43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy

Name of the Procedure:

Gastric Restrictive Procedure with Gastric Bypass for Morbid Obesity; with Short Limb (150 cm or less) Roux-en-Y Gastroenterostomy

Summary

This surgical procedure, commonly known as Roux-en-Y Gastric Bypass, involves reducing the size of the stomach to limit food intake and rerouting a part of the small intestine to create a bypass. This helps in significant weight loss by both restricting food intake and reducing calorie absorption.

Purpose

Medical Condition:

• Morbid obesity

Goals:

• To assist in significant weight loss
• To improve or resolve obesity-related health conditions such as diabetes, hypertension, and sleep apnea.

Indications

Symptoms/Conditions:

• Morbid obesity (BMI ≥ 40)
• Obesity-related health issues like type 2 diabetes, heart disease, hypertension, or severe sleep apnea.

Patient Criteria:

• Typically adults with a BMI ≥ 40 or BMI ≥ 35 with serious obesity-related health problems.
• Failed to achieve sustained weight loss through other means (diet, exercise, medication).

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to current medications as directed by the doctor.
• Preoperative evaluations including blood tests, imaging studies, and possibly a psychological assessment.

Procedure Description

• Step 1: The patient is placed under general anesthesia.
• Step 2: The surgeon creates a small pouch at the top of the stomach using surgical staples.
• Step 3: The small intestine is then divided, and the bottom end (the Roux limb) is connected to the small stomach pouch.
• Step 4: The remaining portion of the stomach and the upper part of the small intestine (bypassed section) are reconnected further down.
• Tools and Technology: Laparoscope, surgical staples, and other standard surgical instruments.
• Anesthesia: General anesthesia is used to ensure the patient is completely asleep and pain-free.

Duration

• The procedure typically lasts between 2 to 4 hours.

Setting

• Performed in a hospital or specialized surgical center.

Personnel

• Surgeons, anesthesiologists, nurses, and surgical technicians.

Risks and Complications

Common Risks:

• Infection, blood clots, and bleeding.

Rare Risks:

• Nutritional deficiencies, ulcers, bowel obstruction, or severe complications requiring additional surgeries.

Management:

• Monitoring, medications, or additional corrective surgeries may be required.

Benefits

• Significant weight loss.
• Improvement or resolution of related health issues.
• Improved quality of life and increased lifespan.

Recovery

• Hospital stay of 2 to 3 days typically required.
• Gradual transition from liquid to solid foods over several weeks.
• Pain management through medications.
• Follow-up appointments for monitoring weight loss and nutritional status.
• Regular physical activity and adherence to dietary guidelines post-surgery.

Alternatives

Other Treatment Options:

• Lifestyle changes (diet and exercise)
• Medications for weight loss
• Other bariatric surgeries such as sleeve gastrectomy or adjustable gastric banding.

Pros and Cons:

• Lifestyle and medications may not be as effective for significant weight loss for morbidly obese patients.
• Other bariatric surgeries may offer different benefits and risks.

Patient Experience

During Procedure:

• The patient will be under general anesthesia and unconscious.

After Procedure:

• Patients may experience pain, which can be managed with medications.
• Discomfort and dietary adjustments as the digestive system heals and adjusts.
• Continuous support and counseling may be provided for lifestyle changes and nutritional needs.