Normal Anatomy

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RYGBP – ROUX EN Y GASTRIC BYPASS

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  • IRON, CALCIUM, AND VIT B12 NEED TO BE REPLACED POST OP.
  • FOOD PASSES FROM THE POUCH STRAIGHT TO THE JEJUNUM.
  • STOMACH, PANCREATIC JUICES AND BILE KEEP THEIR NORMAL COURSE UNTIL THEY MIX WITH THE FOOD AT THE JEJUNO -JEJUNOSTOMY.

RYGBP: HOW IT WORKS

  • EAT SMALL MEALS (pouch of about 25 cc). Patients will get sick and vomit if they eat too much.
  • CHEW VERY VERY WELL (passage into SB is narrow, about 1 cm diameter) If patients don’t chew well, they will again get sick and vomit. Pills (medications) need to be crushed or cut into smaller pieces.
  • EAT AND DRINK SLOWLY, to avoid developing the DUMPING SYNDROME.

RESULTS

  • RYGBP IMPROVES OR CURES MOST OBESITY-RELATED CONDITIONS: DIABETES,HYPERTENSION, ARTHRITIS ,SLEEP APNEA SYNDROME,HYPERLIPIDEMIAS, SNORING ETC.
  • 80 TO 90 % OF PATIENTS LOSE 60-70% OF THEIR EXCESS WEIGHT THE FIRST YEAR.
  • 70 TO 80 % OF PATIENTS MAINTAIN THEIR WEIGHT LOSS LONG -TERM.

Dumping Syndrome

The dumping syndrome appears to be due largely to rapid entrance of ingested food into the small bowel. Water flows in from the bowel wall, producing both intestinal distention and a reduction in plasma volume. Generalize vasodilation may be a factor.

Symptoms of Dumping Syndrome

  1. cramps
  2. nausea
  3. oligemia (reduced blood flow)
  4. hypotension (low blood pressure)
  5. sweating
  6. vertigo
  7. tachycardia (rapid heart rate)
  8. vomiting
  9. diarrhea

POTENTIAL COMPLICATIONS

  • MORTALITY 0.5% (O.3 TO 2..3 %)
  • BLEEDING FROM STAPLE LINES
  • PNEUMONIAS
  • DEEP VEIN THROMBOSIS O.35 %
  • PULMONARY EMBOLISM O.O3%
  • SUBPHRENIC ABSCESS O.O9 %
  • LEAK FROM ANASTOMOSIS 0.1 %
  • ULCERS AT THE HOOK UP 13%
  • STRICTURE AT THE ANASTOMOSIS 10 TO 15 %
  • WOUND INFECTION 5%
  • HERNIAS 5 TO 10%
  • FAILURE RATES DUE TO STAPLE LINE BREAKDOWN, STRETCHED POUCH AND/OR OUTLET IS ABOUT 5 TO 10 %.
  • GALLSTONES 30 %
  • NUTRITIONAL DEFICIENCIES, ANEMIA, AND/OR OSTEOPOROSIS WILL DEVELOPED IN ABOUT 30% IF PROPER NUTRITION, VITAMIN AND MINERAL SUPPLEMENTS ARE NOT MAINTAINED.

RECOVERY

  • SURGERY TAKES 30 TO 45 MINUTES.
  • HOSPITAL STAY IS ABOUT 2- 3 DAYS.
  • PUREED DIET FOR TWO MONTHS AFTER SURGERY.
  • MULTIVITAMIN/ MINERAL, IRON (menstruating women), CALCIUM, B1 & B 50 EVERYDAY. VIT B12 1000mcg IM. ONCE A MONTH or 500mcg SUBLINGUAL qd.
  • FOLLOW UP
  • EVERY TWO WEEKS FOR ONE TO TWO MONTHS OR AS NEEDED.
  • EVERY 3 MONTHS FOR ONE YEAR
  • EVERY 6 MONTH THE SECOND YEAR
  • EVERY YEAR FOREVER
  • LABS: CBC, CHEM 8, LIVER PANEL,B1, B12,VIT D, FOLATE, AND FERRITIN ARE DONE AT EACH OFFICE VISIT.
  • PATIENTS ARE ENCOURAGED TO ATTEND OUR SUPPORT GROUP MEETINGS. “THE STAPLE CLUB”.
  • PATIENTS ARE ENCOURAGED TO WALK, EXERCISE AS TOLERATED, AND REMAIN ACTIVE THE REST OF THEIR LIFE.
  • RETURN TO WORK IN 2 WEEKS FOR LIGHT DESK TYPE OF JOBS AND 6-8 WEEKS FOR HEAVY LIFTING OR STRAINING.