Laparoscopic Roux En-Y-Gastric Bypass: One Surgeon's Technique
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Laparoscopic Roux En-Y-Gastric Bypass: One Surgeon's Technique
- 1. Laparoscopic Roux-en-Y Gastric Bypass: One Surgeon’s Technique George S. Ferzli MD, FACS New York, NY
- 2. Dr. John Linner 1954 Jejuno-ileal bypass THE BEGINNING
- 4. Dr. Edward Mason University of Iowa 1967 Gastric Bypass with loop gastroenterostomy
- 5. GASTRIC BYPASS WITH ROUX-en-Y LIMB Roux-en-Y Gastric Bypass 50 mL POUCH WITH A ROUX LIMB TO MINIMIZE BILE REFLUX COMBINED RESTRICTIVE AND MALABSORPTIVE
- 6. GASTRIC BYPASS WITH ROUX-en-Y LIMB Roux-en-Y Gastric Bypass SUBSEQUENTLY MODIFIED 50 mL POUCH WITH A ROUX LIMB TO MINIMIZE BILE REFLUX ROUX LIMB WAS LENGTHENED TO INCREASE MALABSORPTION AND IMPROVE WEIGHT LOSS COMBINED RESTRICTIVE AND MALABSORPTIVE
Notas do Editor
- The first bariatric procedure to be presented to a recognized surgical society and published in a peer reviewed journal was that of Linner and Kremen in 1954. The case which they presented was of a jejuno-ileal bypass.(JIB). Jejuno-ileal bypass involved joining the upper small intestine to the lower part of the small intestine bypassing a large segment of the small bowel, which is thus taken out of the nutrient absorptive circuit. The premise of this bypass was that patients could eat large amounts of food and the excess would either be poorly digested or passed along too rapidly for the body to absorb. In addition, the procedure caused a temporary decrease in appetite which also resulted in weight loss. The procedure was very successful at producing weight loss, however patients developed chronic diarrhea, kidney stones, and liver disease. So a search for a better procedure followed.
- As a consequence of all these complications, jejuno-ileal bypass is no longer a recommended Bariatric Surgical Procedure. Indeed, the current recommendation for anyone who has undergone JIB and still has the operation intact, is to strongly consider having it taken down and converted to one of the gastric restrictive procedures.
- In 1967 the gastric bypass was devised and performed by Dr. Edward Mason at the University of Iowa. Dr. Mason noted that patients who underwent subtotal gastrectomy for peptic ulcer disease remained below normal weight and could not gain weight easily. His approach involved stapling most of the stomach, bypassing the duodenum, and allowing the undigested food to pass directly into the jejunum. Most of the early operations failed because the pouch eventually became enlarged.
- The technique was modified to obtain a 50 mL pouch and a Roux-en-Y limb to minimize bile reflux from the loop gastrojejunostomy. The roux limb was lengthened to 100-150 cm in order to increase malabsorption and improve weight loss. The technique has been modified throughout the years with regard to the gastric pouch and retrocolic position of the roux limb. This procedure has stood the test of time, with one series of 500 patients followed for 14 years with patients maintaining 50% excess weight loss.
- The technique was modified to obtain a 50 mL pouch and a Roux-en-Y limb to minimize bile reflux from the loop gastrojejunostomy. The roux limb was lengthened to 100-150 cm in order to increase malabsorption and improve weight loss. The technique has been modified throughout the years with regard to the gastric pouch and retrocolic position of the roux limb. This procedure has stood the test of time, with one series of 500 patients followed for 14 years with patients maintaining 50% excess weight loss.