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Laparoscopic Roux-en-Y gastric bypass
Laparoscopic Roux-en-Y gastric bypass involves 6 small incisions. The stomach is stapled off to create a short gastric pouch, about the size of an egg. A rubber tube (‘bougie’) is passed down the swallowing pipe into the stomach. The stomach is stapled off against this bougie to ensure the pouch is sized/calibrated correctly. The remaining stomach remains inside the abdomen long term. The small bowel is then measured and brought up and sutured onto the gastric pouch as the food (‘alimentary’) limb. The second limb (containing digestive enzymes) is then sutured back onto the food limb lower down.
Local anaesthetic is placed in the wounds and the abdominal cavity. Most patients wake up with very little pain or nausea. Many patients are well enough to go home on day 1. Approximately 1 in 20 patients will have significant nausea the next day, and need to stay in hospital an extra night until this settles.
BMI > 40, or BMI > 35 with weight related comorbidities. Please discuss the relative merits of the available weight loss surgery procedures with Dr Dodd.
Bleeding, leak from the joins and bowel obstruction are the main risks of gastric bypass. This can require return to theatre, drains, ICU stay and prolonged hospital stay. Leaks can happen several days after surgery. Symptoms of leak include new onset severe pain, fever, chills and rigors (violent body shakes). If you have any of these symptoms after surgery, please contact Dr Ben Dodd urgently.
Late complications: These include stricture (narrowing at the join), ulcer at the join, hiatus hernia, reflux, dumping, bowel obstruction and abdominal pain. These can be severe enough to require revisional surgery.