Laparoscopic Roux-en-Y Gastric Bypass (RNY):

How it works:

The RNY gastric bypass surgery is a bariatric (weight loss) procedure that has been performed for about 30 years.  Most doctors and insurance companies have accepted it as the standard of care in the treatment of morbid obesity when diets and exercise fail. The traditional Roux-en-Y-gastric bypass was performed through open surgery with one long incision, but with the advancement of surgical instrumentation and stapling techniques most RNY are performed laparoscopically.  At the Chicago Institute of Minimally Invasive surgery we offer this procedure exclusively laparoscopically unless there are extenuating circumstances that would require an open procedure.  This is both a restrictive and malabsorptive procedure.  (See figure).  In this technique, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples.  The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).  Patients will feel full more quickly than when their stomach was its original size, which reduces the amount of food eaten and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed.  Most bariatric surgeons divide a nerve called the Vagus when stapling the stomach in creating the new stomach pouch.  The Vagus nerve helps to regulate the digestive systems’ response to sweets and carbohydrates.  The Dumping Syndrome, which can cause nausea, diarrhea, and weakness, occurs when sweets enter the bloodstream too quickly.  Bariatric surgery that does not preserve the Vagus can cause the dumping syndrome and thus compromise the quality of life.  Dr. Frantzides was the first surgeon to define and publish the importance of preserving this nerve; and has been the founder of advanced surgical stapling techniques (Frantzides - Madan triple stapling technique) that have resulted in an extremely low rate of complications and high rate of patient satisfaction.  A list of some of Dr. Frantzides publications can be found by following this link: Publications

What to expect after surgery:

Patient will be admitted to the telemetry floor of the hospital and can expect to be up and walking about two hours after surgery.  The next day small sips of liquids will be allowed and if there is no discomfort or nausea the patient can expect to go home later that same day.  Dr Frantzides asks that each patient returns to the office one week after surgery and then further advancement of diet (soft food) will be decided upon.  Usually after three months there are no dietary or exercise restrictions.  Dr. Frantzides wishes for long-term successful weight loss and health for all his patients and asks that each individual follows up diligently to ensure a good outcome and patient satisfaction. 

The risks of gastric bypass surgery can be reviewed by following this link: complications of gastric by-pass surgery

Long-term outcome:

Patients should expect rapid weight loss in the first 6 months, which usually settles at a final weight at about 18-24 months after surgery.  One usually achieves about 70% to 80% excess body weight lost at 1 year. Motivated and complainant patients can achieve ideal body weight. The data published in the New England Journal of Medicine on comparison and long term results between diet and surgical interventions can be found by following this link: The New England Journal of Medicine article.

Relevant articles published by Dr. Frantzides on the procedure:

Frantzides, CT, Carlson, MA, and Schulte, WJ:  Laparoscopic Gastric Stapling and Roux-en-Y Gastrojejunostomy for the Treatment of Morbid Obesity:  an experimental model.  J Laparoendosc Surg. 5(2) 97-100, 1995.

Madan AK, Frantzides, C.T., Pesce CR; The quality of information about laparoscopic bariatric surgery on the Internet; Surg. Endosc. 17(5): 685-687, 2003

Madan AK, Frantzides, C.T.; Triple-Stapling Technique for Jejunojejjunostomy in Laparoscopic Gastric Bypass; Arch. Surg. 138-1029-1032, 2003

Frantzides, C.T., Carlson MA, Moore RE, Zografakis, JG, Madan AK, Puumala S, Keshavarzian A; Effect of Body Mass Index on Nonalcoholic Fatty Liver Disease in Patients Undergoing Minimally Invasive Bariatric Surgery: J. Soc. Laparoendosc. Surg. 8(7):849-855, 2004

Frantzides, C.T., Zeni TM, Mahr C, Denham, W, Meiselman M, Goldberg, MJ, Spiess S, Brand RE; Value of Preoperative Upper Endoscopy in Patients Undergoing Laparoscopic Gastric Bypass; Obesity Surgery; 16: 142-146, 2006.

Frantzides, C.T., Zeni, TM, Madan AK, Zografakis, JG, Moore RE, Laguna L; Laparoscopic Roux-en-Y Gastric Bypass Utilizing the Triple-Stapling Technique; J. Soc. Laparoendosc. Surg; 10: 176-179.

Loizides S., Zografakis J, Frantzides, C.T.; Recent Advances in the Surgical Management of Morbid Obesity. Hellenic Journal of Surgery. 6: 365-376, 2007.

Frantzides, CT, Zografakis J; Laparoscopic Roux-en-Y Gastric Bypass; In Atlas of Minimally Invasive Surgery. Frantzides, Carlson (ed.) Elsevier 2008.

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