoscopically. This severely restricts intake for the first year. Because there are no joins, it seems safer than a bypass, but still has a complication rate from leaks and bleeding. People do sometimes get reflux for prolonged periods after the sleeve procedure. Weight loss after a year is about 70% of excess weight, but there is a tendency to regain weight after this. Patients are in hospital for 2-3 days.
Loop (mini) Gastric Bypass
The Loop (Mini) Gastric Bypass operation is a simplified version of the standard gastric bypass operation as it only requires one connection. The surgery uses a combination of techniques that reduce the size of the stomach and alter hormones involved in appetite control. The advantage of the loop bypass is that the single join results in a shorter operating time and less operative complications. Long term, the loop bypass, results in fewer intestinal obstruction problems and less risk for internal herniation.
Disadvantages of the loop gastric bypass include a greater likelihood that patients with a loop bypass will experience greater bile reflux than after a REY gastric bypass, which can adversely affect their quality of life. Another disadvantage of loop bypass is a greater likelihood to develop significant vitamin and micronutrient deficiencies over time. The standard risks and complications that apply to a REY gastric bypass also apply to the loop bypass (such as dumping).
A loop bypass typically results in 60-80% excess weight loss. The most rapid weight loss occurs in the first 6 months after surgery and then continues at a slower pace for up to another 18 months.