43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption

Name of the Procedure:

Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption

• Common Names: Laparoscopic Gastric Bypass, Roux-en-Y Gastric Bypass (RYGB), Gastric Bypass Surgery

Summary

Laparoscopic gastric bypass is a minimally invasive surgery that helps with weight loss by altering the stomach and small intestine. This procedure reduces the amount of food the stomach can hold and changes the digestive process so fewer calories and nutrients are absorbed.

Purpose

• Address obesity and related health conditions such as type 2 diabetes, high blood pressure, and sleep apnea.
• Aim for significant and sustained weight loss, improve or resolve comorbid conditions, and enhance overall quality of life.

Indications

• Severe obesity (BMI ≥ 40) or obesity (BMI ≥ 35) with associated health problems.
• Patients who have struggled to lose weight through diet, exercise, and medical therapy.
• Commitment to post-surgery lifestyle changes.

Preparation

• Pre-surgery instructions generally include fasting for 8-12 hours.
• Adjustments to medication as directed by the healthcare provider.
• Comprehensive pre-surgical assessments including blood tests, imaging, and consultations with a dietitian and psychologist.

Procedure Description

1. Anesthesia administration for patient sedation.
2. Small incisions in the abdomen to insert laparoscope and surgical instruments.
3. Creation of a small pouch at the top of the stomach.
4. Bypassing a portion of the small intestine and connecting it to the new stomach pouch.
5. Routing the remainder of the stomach and intestines.
   • Tools: Laparoscope, surgical staplers, and sutures.
   • Done under general anesthesia.

Duration

Approximately 2-3 hours.

Setting

Typically performed in a hospital's operating room.

Personnel

• Surgeons specialized in bariatric surgery.
• Anesthesiologists.
• Surgical nurses and technologists.
• Possibly a gastroenterologist.

Risks and Complications

• Common: Infection, bleeding, and blood clots.
• Rare: Leaks at the surgical site, bowel obstruction, nutritional deficiencies.
• Management: Monitoring, medications, or additional surgeries if necessary.

Benefits

• Significant weight loss (often 60-80% of excess weight within the first year).
• Improvement or resolution of obesity-related conditions.
• Enhanced quality of life and increased mobility.

Recovery

• Initial hospital stay of 2-5 days.
• Gradual reintroduction of liquid and solid foods over weeks.
• Pain management with medications.
• Restrictions include limited physical activity initially and careful diet monitoring.
• Follow-up appointments with the surgical team and regular nutritional counseling.

Alternatives

• Non-surgical: Diet, exercise, and medication-based weight loss programs.
• Other surgical options: Sleeve gastrectomy, adjustable gastric banding.
• Pros: Non-surgical options are less invasive and carry fewer immediate surgical risks.
• Cons: They may be less effective for significant and sustained weight loss.

Patient Experience

• During the procedure: Under general anesthesia, so no pain is felt.
• After the procedure: Some discomfort or pain managed by medications.
• Pain management: Analgesics and possibly patient-controlled analgesia (PCA) pumps.
• Adapting to a new diet and routine for long-term success.