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The Roux-Y gastric bypass is the most frequently performed weight loss surgical procedure in the United States with an excellent safety profile and long term results.
In this procedure, stapling creates a small (15 to 20cc) stomach
pouch. The remainder of the stomach is not removed, but is completely
stapled shut and divided from the stomach pouch. The outlet from this
newly formed pouch empties directly into the lower portion of the
jejunum, thus bypassing calorie absorption. 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 lower or higher levels of malabsorption.
In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.
In addition to these mechanisms, there is a growing body of evidence pointing to substantial neurohormonal changes following gastric bypass surgery, that directly affect metabolism, insulin secretion and resistance, satiety and hunger. These factors explain the terrific efficacy of gastric bypass in bringing so many co-morbid conditions to resolution is a relatively short time period.
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.
In average, the surgery takes about 1.5 - 2.0 hours to complete, the average hospital stay is 2 days and most people return to work in about 2 weeks following surgery.
Rapid initial weight loss
Better results for patients with higher BMIs
Faster resolution of certain co-morbid conditions, such as type 2 diabetes mellitus, onstructive sleep apnea, hypertension
Long experience in the USA
“Dumping syndrome” can occur and may keep some individuals from returning to old eating habits (beneficial for sweet eaters)
The surgery carries a higher risk since dividing and reconnecting the
stomach and the small bowel is involved
A portion of the digestive tract is bypassed, which may result in nutritional deficiencies
Lifelong vitamin, Ca, Fe supplementation is required to prevent deficiencies (for details, see vitamins and supplements section)
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