Emory Bariatrics
Center at Decatur

The Roux-en-Y gastric bypass operation is one of the most common gastric bypass surgeries. Roux-en-Y gastric bypass is both a restrictive and a mal-absorptive procedure. It alters digestion by limiting the amount and types of foods that you can eat. It can be performed through open surgery with one long incision or laparoscopically using multiple small incisions.

With the Roux-en-Y gastric bypass procedure, a small stomach pouch is created by using special staples or a vertical gastric band. This pouch is then connected to a Y-shaped segment of your small intestine which allows food to bypass the lower section of your stomach and the first segments of your small intestine. Not only is your stomach pouch too small to hold large amounts of food, but by skipping segments of your small intestine, fat absorption is substantially reduced resulting in weight loss.

On average, the Roux-en-Y gastric bypass surgery takes one to three hours of operating time. Most patients remain in the hospital one to two days. Some may stay longer, but it’s not an indication of how well the recovery may be going. As with any surgery, there are some risks involved with the Roux-en-Y gastric bypass procedure, but your surgeon will discuss these with you in detail before your procedure. There is also a detailed follow-up plan for all bariatric surgeries including the lap Roux-en-Y gastric bypass.

Restrictive operations, like laparoscopic adjustable gastric banding surgery, are used only to restrict and decrease the amount of food you eat by reducing the size of your stomach. They do not interfere with your normal digestive process.

With laparoscopic adjustable gastric banding surgery, a hollow band made of special material is placed around your stomach near its upper end through several small incisions in your abdomen. This lap band procedure creates a small pouch and a narrow passage into the larger remaining portion of your stomach.

The small passage created by the lap band procedure reduces the amount of food that your stomach can hold at one time. It also delays the digestion (emptying of food) from the pouch and causes a feeling of fullness for a long period of time. This combination allows you to lose weight without feeling hungry.

With the lap band procedure, the band can be tightened or loosened over time to change the size of the passage. Initially, the pouch holds about 1 ounce of food and later expands to 2-3 ounces. You will need to have regular follow-up visits with your doctor after your gastric banding surgery to make sure your band is properly fitted.

Some patients who have had a laparoscopic adjustable gastric band placed experience problems after their procedure. These may include significant heartburn, vomiting, difficulty eating despite the band being properly adjusted and/or not achieving the weight loss they desire. Others may experience a slipped band, which can result in the band not functioning properly.

Our physicians can remove the adjustable band and convert to one of three other bariatric procedures, the Sleeve Gastrectomy, Gastric Bypass, or Loop DS. These procedures can be done laparoscopically, and are very good surgical alternatives for band patients who are experiencing complications or who have not reached their weight loss goals.

Sleeve Gastrectomy with Single Anastomosis Loop Duodenal Bypass (or Loop DS) is very similar to the duodenal switch (this refers to where most of the stretchable stomach is permanently removed and significantly shrinks the stomach capacity, but the basic stomach structure remains the same so calorie absorption decreases).

With this procedure, a portion of the stomach is removed (a.k.a. sleeve gastrectomy). In addition, the intestines are rerouted so calorie absorption is reduced. The intestine is attached approximately 8 -10 feet from the colon to the first part of the small intestine to the pyloric valve (which controls the flow of partially digested food from the stomach to the small intestine). This creates a loop that diverts the food stream from the top half of the small intestines, and in turn, creates a shorter channel which helps decrease the chances of weight regain by decreasing calorie absorption. Patients typically report a significant decrease in hunger and food consumption after this operation.

During a laparoscopic sleeve gastrectomy, a thin vertical sleeve of stomach is created using a stapling device, and the rest of the stomach is removed. The sleeve is approximately the size of a banana. The laparoscopic sleeve gastrectomy weight loss procedure limits the amount of food you can eat at any given time and helps you feel full sooner. Food consumed passes through the digestive tract in the usual order, allowing it to be fully processed in the body without altering the normal absorption of vitamins and minerals.

The majority of weight loss sleeve gastrectomies performed today use a laparoscopic technique, which is considered minimally invasive. Laparoscopic surgery usually results in a shorter hospital stay, faster recovery and smaller scars. Laparoscopic sleeve gastrectomy also has less pain involved than open surgical weight loss procedures.

Laparoscopic sleeve gastrectomy can be the first step before gastric bypass or it can be a single weight loss procedure. If a sleeve gastrectomy is used as part of a two-step weight loss procedure, the first step is for the surgeon to create the small stomach "sleeve." After a period of time determined by the surgeon, another weight loss procedure would be performed in which the surgeon attaches a section of the small intestine directly to the stomach pouch. This allows food to bypass a portion of the small intestine, which results in absorbing fewer calories.

The laparoscopic sleeve gastrectomy weight loss procedure significantly decreases hunger by removing the part of the stomach that produces the main stimulating hormones. It can also minimize the chance of developing ulcers.