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 third clinic visit when you discuss options with your surgeon. See the picture below for an idea of the placement of incisions.

Laparoscopic or Open Roux-en-Y Gastric Bypass Procedure

The surgical procedure is only slightly different whether done with the laparoscope or as an open procedure (see figure below).

A small stomach pouch is created with a stapler device. The small intestines are then divided and one end brought up and connected o 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 judgment 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

Most patients lose between 80 and 140 pounds. The exact amount of weight you lose will depend on your compliance with the dietary instructions and commitment to exercise. Most of the weight is lost during the first eight months.

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. The following charts depict the average weight lost by our patients based on their initial BMI:

Patient Manual Index

• Introduction

• Questions to Ask Your Insurance Company

• Your Health Care Team

• Roux-en-Y Gastric Bypass

• Lap-Band Procedure

• Path to Surgery

• The First Clinic Visit

• The Second Clinic Visit

• The Third Clinic Visit

• Preparation Instructions for Surgery
• Day of Surgery and Postoperative Stay
• Hospital Course Following a Roux-en-Y Gastric Bypass
• Hospital Course Following a Lap-Band Procedure
• Post Surgery Follow-up Care
• Potential Complications of Roux-en-Y Bypass Surgery