Laparoscopic Roux-en Y gastric bypass is one of the oldest and time tested bariatric procedures in the world. Commonly acknowledged as a gold standard weight loss procedure, this surgery is being performed for over 50 years all across the world and for almost 20 years in Mumbai.
Laparoscopic banded Roux-en y gastric bypass surgery is a modification of the standard gastric bypass where a silicon band is placed on the stomach pouch for better maintenance of weight in the future.
As per the IFSO-APC guidelines, if your BMI is more than 37.5 Kg/m2 (BMI- weight in kg/height in m2), you can undergo a laparoscopic Roux-en Y gastric bypass in the absence of any associated illnesses. You can also undergo this procedure if your BMI is ≥ 32.5 Kg/m2 and you have 2 or more obesity associated diseases like type 2 diabetes, high blood pressure, high cholesterol etc. As per the new DSS guidelines formed by a group of international diabetes federations in London, laparoscopic Roux-en Y gastric bypass may also be considered as a treatment option for control of diabetes in patients with class I obesity (BMI- 27.5-32.5 Kg/m2) if their diabetes is poorly controlled.
In built formula for calculating BMI
Laparoscopic banded Roux-en Y gastric bypass surgery is a surgical procedure in which a small pouch of the stomach is created using staplers and the small intestine is rearranged and joined to this stomach pouch. Major part of the stomach, duodenum- which is the first part of small intestine and the first part of jejunum is bypassed in this surgery. In laparoscopic banded Roux-en Y gastric bypass surgery, an inflexible silicon ring is placed on the stomach pouch. This ring helps in prevention of enlargement of the stomach pouch and the joint where the stomach pouch is attached to the intestine.
Banded Roux-en Y gastric bypass surgery is one of the best bariatric procedures and leads to weight loss by a combination of multiple mechanisms. First of all, as the stomach pouch is very small, you will not be able to eat too much and your intake will be restricted. Secondly, you will feel full even after eating small quantities and will feel satiated much earlier. The band on the stomach pouch prevents the pouch from dilating in future and helps in the long term maintenance of weight loss. Thirdly, “ghrelin” the hunger inducing hormone which is produced from the fundus of the stomach, does not come in contact with the food and hence the sensation of hunger is curbed to a large extent. Fourthly, as the stomach and first part of intestine are bypassed, banded Roux-en Y gastric bypass surgery also leads to some degree of mal-absorption. In addition to this there are GI hormones that play a big role in weight loss as well as control of diabetes. There are also other factors like bile acids, gut microbiota and certain unknown factors that augment the effect of a banded Roux-en Y gastric bypass surgery.
Bariatric/metabolic surgery is the only proven method for sustained weight loss in people suffering from clinically severe obesity. Most bariatric procedures will lead to an excess weight loss to the tune of 65 to 75% over a period of 18 to 24 months. This weight loss journey is a partnership between the doctor and the patient and the results depend on the level of commitment from either party. All bariatric procedures lead to a significant improvement in type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, venous thrombo-embolism, PCOD, infertility and many other diseases related to obesity. Weight loss leads to a significant decrease in the risk for heart disease also. Overall, bariatric/metabolic surgery leads to a marked improvement in health, quality of life and confidence of the patient.
Dr. Aparna Govil Bhasker has been performing this procedure for over a decade and she has one of the highest experiences in this surgery. This surgery requires a lot of disposable equipment in the forms of stapler guns, trocars, cartridges, energy sources etc. We also use a silicon band in case of banded Roux-en Y gastric bypass surgery. The cost also depends on the number of days you need to stay in the hospital, type of room that you select as well as the hospital in which you get operated. The doctor will guide you about the cost after assessing and evaluating all the above details.
In a banded laparoscopic Roux-en Y gastric bypass, a non-adjustable silicon ring is placed around the stomach pouch. Dr. Aparna Govil Bhasker recommends this over a normal non-banded laparoscopic Roux-en Y gastric bypass as this helps in long term weight maintenance. In a non-banded laparoscopic Roux-en Y gastric bypass, there are chances of weight regain in future whereas with a banded laparoscopic Roux-en Y gastric bypass, chances of weight regain are reduced. Its biggest advantage is that it helps to maintain restriction in the long term. Though it is safe in approximately 98% of patients, 2 to 3% patients may experience erosion or slippage of the ring. If the ring were to erode into the stomach pouch, most of the times it can be removed non-surgically by endoscopy.
Weight loss is a gradual process after a laparoscopic Roux-en Y gastric bypass. You will lose weight quite fast in the first 3 to 4 months after which, weight loss slows down. You will continue to lose weight for about 12 to 18 months after your surgery and can expect to lose about 65 – 75% of your excess weight with help of a laparoscopic Roux-en Y gastric bypass.
