Roux-en-Y Gastric Bypass In Baltimore, Maryland

Gastric bypass involves both restrictive and malabsorptive components to produce long-term weight loss. It is restrictive as a result of the creation of a small stomach pouch, and malabsorptive because it creates a method for bypassing a variable portion of the small intestine depending on a patient’s BMI before surgery.

There are two components to the gastric bypass procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, a Y-shaped section of the small intestine is attached to the pouch allowing food to bypass the main stomach. Bypassing the two segments of the small intestine, known as the duodenum and part of the jejunum, allows the body to reduce the amount of calories the body absorbs.

The gastric bypass is successful because the newly created stomach pouch is considerably smaller and can only hold a few ounces of food at a time, which translates into fewer calories consumed. There is less digestion of food by the smaller stomach pouch, and the segment of small intestine that would normally absorb calories no longer has food going through it, so there is less absorption of food. Most importantly, the rerouting of the digestive process produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Gastric bypass surgery is performed as a laparoscopic (minimally invasive) procedure that involves the use of a small telescope-like camera inserted through a small incision made in the abdomen, but not everyone is a candidate for this type of surgery.

You and your surgeon can decide together which procedure is right for you.

• Low mortality rate (0.2%)
• Weight loss of 65 to 70% of pre-operative excess weight within one year
• Overall improved health
• Improvement or elimination of co-morbidities such as type II diabetes, sleep apnea, hypertension and some others

• Disruption of the staple line can lead to leakage or serious infection
• Possible malnutrition or anemia
• Possible obstruction of the GI tract
• Risk of marginal ulcer
• Risk of dumping syndrome
• Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance

Morbidly obese patients prior to bariatric surgery suffer from a higher frequency of reflux symptoms compared to the general population. To minimize the risk of significant GERD after bariatric surgery we actively screen patients for symptoms of reflux and hiatal hernia.

If detected, we repair it at the time of the bariatric procedure. This approach minimizes the risk of possible delayed surgery for this condition and greatly improves their quality of life after bariatric surgery.

Morbidly obese patients are known to have a higher frequency of Gall Bladder disease both prior to and after bariatric surgery compared to the general population. Asymptomatic gall stones can cause acute inflammation with significant weight loss after bariatric surgery in 30-40% of patients. It is our policy to actively screen patients for gall bladder problems prior to surgery and if anything is detected (gall stones, chronic cholecystitis due to dyskinesia, cholesterol polyps), removal of the gall bladder at the time of main bariatric procedure might be recommended. If no problems with the gall bladder are detected, after bariatric surgery patients are treated with Ursodiol or Actigall for first six months after bariatric surgery in to prevent problems with the gall bladder.