The current bypass procedure is a testament to the pioneers in the field of bariatrics and their surgical literature. We stand on the shoulders of giants and deliver a procedure that is time-tested and true. Although, the predecessor forms of these stapling procedures created a storm of ‘doubt and bad perception’ which misrepresents, to this day, the true results of what a bypass procedure is and can have on the life of a person afflicted with morbid obesity. Indeed, the gold standard of bariatric surgery and the most commonly performed bariatric intervention nationally.
The bypass, a combination procedure, utilizes aspects of both restrictive and malabsorptive procedures. Generally the stomach is physically divided into a small portion, pouch, still connected to the esophagus and the remaining larger stomach still connected to the small bowel. The jejunum is also divided. The reconstruction, as illustrated, is performed with a bypass of 125-150 cm of jejunum. Absorption starts at the lower point of connection, where the biliary pancreatic enzymes meet nutrients passing from above.
Bypass procedures have many differing methods of construction. I utilize the methods chosen by my mentors in bariatrics that were tailored during 20 years of practice. They, as I, base what they do and how they do it on sound theory and are proven with the test of time.
For instance, when creating a gastro-jejunal anastomosis (connection between the stomach and the small bowel); the viability of the connection depends on tension, blood supply and the area of contact. This path of least tension and greater blood supply is a retro colic, retro gastric position. Hence I pass the jejunal limb under the stomach and colon, thereby perform a tension-free anastomosis to the pouch with an uncompromised blood supply. Also in performing this connection, for time-sake, one can choose to staple; however, I choose to assure the success of this connection and hand-sew in two separate layers, seeing each and every point of contact.
The pouch size is another major determinate in your success with a gastric bypass. I do not settle for a large or even a medium size pouch, every effort is taken to perform a small pouch and reduce your chances of weight re-gain. Stated by Laplace, the forces and growth of the pouch will be directly proportional to the radius of that pouch. Therefore using the example of a balloon, if you blow up a large balloon, it gets very large quickly; with a small balloon, the force required to inflate is much greater and will remain smaller. The same is true for your gastric pouch. I understand and apply these principles in every case, maximizing your long-term results.
These are not such trivial points if you consider the likely step-wise progression of a stricture to a leak from poor blood supply and tension with their accompanying morbidity. Although, problems may still arise, I am taking every effort to reduce or prevent any potential complications.