It is important to note that bariatric/metabolic surgery is a tool that pushes you into a lifestyle change. While bariatric/metabolic surgery helps to lose massive amount of weight, it is also important to exercise every day and follow a healthy diet. Our experience shows that patients who embrace the lifestyle change along-with surgery, tend to do much better in terms of weight loss and weight maintenance.
Banded Roux-en y gastric bypass surgery is known to lead to improvement in type 2 diabetes. It has been observed that a lot of patients do not need to go back on their anti-diabetic medications after the surgery. For those who need to continue medications, the dose is reduced considerably and a lot of times patients who have been on insulin may not require it post-operatively. The outcomes of diabetes remission depend on a lot of factors like the duration of diabetes, type of diabetes (type 1/type 2), age of the patient, c-peptide levels, use of insulin etc. It also leads to improvement in other associated diseases like high blood pressure, high cholesterol, obstructive sleep apnoea, gout, joint diseases, PCOD, infertilty etc. The overall risk for heart disease goes down considerably due to significant weight loss and overall improvement in associated co-morbidities.
Banded Roux-en Y gastric bypass surgery has been shown to lead to remission or improvement in obese diabetics. Most often their blood sugars come under control within a few months of surgery and a lot of times patients do not need to take medications.
If you are a diabetic but you are not overweight or obese, the chances are that this surgery may not help you for improvement of diabetes. The latest DSS guidelines recommend metabolic surgery for patients with a BMI greater than 27.5 kg/m2 if their diabetes is uncontrolled despite best medical management. Presently, there is no evidence to recommend this surgery to a diabetic patient with a BMI less than 27.5 kg/m2.
Once you see the doctor, you will need to undergo investigations and medical checks for fitness. Additionally, you may need to see a chest physician, an endocrinologist, a nephrologist or a cardiologist, based on your clinical profile. You will also need to be on a high protein liquid diet for about 5 to 7 days prior to surgery. We would want you to lose atleast 3 to 5 kg before you undergo any bariatric/metabolic surgery. This also helps to reduce the swelling on the liver, and makes surgery easier for the surgeon and in turn, safer for you. In a way it is also a test of your compliance for long term follow up. It has been seen that patients who follow the pre-operative diet well, they tend to get better results after any bariatric/metabolic surgery.
You will be admitted to the hospital one day before the surgery or in special cases as per the advice of the doctor. The surgery typically takes about 60 to 90 minutes to perform depending on the grade of difficulty. You are encouraged to walk within 4 to 6 hours of surgery. Most patients get discharged the next day, of course it will depend on your clinical condition and the doctor’s decision.
Follow up is the most important part of any bariatric/metabolic surgery. You will need to see Dr. Aparna Govil Bhasker 7 days after your surgery. After this in the first year, you need to do your tests and visit at 3 months, 6 months and at the end of 1 year. Post 1 year, all patients need to get investigated once a year and visit the centre for a check up. Life long follow up is advised after all bariatric/metabolic surgeries.
After the laparoscopic Roux-en y gastric bypass surgery, you will be on liquid diet for 15 days followed by soft diet for 15 days. You can commence normal home food after a month of surgery but it will be restricted in quantity. The nutritionists will guide you at every step and will be there to answer all your queries. You will need to avoid high calorie foods, fired food, sweets and alcohol. High sweet intake can lead to dumping syndrome after a laparoscopic banded Roux-en y gastric bypass surgery.
After any bariatric/metabolic surgery, you need to be on nutritional supplements. There are two reasons for that. Firstly, your intake will reduce considerably and secondly after a laparoscopic Roux-en Y gastric bypass you will not absorb certain nutrients due to its mal-absorptive component. You may also need to be on other medications as advised by the doctor based on your clinical profile.
Laparoscopic banded Roux-en y gastric bypass surgery is said to be as safe as a laparoscopic gall bladder surgery or a knee replacement surgery. Its complication rates are much lower when compared to other major surgeries like cardiac bypass or surgery of the food-pipe or many other cancer surgeries. In the internet savvy world of today, google search will bring up a host of complications but its best if the doctor discusses this in person with you during your consultation.
Smoking is a contra-indication for any bariatric/metabolic surgery. If you are a smoker, you need to give up smoking completely atleast 15 days prior to undergoing surgery. If you are not confident about being able to stop smoking altogether, then our advice is that you must not undergo bariatric surgery, in order to avoid serious complications in future.
Long term weight maintenance depends on a host of factors. Some degree of weight regain has been observed in the long term after a laparoscopic banded Roux-en y gastric bypass surgery. Addition of the band helps in better weight maintenance. However, it is imperative to exercise and bear moderation in diet after the surgery.