Laparoscopic Roux-Y-Gastric Bypass Procedure


Introduction
Roux-Y gastric bypass is a bariatric procedure, or as we prefer endocrine surgery. The Netcare Greenacres facility is registered as a Center of Excellence with the National body, CEMMS. The Bariatric team consists of Dr G Hough (Endocrinologist), Mary-ann Victor (Dietician), Dr. K von Staden (Psychiatrist) and Dr N van Niekerk (Surgeon) The team is held to the highest standards, and under constant peer review. Annual audit by the South African Society for Surgery, Obesity and Metabolism, SASSO , forms part of the continuous accreditation process.

Disease
A person with a BMI (Body Mass Index) of more than 40, or a BMI of 35, with two co-morbidities, will qualify to be entered into the program. Co-Morbidities, are diabetes; hypertension; hypercholesterolemia and sleep apnea.

Pre-operatively
Evaluation by all the members of the team is essential. Once a unanimous decision has been reached that the patient is a good candidate for the procedure, an anesthetist will evaluate the patient and a surgery date will be given Dr. van Niekerk will discuss the benefits, risks, and possible complications of the operation.

Procedure
The procedure requires only five small incisions, patients experience minimal pain and recover faster. The laparoscope, which is a telescopic videocamera, gives a better view of internal organs than can usually be achieved in a traditional open procedure. Magnified images viewed on the video monitor reveal internal structures, including blood vessels, in exquisite detail.

A 50mL stomach pouch is developed by means of an endo-stapeling device. A 120cm Roux-Y limb is attached to this pouch. The complete procedure is performed laparoscopically.

Post operatively
In the hours following the operation, you will experience some pain from the small incisions your surgeon made to perform the procedure. "Air bubbles" under the diaphragm might cause discomfort in the shoulder/ neck this is a common post operative phenomena, and will resolve within 24 hours. 6 hours post operatively you will be mobilsed out of bed with the help of the physiotherapist. Your urinary catheter will be removed as soon as you mobilse.

Day 2 post-operatively you will be evaluated with a CT scan and oral contrast

Discharge out of hospital by day 3, and booked off from work for 10 days post-operatively.

Full physical-, and sport-activity may resume THREE weeks after surgery, it is essential to stay in constant contact with the dietician.

Dr Hough will see you 1 month post-operatively and. Dr. van Niekerk will do a gastroscopy THREE months post -operatively.

The surgical incisions will be barely visible a few months after the procedure.