• Roux-en-Y Gastric Bypass
  • Complications Following Roux-en-Y Gastric Bypass at Duke WLS
  • Expected Weight Loss
• LapBand Procedure
  • Expected Weight Loss

Roux-en-Y Gastric Bypass:

The most common operative procedure we perform for weight loss is the Roux-en-Y Gastric Bypass. This is currently considered to be the "Gold Standard" weight loss surgical procedure. It results in weight loss mostly by reducing the size of your stomach, so you cannot eat as much, and partly by bypassing some of your small intestines so you absorb less fatty foods. This operation is accepted by obesity surgeons and the major obesity physician societies as being the most effective in weight reduction and maintenance of weight loss.

For your insurance company, the code for this operative procedure is: CPT 43644 and the ICD-9 code for the diagnosis of morbid obesity is 278.01

We prefer performing the surgery using laparoscopic techniques, avoiding a large incision in your abdomen, however an abdominal incision is sometimes necessary based on your weight, body shape, and previous surgery. The decision to proceed with laparoscopy versus open surgery will be made during your clinic visit.

Click here for videos of the procedure.

The surgical incisions needed for each approach are shown below:

Open Incision Laparoscopic Trocars

The surgical procedure remains the same regardless if done with the laparoscope or as an open procedure. A small stomach pouch (about the size of a medium egg) is created with a stapler device. The small intestines are then divided and one end brought up and connected to the small stomach pouch using the stapler. The intestines are reconnected as shown.

Several studies have shown that people who experience significant weight loss can develop gallstones. On the other hand, people who have, or who subsequently develop gallstones, often do not suffer any consequences or even know they have them. Due to the required location of the trocar sites to perform the weight reduction surgery, removal of the gallbladder at the time of a roux-en-Y gastric bypass is somewhat difficult. In many cases the risk of taking the gallbladder out at the same time may well exceed any potential benefit. For this reason, unless you currently have gallstones that are causing trouble, we do not routinely remove the gallbladder at the time of your weight loss surgery operation. If you are known to have gallstones, we will discuss the possible risks for removing it with you and use our best judgement with respect to its removal at the time of surgery.

Duke WLS Complications Following Roux-en-Y Gastric Bypass: The following table shows the incidence of complications we monitor following surgery. Where available, the reported incidence from other centers is given.

Expected Weight Loss:

Patients lose between 100 and 180 pounds. Most of the weight is lost during the first 14 months, although some aditional weight can be lost up for up to two years.The exact amount of weight you will lose depends on your preoperative body mass index (heavier people lose more weight) and your compliance with the dietary instructions. The charts below demonstrate our patient's experiences to date based on their initial body mass index and can be used to estimate your posssible weight loss. You will need to watch your diet very carefully after your weight stabilizes as failure to continue to restrict your intake can result in some weight regain.

Average Weight Losses of Our 1702 Patients as of 3/11/07

Considerable experience has been obtained, mainly in Australia, Mexico, and Europe, with placement of an inflatable silastic band around the top part of the stomach to create a small gastric pouch, without the need for any bowel anastomosis. This procedure is performed laparoscopically and is called the LapBand Procedure. Implantation of this device was approved by the FDA in 2001 so experience in the United States remains limited. Only a few insurance companies have accepted the procedure for coverage, so most patients must self-pay. For your insurance company, the code for the LapBand operative procedure is: CPT 43770 and the ICD-9 code for the diagnosis of morbid obesity is 278.01

The surgical incisions for the needed laparoscopic ports are shown below:

The entire device looks like this. It consists of a band, connection tubing, and a plastic access port. The band has a plastic ring lining the inside that can be filled with water to narrow the stomach opening, thus limiting the amount of food that can pass over time. The access port is used to add or remove water from the band, here shown with a needle and syringe placed for an adjustment.

An area is cleared at the top of the stomach for passage of the band and the band is secured about the stomach by an interlocking mechanism. After placement of the band, all instruments are removed from the abdomen and a small plastic access port is implanted just under the skin. The band has a plastic ring lining the inside that can be filled with water to narrow the stomach opening, thus limiting the amount of food that can pass over time. The amount of water in the plastic ring is adjusted by placing a needle into the plastic access port and adding or withdrawing fluid. Placement of the needle is minimally painful.

Expected Weight Loss:

Results of the LapBand procedure have been encouraging, however weight loss is slightly less than for the Roux-en-Y gastric bypass and management requires more frequent clinic visits to adjust how the band narrows the stomach. Most patients will lose between 60 and 100 pounds. The exact amount of weight you lose will depend on your compliance with the dietary instructions and your tolerance to adjustments to the tightness of the band. Weight loss is slower with this procedure progressing over 3 t0 4 years. You will need to watch your diet very carefully as the band is adjusted and continue long-term follow up to achieve and maintain satisfactory weight loss.

The following graph depicts the weight loss achieved by our 68 patients as of 3/11/07.

LapBand Outcome Graph