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Laparoscopic Roux–en–y Gastric Bypass (Lap RYGB)

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Procedure –

This is the gold standard among bariatric surgeries. Compared to purely restrictive operations weight loss after this operation is more and long lasting. Compared to mostly mal-absorptive operations vitamin and mineral deficiencies are less after this operation. A pouch of < 30 ml is created in the upper part of stomach by dividing it with the help of linear staplers. Jejunum is divided 50 cm below the duodenojejunal junction. Lower divided end of jejunum is attached to the gastric pouch with the help of linear or circular staplers. Upper divided end of jejunum is attached to the side of small intestine 50 to 150 cm below the gastrojejunostomy. Food intake is restricted because of small size of the gastric pouch. As the main absorptive areas of small intestine like duodenum and proximal jejunum are bypassed, calories and nutrients absorption is reduced. This gives effective loss of weight.

Laparoscopic Roux–en–y Gastric Bypass  (Drawn by Dr. V. Amar)

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Complications –

roux-en-y gastric bypass is safe if it is performed on the right candidate properly. But problems do occur in a small percentage of patients. They are related either to the anesthesia, surgery or postoperative management. After this operation patient may develop lung problems, leak from the stapled edges in immediate postoperative period. In long run they can develop gall bladder stones, narrowing of the gastrojejunostomy, ulcers in the gastrojejunostomy, anemia, internal hernias, dilatation of the pouch, vitamin and mineral deficiencies, osteoporosis etc. Even though this is more successful in achieving and sustaining weight loss compared to restrictive operations, vitamin and mineral deficiencies are more likely after this operation. But this risk is less compared to mostly mal-absorptive operations like Lap BPD, Lap BPD-DS. Patient needs to be on lifelong vitamin and mineral supplements after Laparoscopic RYGB.

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