Laparoscopic surgery first began to be performed widely in the U.S. in the early 1990's as a procedure for the removal of the gallbladder. The surgeon views on a TV monitor what is inside the patient's abdomen by using a thin tubular telescope and a high-resolution video camera. This telescope, and other instruments are passed through "portal" incisions in the abdominal wall to do the actual surgery. Lasers can also be used laparoscopically.

 

     The Laparoscopic Roux-en Y gastric bypass procedure is considered to be "Advanced Laparoscopy." The surgeon must learn to move the various instruments based on what is shown on the TV monitor. This requires a high degree of eye-hand coordination. A wide variety of instruments have been developed, including sophisticated stapling and suturing devices, which permit laparoscopy to be used for this and many other surgical operations. Although performing surgery laparoscopically is less intrusive and recovery time is normally less than that of "open" procedures, this is still major surgery and complications from laparoscopic surgery are similar to those of "open" surgery.

     Click on the image to view an actual surgery performed by surgeons from The Weight Loss Clinic and sponsored by Pinnacle Health OR-Live.

 

     The gastric bypass procedure referred to as Roux-en Y has become the standard operation for the treatment of morbid obesity. The procedure can be broken down into three areas:

• Partitioning of the stomach into two parts: an upper small pouch, and a lower large pouch
• Cutting the small intestine and creating of a Y-connection in the small intestine, to connect the small upper stomach pouch to the original small intestine exiting the lower portion of the stomach
• Connection of the new small intestine end to the upper small stomach pouch

     The patient leaves the hospital 2 - 3 days after surgery. When the patient is discharged from the hospital, he/she is able to walk and move around reasonably comfortably. The first follow-up, if there are no problems, will be in approximately 1 week in the office. The doctor will make an assessment at that time as to what medical restrictions the patient will be removed from. The patient may be allowed to drive and to undertake physical activity if the patient feels up to it.

     The gastric bypass, in particular the Roux-en Y procedure, has been shown to be the best surgical procedure for the treatment of severe or morbid obesity. The procedure reduces the capacity of the stomach to about 30cc by stapling across the stomach near the top where the esophagus leads into the stomach. This leaves approximately 90 percent of the stomach below the staple line.

     The small intestine is cut and attached to the small stomach pouch above the staple line. The other end of the small intestine is then attached to the small intestine which exits the stomach at the appropriate point to form a "Y", from which a portion of the name of the procedure, Roux-en Y comes.

     With the procedure complete, food enters the small stomach pouch through the esophagus and then passes to the small intestine through a small opening, approximately 1/2 inch or 1cm in diameter. Digestive juices continue to mix in the stomach and the upper part of the existing small intestine and enter the "new" digestive tract at the "Y" junction from which the absorption of nutrients begins.

     The reduced size of the stomach in combination with the narrow opening into the connection between the small stomach pouch and the small intestine are responsible for significant limitations on the patient's ability to eat large meals and the body's ability to absorb the food. These factors coupled with a medically supervised diet assist the patient to lose his/her excess body weight over the first 18 - 24 months following surgery.