Greater options now exist for potential weight loss surgery patients. Thanks to new research on combining restrictive and malabsorptive approaches, clinicians now have the ability to decrease patient appetite. Food is slowed in mixing with bile and pancreatic juices that aid in the absorption of nutrients, allowing the patient to feel fuller and more satisfied without consuming as much food.
By stapling the stomach, a small 15-20 cubic centimetre stomach pouch is created. The procedure separates the pouch from the rest of the stomach. Calorie absorption is limited by redirecting consumption precisely into the lower portion of the jejunum, by sectioning the the small intestine and bringing it away from the duodenum, the aim of which is to create a link to the new, smaller stomach pouch. By connecting the other end with the Roux limb of the intestine, a “Y” shape is formed, hence, where the name of the technique is derived from. Both segments may be adjusted in order create more or less malabsorption.
– Weight loss may occur at up to 77% of excess body weight, one year post-surgery.
– By 10-14 years, studies have shown some patients have maintained up to 50-60% body weight loss.
– The health conditions of up to 500 patients were either improved or resolved as shown by a study in the year 2000.
Absorption of iron and calcium occurs through bypassing the duodenum, often causing a reduced level of iron in the body, and sometimes also contributing to a predisposition of iron deficiency anaemia. Patients experiencing chronic blood loss such as during menstrual flow or haemorrhoids are of special concern. Increased bone calcium loss may occur for women, who are already at risk of osteoporosis.
Bone disease, bone pain, height decrease, humped back and rib and hip bone fractures can occur from bypassing the duodenum. A well maintained diet and vitamin supplements, however, can help in managing the aforementioned risks.
A vitamin B12 deficiency can sometimes cause chronic anaemia, however this may be managed with Vitamin B12 pills or injections.
As a result of the instant emptying of stomach contents into the small intestine, a condition called “dumping syndrome” may occur after eating. This is sometimes caused by an increase in the amount of sugar or food consumed, where symptoms may include nausea, weakness, sweating, faintness, and sometimes diarrhea. Some patients may not be able to consume sweet foods post surgery.
In cases where the stomach pouch is stretched or left bigger than 15-30cc, the procedure may decrease in desired effectiveness.
It is known that X-ray or endoscopy have trouble visualising the remainder of the stomach, the duodenum, and parts of the small intestine. Thus problems including ulcers, bleeding or malignancy may not be easily found if they were to occur.
Extended (Distal) Roux-en-Y Gastric Bypass (RYGBP-E)
Another means of creating malabsorption is through Distal Roux-en-Y Gastric Bypass (RYGBP-E), which means stapling or dividing the stomach, leaving a smaller stomach pouch. The stomach is attached to part of the small intestine to redirect the bile and pancreatic juices. Fewer surgical risks are associated with this procedure, as it doesn’t involve removing the lower ¾ of the stomach. The length of the bypassed intestine and gastric pouch size are responsible for the risk of ulcers, malnutrition and other such risks.