Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)

CPT4 code

Name of the Procedure:

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)
Common Name(s): Laparoscopic gastric bypass, Roux-en-Y gastric bypass (RYGB)

Summary

Laparoscopic gastric bypass is a surgical weight-loss procedure that involves creating a small stomach pouch and rerouting a portion of the small intestine to this pouch. This technique is performed using minimally invasive laparoscopic methods, which generally result in smaller incisions and faster recovery times.

Purpose

The primary purpose of this procedure is to aid in significant weight loss for individuals struggling with severe obesity. The goals are to reduce the patient's stomach capacity and cause hormonal changes that facilitate weight reduction, improved metabolism, and to potentially resolve obesity-related conditions such as type 2 diabetes, high blood pressure, and sleep apnea.

Indications

Severe obesity (Body Mass Index [BMI] of 40 or higher)
BMI of 35 or higher with obesity-related health conditions such as diabetes, hypertension, or severe sleep apnea
Previous unsuccessful attempts at weight loss through diet, exercise, and medication
Obesity with significant impact on physical health and quality of life

Preparation

Patients are typically required to follow a liquid diet for 1-2 weeks prior to the procedure.
Fasting from midnight before the day of the surgery.
Pre-operative diagnostic tests may include blood tests, electrocardiograms (EKG), and nutritional assessments.
Medication adjustments, including cessation of blood-thinning agents as advised by the physician.

Procedure Description

Under general anesthesia, several small incisions are made in the abdomen.
A laparoscope (a thin tube with a camera) and surgical instruments are inserted through these incisions.
The surgeon creates a small stomach pouch about the size of a walnut, making sure to separate it from the rest of the stomach.
A portion of the small intestine is divided and one end is connected to the new stomach pouch (Roux limb).
The other end of the small intestine is reconnected further down, allowing digestive juices to mix with food at this later stage.
The incisions are closed, and the patient is monitored until they wake from anesthesia.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

Hospital operating room
Specialized surgical center

Personnel

Surgeon specialized in bariatric surgery
Anesthesiologist
Surgical nurses
Possibly a surgical assistant or physician assistant

Risks and Complications

Common risks: infection at the incision sites, bleeding, and adverse reactions to anesthesia
Rare risks: deep vein thrombosis (DVT), leaks in the gastrointestinal system, bowel obstruction, and nutritional deficiencies
Long-term complications can include: hernias, dumping syndrome, and marginal ulcers

Benefits

Significant and sustained weight loss
Improvement or resolution of obesity-related conditions such as diabetes, hypertension, and sleep apnea
Enhanced quality of life and increased mobility
Benefits are typically evident within the first year following the procedure

Recovery

Hospital stay typically lasts 2-3 days
Patients may need to follow a specific diet that progresses from liquids to soft foods before resuming a regular diet
Pain management will include prescribed medications
Light physical activities can be resumed within a few weeks, but strenuous activities should be avoided for 6-8 weeks
Follow-up appointments are necessary to monitor progress and nutritional intake

Alternatives

Diet and exercise programs
Medications for weight loss
Other weight-loss surgeries such as sleeve gastrectomy or adjustable gastric banding
Pros and cons: While alternatives might be less invasive or carry different risk profiles, they may not provide the same level of significant or sustained weight loss that gastric bypass offers.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel any pain.
Post-procedure, patients may experience discomfort at incision sites, nausea, and changes in appetite. Pain management strategies will be employed to ensure patient comfort.
Encouragement and guidance from a healthcare team are provided throughout the entire recovery process to help adjust to the new diet and lifestyle changes.