How does it Work?                                                             

• It is a malabsorptive procedure
• Part of the stomach is removed creating a smaller pouch, about 4-5 oz 120-150cc)
• The stomach is connected to the jejunum
• A large segment of small intestine is bypassed
• The intestine is re-routed so the food bypasses most of it to decrease the absorption of calories
• Operative time: 3 hours
• Hospital stay: 5-7 days
• Return to work: 2-3 weeks
• Can be done in two stages (Sleeve gastrectomy being the first stage)

Advantages:

• Rapid initial weight loss. Can lose 80% of excess weight
• Good for high BMI patients > 55 kg/m2 who need quick weight loss
• Higher total average of weight loss of all operations
• Moderately restricts the volume of food that can be consumed
• Good for patients who cheat on their diet
• Theoretically can be reversed but difficult

Disadvantages:

• Requires cutting of the stomach and small bowel
• More operative complications than the LAP-BAND and Sleeve gastrectomy
• Complications due to malabsorption: anemia, osteoporosis, severe diarrhea, bloating, heartburn, bowel obstruction, kidney stones, vitamin deficiency more so than gastric bypass
• Higher incidence of gallstones (gallbladder is not stimulated)
• Less dumping syndrome when consuming carbohydrates
• Unable to access the biliary tree with diagnostic testing, if needed
• Higher mortality rate (1%)
• Reversing is necessary in some patient due to severe weight loss and malnutrition

Surgical Complications:

• 3% Leaking from stomach cut edge or small bowel connections
• 2% Small bowel obstruction