In the normal human anatomy, ingested food travels from the esophagus to the stomach where it mixes with acid and enzymes that help to break the food down. The process of absorbing the food also begins here in the stomach. The food will then travel slowly into the small intestine where additional enzymes from the pancreas as well as bile from the liver continue to act on the food, further breaking it down and contributing to the absorption of the components throughout the length of the small intestine.
Creating the Gastric Pouch
The initial step in the gastric bypass is to divide the upper portion of the stomach into a small pouch. Initially this pouch is about the size of one's thumb and will accomodate about 1.5-2 ozs of food at one time. As time progresses this pouch will be able to accomodate approximately 5-6ozs of food at one time. This is the restrictive part of the operation because it restricts the amount of food that one can eat at one time.
Placing the Silastic Ring
Your surgeon may choose to place a silastic ring around your pouch. This ring serves the purpose of preventing the pouch from stretching over time and maintaining the feeling of fullness and satiety with smaller quantities of food.
The Roux Limb
The small bowel is then divided creating a Roux limb, named
after the french surgeon, Dr. Phillibart Roux. This limb of small intestine is brought up and attached to the newly created stomach pouch. This is usually performed with a combination of staples and sutures.
Complete
The operation is then completed when the divided small bowel is reattached to the roux limb, a distance of usually 75-150cm from the connection to the new gastric pouch. At this time the normal passage of food is through the esophagus (swallowing tube) into the new pouch, making one feel full with small quantities of food. The food will stay in this pouch approximately 1- 1.5 hours and then will slowly be emptied into the small intestine. This food then travels through a portion of the small intestine without fully being absorbed. This happens because the food does not come in contact with the enzymes from the pancreas and the bile from the liver until it reaches the area where the two portions of small intestine have been reconnnected. This is the malabsorptive portion of the operation and in conjuction with the restrictive portion serves as a very powerful tool for long-term weight loss.
Adjustable Gastric Banding
Placing the Band
The initial step is to insert the Band into the abdomen. The Band, introduced through a small incision, is passed around the upper aspect of the entire stomach. Once in this position, the Band is closed and securely attached to the stomach to prevent slipping. The closure creates the hourglass shape of the stomach.
Securing the Port
The tubing of the Band is brought out above the muscle layer. A pocket is created to place the Band’s port after attaching the port to the tubing. Adjustments are made by using a needle to instill sterile fluid into the port every 6 to 8 wks after the placement.
