Gastric bypass

Gastro-jejunal bypass is currently the "goldstandard" option in bariatric surgery, particularly in « difficult cases ». Nowadays, this operation is routinely performed through the laparoscopic approach if possible.
1. Technical procedure :
An anastomosis (sewing) takes place between the stomach and the small bowel: the operation is called "By-Pass" (or Roux-en-Y gastro-jejunal bypass RYGBP), or digestive short-circuit. It is very common in the United States, where patients are more obese than in Europe, and offers the best long-term results. It is often deemed too agressive as a primary choice in Europe, owing to its risks, side-effects and non reversibility. On the other hand it is a valuable procedure in case of failure of a previous « simple » procedure such as adjustable gastric banding. Gastric bypass combines three elements: food intake restriction and rapid satiety, a certain effect of malabsorption (dependant on to the length of bypassed small bowel), and a so called « dumping effect» if the patients swallows milk products too fast . The stomach is divided in two parts: a proximal small gastric pouch of about 50 ml, separated from the rest of the stomach. The small pouch is then connected to the small bowel (the jejunum) through an anastomosis using staples and/or stitches. Food goes all the way down to the proximal small bowel, so that the rest of the stomach is actually bypassed, as well as the duodenum and the beginning of the small bowel.
The picture shows the set-up : there is a stapling + section of the stomach, followed by an anastomosis between the gastric pouch and the small bowel, called "en Y" and connected to the jejunum 150 cm below.