Gastric Bypass: The Roux-En-Y Procedure

Gastric bypass is just what the name suggests. A surgical procedure performed to “bypass” the stomach. A smaller “pouch” is formed and becomes the functional stomach for the individual. Although there are different types of gastric bypass surgeries, this article is devoted to the most common – the Roux-en-Y. We will examine the actual procedure, determine why it is the best route to take, discuss insurance and Medicare coverage, talk about complications and touch on actual cost of the procedure.

In a Roux-En-Y surgery, a pouch of one ounce or less is formed at the end of the esophagus. A length of intestine is then anastamosed (surgically connected) to this pouch and is called the “Roux limb”. This limb completely bypasses the stomach. The portion of intestine that is still connected to the stomach includes the pyloris, and duodenum and is now considered the “bypassed limb” This limb still contributes digestive juices from the stomach but these juices are not mixed within the Roux limb. The Roux limb and the bypassed limb join together below the stomach to form the “common channel”. Exactly where this common channel is formed depends on individual anatomical structure. It is important to know that, since digestive juices from the bypassed limb do not mix with the food passing through the Roux limb, the greater chance for malabsorption problems to occur. Hence, “The longer the Roux limb, the longer the portion of intestine trying to absorb nutrients without the benefit of these digestive juices. Both of these changes result in less absorption of nutrients and contribute to weight loss, and are called the Malabsorptive components of the procedure” (Obesity Surgery Center, 2008).

The Roux-En-Y gastric bypass surgery can be performed either by open incision or by laparoscopic means. Most surgeons today will attempt the latter unless it becomes evident that an open procedure must be performed. This can be either due to large amounts of fat obscuring the scope lens or any number of problems.

So, why would anyone choose the Roux-en-Y procedure? According to studies published by the Journal of American Medical Association (JAMA) Gastric bypass is more effective than other types of procedures. In short, it works! The study led by Dr. Henry Buchwald found that

· Patients who underwent weight-loss surgery typically lost more than 60% of their excess weight, often more than 100 pounds;

· Diabetes was eliminated in almost 77% of those patients;

· Cholesterol levels declined in at least 70% of patients;

· High blood pressure was alleviated for nearly 62% of patients; and

· Obstructive sleep apnea was cured or improved in 83.6% of affected patients.

(Buchwald, 2008)

The analysis by Dr. Buchwald also concluded that the gastric bypass procedure is more effective than other procedures such as gastric banding. “The analysis also found that stomach-stapling surgeries, known as Roux-en-Y gastric bypass procedures, are the most effective weight-loss surgeries, while banding surgeries -- a new technique that involves placing a rubber band around the upper portion of the stomach -- are the least effective (American Healthline, 2008). Furthermore, insurance companies and Medicare are willing to pay for the bypass procedure more so than the banding procedure. (Results of Dr. Buchwald’s analysis can be found online here.)

Complications of the Roux-en-Y procedure include gastric leaks and nutritional deficiencies secondary to the “malabsorption” process. Thiamine deficiency seems to be a major problem after gastric bypass surgery. To offset this, patients receiving the surgery are required to take nutritional supplements daily. This process will be ongoing throughout their lifetime. Heart attack, kidney failure, and stroke are some of the more serious complications associated with gastric bypass (Healthcare Purchasing News, 2008).

The time spent in the hospital after gastric bypass depends to a large extent on the patients themselves and if there were any complications. On average, the length of stay is three days for a laparoscopic procedure and slightly longer for an open approach. (Journal of Robotic Surgery, 2008)

Cost of the bypass procedure also depends on whether the procedure was performed openly or laparoscopically, complications, and healing time. The average cost for gastric bypass in 2005 was $25,000.00 (Harder, 2005). However, this figure only represents the cost of the surgery alone and does not factor any subsequent surgeries related to the bypass. “The operations nevertheless have substantial risks. David S. Zingmond of the University of California, Los Angeles and two colleagues found signs that gastric bypass increased the risk of serious health problems for several years. For example, 19.3 percent of California patients who had undergone the surgery returned to a hospital within a year. By comparison, only 7.9 percent had been hospitalized in the year before the surgery “(Harder, 2005)

In sum, gastric bypass surgery can be beneficial to those who are morbidly obese. It can reverse several medical conditions and is the surgery of choice for effective weight loss. Having said this, gastric bypass surgery has the possibility of serious complications as well as an ongoing regimen of nutritional supplements. The cost of surgery is usually covered by some insurance and Medicare reimbursement. However, the prospective surgical candidate needs complete pre-screening and respectable weight loss clinics will discuss this with the candidate during the initial visit. Be prepared and research extensively before making the decision to have the surgery. Remember, “Forewarned, forearmed; to be prepared is half the victory.” (Miguel de Cervantes Saavedra)