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Schematic of gastric bypass using a Roux-en-Y anastomosis. The transverse colon is not shown so that the Roux-en-Y can be clearly seen. The variant seen in this image is retrocolic, retrogastric , because the distal small bowel that joins the proximal segment of stomach is behind the transverse colon and stomach.
The Roux-en-Y laparoscopic gastric bypass, first performed and reported on in case studies between 1993 and 1994, [3] is regarded as one of the most difficult procedures to perform by limited access techniques.
It has been found to produce a weight loss comparable to that of Roux-en-Y gastric bypass. [18] The risk of ulcers or narrowing of the gut due to intestinal strictures is less so with sleeve gastrectomy versus Roux-en-Y gastric bypass, but it is not as effective at treating GERD or type 2 diabetes. [18]
The alkaline environment causes the retained gastric tissue to produce acid, which may result in ulcers in a rare complication known as retained antrum syndrome. All patients lose weight after gastrectomy, although the extent of weight loss is dependent on the extent of surgery (total gastrectomy vs partial gastrectomy) and the pre-operative BMI.
Billroth I, more formally Billroth's operation I, is an operation in which the pylorus is removed and the distal stomach is anastomosed directly to the duodenum. [1] [2]The operation is most closely associated with Theodor Billroth, but was first described by Polish surgeon Ludwik Rydygier.
Billroth II, more formally Billroth's operation II, is an operation in which a partial gastrectomy (removal of the stomach) is performed and the cut end of the stomach is closed. The greater curvature of the stomach (not involved with the previous closure of the stomach) is then connected to the first part of the jejunum in end-to-side anastomosis.
According to reports, 0.2% of patients after distal gastrectomy with Roux-en-Y reconstruction, 1% after laparoscopic distal gastrectomy with Billroth II reconstruction, and 0.3–1.0% of patients following total gastrectomy with Billroth II or Roux-en-Y reconstruction have afferent loop syndrome. [15]
Combined restrictive and malabsorptive techniques are called gastric bypass techniques, of which Roux-en-Y gastric bypass surgery (RGB) is the most common. In this technique, staples are used to form a pouch that is connected to the small intestine , bypassing the lower stomach, the duodenum , and the first portion of the jejunum .
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