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Joseph Afram, MD
Obesity Surgery
Center For Obesity
. http://www.obesitycenter.org

Obesity Surgery

There have been remarkable advances in obesity surgery during the last few years making the operations safe and effective.
There are several types of operations done in this country to treat obesity. They can be classified into three types restrictive, malabsorptive and a combination of restrictive and malabsorptive.
The Roux-en Y gastric bypass is a restrictive procedure combined with a modified gastric bypass that moderately limits calorie and nutrient absorption and may lead to altered food choices. The Roux-en Y works by decreasing food intake, limiting the amount of food the stomach can hold by closing off a significant portion of the stomach and delaying the emptying of the stomach (gastric pouch).
In this operation, the stomach is divided into two compartments with several rows of titanium staples. The newly created stomach pouch is measured at less than 30 ccs. The small intestine is then divided in the proximal jejunum and the lower end brought up and joined to the new small stomach compartment.
The pouch initially holds about one ounce of food and expands to 2-3 ounces with time. The pouchs lower outlet usually has a diameter of about 1/2-inch. The small outlet delays the emptying of food from the pouch and causes a feeling of fullness.
After an operation, the person usually can eat only 5-10 bites of food before feeling full. With time, the capacity may increase to half to a whole cup of food that may be consumed without discomfort or nausea. Food has to be well chewed. For most people, the ability to eat a large amount of food at one time is lost, and some of the food consumed will not be absorbed due to the bypass segment of the operation.
Most patients report that their tastes change after surgery. They are more interested in lighter and healthier food. Many patients experience the dumping syndrome in which foods, usually those high in fat and/or sugar, are not well tolerated. In the dumping syndrome, stomach contents move too rapidly through the small intestine. Symptoms include nausea, weakness, sweating, faintness, and, occasionally, diarrhea after eating these foods. Patients find that this negative incentive helps them to eliminate high
caloric foods and sweets from their
The proximal Roux-en Y gastric bypass can be done through a small midline incision (mini-lap) of 4-5 inches and the skin is closed with sutures under the skin (plastic surgery closure).
The benefits of the Roux-en Y gastric bypass procedure include
Excellent cosmetic result (small incision)
Short operating time (average 1.5 hours)
Short hospital stay (average 2 days)
Less pain (use of narcotics 2-3 days)
Fast recovery (back to work in 10-12 days)
Safety (less complication rate)

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