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Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a more complicated procedure than LAGB. It involves creation of a small stomach pouch and an outlet from the pouch directly into the upper intestine, where nutrients are absorbed. By doing this, the majority of the stomach is bypassed, and the pouch, which has less volume than the stomach did, fills more quickly and makes the person feel full and eat less.
Gastric bypass also intentionally reduces the absorption of some nutrients into the bloodstream. This is because the enzymes that allow our bodies to break down and digest nutrients come from the stomach and the pancreas. After bypass, these enzymes travel downstream and don’t come into contact with the food eaten until later in the digestive process. Usually Dr. Sasse creates a length of intestine of 100 cm, although sometimes he creates longer segments for higher BMI patients.
This first part of the intestine is not absorbing nutrients as it would normally because there are no digestive stomach and pancreatic enzymes present over the length of the first 100 cm. After that distance of intestinal length, the enzymes join the digesting food, and normal absorption of nutrients begins in the remaining length of the intestine.
Dr. Sasse believes that you make your own success by hard work and determination, but one reason LRYGB works for so many people is that the restrictive nature of the pouch limits the amount of food that can be eaten – there simply isn’t room in the stomach any longer to allow the person to overeat. The same kinds of hormonal, psychological and nerve-mediated weight-loss signals may be at work as we described for LAGB. In addition, malabsorption causes fewer of the calories eaten to actually be absorbed into the bloodstream and into the body to be burned or stored as fat.
Many patients who undergo LRYGB experience a phenomenon known as “dumping syndrome,” which is not quite as unpleasant as it sounds. Dumping syndrome results in flushing, cardiac palpitations and nausea when the patient eats foods rich in carbohydrates (such as desserts). While these side effects are unpleasant and can continue to be present as late as 10 years after the operation, they also work as negative reinforcement, a kind of a behavioral conditioning technique that backs up medical advice to avoid carbohydrates after undergoing the LRYGB procedure. On the plus side, many studies have shown long-term sustained weight loss from 49 to 95 percent of excess preoperative body weight.
A variation on the LRYGB procedure allows for a longer bypass to be created with a 150-cm or 200-cm Roux limb (the part of the intestine brought up and connected to the stomach pouch), which may increase weight loss in patients with higher than average BMI. The greater weight-loss results from even more calories passing through the intestine without being absorbed into the bloodstream.
LRYGB is not a new procedure. It’s been with us for decades. The name comes from a French surgeon named Roux and the “Y” configuration that results when the intestine is brought up to connect to the stomach pouch. While it’s not the newest procedure in Dr. Sasse’s arsenal of weight-loss solutions, the procedure has come a long way since the 1960s and 70s and even since the 1980s and 90s when the operation was still usually performed with an open technique. Some modifications have taken place, such as improved knowledge of the ideal stomach pouch size, ideal length of the Roux limb and better stapling techniques. Now, with the minimally invasive, or laparoscopic, technique, many surgeons favor it as the state-of-the-art weight-loss operation with the best long-term results, especially for more seriously overweight patients.
Dr. Sasse’s patients stay overnight if they opt for the LRYGB. However, LRYGB can be performed as outpatient weight-loss surgery under special circumstances – if the patient is a safe candidate, without serious heart or lung problems, and motivated to walk, move and recover quickly.