Laparoscopic Conventional Roux-en-Y Gastric Bypass (LCRYGB)

General Information

Conventional Roux-en-Y Gastric Bypass (CRYGB) is a surgical procedure that can be performed by a miniinvasive (Video)surgical method. The procedure reduces food intake AND reduces the absorption of nutrients from the food. Absorption of nutrients is limited because part of the intestines is bypassed and not used. The volume of the stomach pouch after LCRYGB is between 15 and 25 ml. The alimentary limb (AL, green in the image) in RYGB is 120 - 150cm long, the biliopancreatic limb (BPL, pink in the image) consists of the 50 cm of small intestine.

Laparoscopic Conventional Roux-en-Y Gastric Bypass

Laparoscopic Conventional Roux-en-Y Gastric Bypass – Facts

Duration of surgery

  • between 1 and 2 hours

Anaesthesia

  • general anaesthesia

Hospitalisation

  • 4-7 days

Indications for LCRYGB

  • BMI 40 (or 35 with related diseases) to 50
  • Treatment of:
    • Diabetes Mellitus type II
    • arterial hypertension
    • other related diseases
  • Redo surgery after other metabolic operation in patients with high compliance
  • accepts obligatory supplementation of vitamins and minerals
  • sweet eaters
  • patients with heartburn

Typical LYRYGB Patient

  • patient with BMI from 40 (or 35 with related diseases) to 50
  • patient who accepts obligatory supplementation of vitamins and minerals
  • sweet eaters
  • patients with heartburn

Advantages

  • very successful (50-70% of excess weight loss)
  • operation for patients who failed restrictive procedures like balloon, banding and sleeve gastrectomies
  • operation for sweet eaters
  • operation for patients with heartburn

Disadvantages

  • relatively high early complication rate (like dumping syndrome)
  • mortality 0.5 – 2%
  • irreversible change in the anatomy
  • life-time vitamins and minerals after surgery
  • Conventional upper gastroscopy of duodenum and remnant stomach is not possible

Operation Time

  • The LCRYGB procedure takes one  to 2 hours.

Technical description 

Laparoscopic Roux-en-Y Gastric Bypass reduces the size of the stomach through surgical stapling. This type of weight loss surgery cuts the stomach and leaves a reservoir approximately the size of a walnut. Afterwards the biliopancreatic limb is measured (50cm). The distal from separated intestines are connected to the stomach pouch (Gastro-enteroanastomosis GEA) mostly with the round stapling method. This causes the food to be directed immediately from the stomach to the jejunum. The small intestine junction called jejuno- jejuno anastomosis (JJA) is created 120 - 150 cm from the GEA.

Hospitalisation Time

The procedure requires a 4-to-7-night stay in the hospital after the operation.

After Surgery

After surgery, the patient must follow special diets and vitamin intake to lose weight in a controlled manner.

Weight loss differences

  • The EWL after conventional GB reached 58.2% after five years in the best series. Bessler performed the first prospective study that directly compared the two operation methods.
  • After the second or third postoperative year, the patient seems to adapt to the surgery and to suffer its side-effects in lower intensity, which brings a tendency for some recovery of lost weight. But weight gain is very slight compared to the conventional gastric bypass

Lab Tests after LCRYGB:

  • Morphology1
  • Electrolytes1
  • Ferrum1
  • Creatinin
  • Liver ferments1
  • Vitamins B1, B12-Spiegel1
  • HDL, LDL, VLDL, Chol2.
  • Ferritin2,3
  • Transferrin2,3
  • Zink2,3
  • Magnesium2
  • 1,25-Dihydroxy-Vitamin D32,3
  • Haemoglobin A1c2

1. 1 Mo, 3 Mo, 6 Mo, yearly
2. 6 Mo, 1 year
3. yearly

 

Supplementation after LCRYGB:

  • Calcium with Vit D3
 1000mg (with 130ug) per Day
  • Multivit+minerals
 1 tab. per Day
  • Fe+2 iron
 1 tab per Day 30mg – one week long in a month, (3 eeeks with out the Ferrum) 
  • Proteins
 50g per Day
  • Vit. B12
 every 3 Months i.m. (1000ug) or 25000 I.U. sublingual 2 times a week
  • Vit B1
 when needed
  • Zinkum
 1 tab.15 mg per Day
  • Biotin, Selenium, Vitamin B9 (B11)
 Daily for 3 Months

Bariatric Analysis and Reporting Outcome Score – BAROS 

  • Once a year

Standard Medication after Operation

  • PPI 20mg, 0-0-1 (3 Months)

Sport and physical activity

  • Three weeks after operation
  • 3 hours of physical activity per week but under sport medical supervision and medical advice.

Diet after LCRYGB

see: Diet after Roux-en-Y Gastric Bypass or Loop Gastric Bypass ( BII )