The gastric bypass celebrates its 50th birthday in 2017. A gastric bypass procedure for weight loss was first done in 1967. The operation was performed by traditional open surgery, and this continued until the 1990s. Keyhole surgery was first used to do the gastric bypass in 1994. The operation was now called the laparoscopic gastric bypass. This operation became the gold standard for weight loss surgery in the modern era. In 2017, all weight loss surgery is done by laparoscopy. About 50% of all weight loss operations in the UK are gastric bypasses. The other operations are the gastric band and the gastric sleeve.
What is a Gastric Bypass?
In a gastric bypass, surgical staplers are used to make a very small compartment at the top end of the stomach. This small compartment is called the gastric pouch. The pouch is disconnected from the rest of the stomach. The small bowel is then joined to the gastric pouch. Food and drink enter the small gastric pouch and then pass directly in to the small bowel. The lower part of the stomach and the upper part of the small bowel are bypassed – hence the name of the operation.
What is Roux-en-Y Gastric Bypass?
The full name for the gastric bypass is the Roux-en-Y gastric bypass. This is sometimes abbreviated to RYGB or LRYGB. ‘Roux-en-Y’ refers to the way of joining or ‘plumbing’ the small bowel to the stomach. The small bowel is a tube that is 25-35 feet long. This tube can be joined to the stomach pouch in two ways. One way is to join the small bowel tube directly to the gastric pouch. Such a join is called a ‘loop gastro-jejunostomy’. The second way is to divide the small bowel at the point that needs to be joined to the stomach pouch. The lower cut end of the small bowel is joined to the stomach. This part of the bowel carries food out of the stomach and is called the alimentary limb. The upper cut end of the small bowel receives bile from the liver and digestive juices from the pancreas. This is called the biliopancreatic or BP limb. The BP is now joined to the alimentary limb about 3 feet below join with the stomach. This second way of joining the bowel to the stomach is called a ‘Roux-en-Y gastrojejunostomy’.
What is the difference between a Roux-en-Y and a Loop Gastrojejunostomy?
The difference between a loop and Roux-en-Y can be confusing. Simply, in the loop there is only one anastomosis or join: that between the stomach and the small bowel. This join is called the gastrojejunostomy. In the Roux-en-Y there are two joins: the gastrojejunostomy and a separate join between the alimentary and BP limbs of the small bowel. The join between the two bowel limbs is called the jejuno-jejunostomy.
What is the Mini Gastric Bypass?
The main difference between the Roux-en-Y Gastric Bypass and the Mini Gastric Bypass is in the way the small bowel is joined to the stomach. In the Mini Gastric Bypass, the join is a loop and not Roux-en-Y. The Mini Gastric Bypass is technically simpler than the Roux-en-Y Gastric Bypass because there is only join – the gastrojejunostomy – in the Mini Bypass. The second join – the jejuno-jejunostomy is avoided in the Mini Bypass. A second difference is that the gastric pouch in the Mini Bypass is made considerably longer than in Roux-en-Y Bypass.
What are the Pros and Cons of the Mini Gastric Bypass?
Supporters of the Mini Bypass say that the operation is safer than the Roux-en-Y bypass because there is only one anastomosis. Some experts call the Mini Bypass the One Anastomosis Gastric Bypass (OAGB). The main worry with the Mini Bypass is that bile can enter the stomach. The Roux-en-Y method was designed specially to keep bile away from the stomach. Bile can cause cancer of the stomach and the oesophagus. But, the supporters of the Mini-Bypass say that the risk of cancer is negligible. Apart from being technically simpler, the Mini-Bypass is claimed to have lower risk of ulcer and stricture at the gastrojejunostomy. Short term data seem to show similar weight loss and improvement in illness, such a diabetes and high blood pressure, with both operations.
How to Choose a Weight Loss Operation?
Which is better: the Roux-en-Y Gastric Bypass or the Mini-Gastric Bypass? There is no definite answer to this question. One size does not fit all. Consider all the options, including gastric sleeve and gastric band, in order to make a final choice of a weight loss operation.