Surgical Procedures

The Roux-en-Y Gastric Bypass
The first step in the Roux-en-Y Gastric Bypass is the creation of a small stomach pouch using a surgical stapler. The stomach pouch, about the size of a thumb, is created out of the top portion of the existing stomach. The small stomach pouch restricts the amount of food eaten in one sitting. Next, the small bowel is divided about two feet from the stomach. One end of the small bowel is attached to the "new" stomach pouch, referred to as the gastrojejunostomy. The other end of the section of small bowel, still connected to the remaining large portion of the pre-existing stomach, is reconnected to the intestinal tract. This is referred to as the jejunojejunostomy.

As implied by the term "gastric bypass," food is now routed past most of the stomach and the first section of the small intestines. The procedure causes a restriction in the amount of food that is consumed and a reduction in the nutrients that are absorbed.

The Lap-Band Procedure
The procedure is usually done completely laparoscopically. The idea of the procedure is to create a restrictive pouch, about 15 cc, at the top of the stomach. The procedure is a restrictive because it limits intake of food. The procedure requires no cutting or stapling of the stomach. The adjustable band is placed at the bottom of the pouch. The band is adjusted through a small port under the skin on the abdominal wall by which normal saline is injected. The amount of saline increases or decreases the amount of food that is allowed to pass through the restrictive pouch to the rest of the stomach.

The Sleeve Gastrectomy
The Sleeve Gastrectomy is also a restrictive procedure. The objective of the procedure is relatively simple, to reduce the size of the stomach by about 60%. The new stomach is in the shape of a sleeve, giving the gastrectomy its name.