Roux-en-Y Gastric Bypass

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States. Dr. Spivak is considered a leading expert on this procedure. He has taught the operation to many surgeons and he is frequently visited by physicians from the US and abroad arriving to watch him operating and learn his techniques.

Dr. Spivak has his own surgical team and he uses the best anesthesiologists for his patients. His practice is designated as “Center of Excellence" by the American Society for Bariatric Surgery. Dr. Spivak has recently perfected a technique to laparoscopically convert failed Lap-Band procedures to Gastric Bypass (see publications and presentations section).

Please remember: You must attend Dr. Spivak's free educational seminar prior to the doctor’s appointment (you can do both the same day).

Technique

In this procedure, the surgeon creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely divided and separated from the stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing the gastric enzymes. This is done by dividing the small intestine just beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce higher levels of malabsorption. Dr. Spivak prefers the proximal Gastric Bypass technique where the bilio-pancreatic limb measures approximately 40 cm and the enteric limb measures up to 100 cm. Using this technique, Dr. Spivak minimilizes the malabsorption effect of his procedures.

Advantages

Multiple studies have documented that severe obesity is associated with very high risks of health problems, early death, and cancer. The loss of as little as 10% of excess weight has been shown to reduce or eliminate the need for medications associated hypertension, diabetes and lipid disorders

The average excess weight loss after the Roux-en-Y procedure is higher in a compliant patient than with purely restrictive procedures.
One year after surgery, weight loss can average 80% of excess body weight.
In the long run, most of the weight loss is maintained.
Most associated obesity health conditions (diabetes, back pain, sleep apnea, high blood pressure, hyper lipids) are improved or resolved after weight loss with Gastric Bypass.

Risks

Surgery for severe obesity is a major operation in which complications can arise whether performed by a laparoscopic or open technique. Overall about 5-8% of patients have a risk of a complication related to the surgery, and 0.5% risk of death reported in USA. Other than the known risks of anesthesia and any major abdominal surgery, the specific problems which have been reported include:
1. Pulmonary Embolism
2. Bleeding or injury to the spleen
3. GI tract obstruction due to adhesions, scarring, or hernias.
4. Malnutrition or anemia
5. Ulcers, perforation
6. Chronic vomiting or diarrhea
7. Infection due to leakage from the stomach or intestines
In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched.

Long term, 1-2% of patients have their surgery reversed due to side effects or dissatisfaction with the restriction on food intake. All patients are advised to take vitamin and mineral supplements to minimize nutritional or metabolic side effects. Because of the potential for nutritional problems, patients should undergo periodic assessments for life.

Gastric Bypass Surgery Animation Video

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