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Laparoscopic Roux en Y Gastric bypass

Laparoscopic gastric Bypass procedure involves creating a stomach pouch out of a small portion of the stomach approximately the size of an egg. This pouch is then attached directly to the small intestine, bypassing a large part of the stomach and duodenum. Not only is the stomach pouch too small to hold large amounts of food, but by skipping the duodenum, fat absorption is substantially reduced. Due to the connection of the pouch to the intestine and the lack of a pyloric valve, an gastric bypass patient eating sugary foods will sometimes suffer from "dumping syndrome". This is what happens when a high sugar food is eaten or drunk, the body dumps in a lot of insulin to counteract the sugar level, this results in a low blood sugar level which causes nausea and vomiting and a generallly awful feeling. For this reason, the gastric bypass is believed to be the operation for those with a sweet tooth as the dumping syndrome will hopefully deter the patient from eating sugar too much. gastric bypass patients have to take vitamin supplementation for life and need to have their bloods checked at regular intervals.
The Laparoscopic Gastric Bypass is performed by dividing the stomach into two compartments, creating a very small pouch (approximately 30 ml) that remains connected to the esophagus (food pipe). The larger portion of the stomach is left in its place and not removed. The two parts of the stomach are completely separated. The small intestine is divided downstream from the stomach and the distal ends is attached to the small stomach pouch. The intestine is then reconnected downstream from the pouch to receive the acid secretions made by the bypassed portion of the stomach. This operation induces weight loss by limiting the amount of food you eat and by limiting absorption of food in the intestine.
On average, patients who undergo gastric bypass surgery experience a 85% loss of excess weight. 

Advantages of laparoscopic gastric bypass:

1. Most commonly performed weight reduction operation in the United States.
2. Most reliable operation for long-term weight loss.
3. Long-term weight loss averages 70 to 85 percent of excess body weight.
4. Works by both restriction and malabsorption.
5. Significant malnutrition following laparoscopic bypass is unusual.
6. Substantial improvement in many health problems related to morbid obesity such as:
            - Type 2 diabetes mellitus,
            - Sleep apnea,
            - Hypertension,
            - High cholesterol,
            - High triglycerides
            - Heartburn from gastro-esophageal reflux disease, and  Urinary stress incontinence

Disadvantages of laparoscopic gastric bypass:

1. Not reversible.
2. 5% chance of significant peri-operative complications.
3. 5% long-term chance of stricture of gastro-jejunostomy.
4. Long-term risk of protein deficiency, vitamin deficiency, and marginal ulceration of the gastro-jejunostomy.
5. 2% long-term risk of intestinal obstruction or internal hernia.


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