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The Roux-en-Y Gastric Bypass ProcedureAt this time the Roux-en-Y gastric bypass procedure is considered the standard of care for long-term surgical weight loss management. However, there are multiple other procedures that include gastric band, vertical banded gastroplasty, biliopancreatic diversion, extended distal gastric bypass and biliopancreatic diversion with duodenal switch. Our practice at this time offers the Roux-en-Y gastric bypass procedure in either by conventional methods or the laparoscopic minimally invasive approach, depending on patient's characteristics. The Vertical Banded Gastroplasty 
The essential surgical components to a successful weight loss procedure include both restrictive and malabsorptive benefits. The vertical banded gastroplasty** is a restrictive procedure which typically requires less trauma in surgery. However, the long-term results are poor as it compares to long limb Roux-en-Y gastric bypass procedure. Immediately there is a 21% failure rate. Success has been measured by the mean loss of only 50% of excess body weight, and unfortunately long term results lead to failure in 40 to 60% of cases. However, it is an indicated procedure for specific patients. ** this is no longer an offered surgical procedure. The Long Limb Roux-en-Y Gastric Bypass Procedure The long limb Roux-en-Y gastric bypass procedure is a combined restrictive and malabsorptive procedure with much better results. The loss of 75% of excess body weight can be expected from this procedure in approximately 70 to 80% of patients. It results in better reduction in comorbid disease. It is much more extensive surgery with increased risks. However, as stated, benefits often increase the risk depending on patient's comorbid problems. 
The physiology of the gastric bypass procedure is such that the pouch is a small pouch which restricts the number of calories. The bypassed stomach and initial portion of the small intestine result in the malabsorptive portion of the procedure. The procedure is directed at altering the energy balance in patients. Energy balance is related to the amount of food absorbed and the amount of energy used. Excess energy is stored as fat and from these reserves energy is drawn as the body needs it. The Roux-en-Y gastric bypass procedure decreases calories and also causes certain food to be digested poorly and incompletely and thereby eliminating calories in stool.The bypassed portion of the intestine results in chronic malabsorption problems which are well managed with supplements which include the decrease in vitamin B12, calcium, iron in menstruating women, thiamine and folic acid. These are typically replaced with a multivitamin, vitamin B12 and iron replacement for life.  Back to Top
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