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At UCSF, the vast majority of weight-loss surgeries are performed laparascopically using minimally invasive techniques. These procedures require special training.  UCSF bariatric surgeons practice in the setting of a high volume, tertiary center of excellence, an enviornment that leads to fewer complications, faster recovery and more patient satisfaction with the results. 

Bariatric Surgery »  Treatments »  Extended Roux-en-Y Gastric Bypass

Extended Roux-en-Y Gastric Bypass (RYGBP-E) - Malabsorptive Procedure

RYGBP-E is an alternative to achieve malabsorption by creating a stapled or divided small gastric pouch, leaving the remainder of stomach in place. A long limb of the small intestine is attached to the stomach to divert the bile and pancreatic juices. This procedure carries with it fewer operative risks by avoiding removal of the lower three-quarters of the stomach. Gastric pouch size and the length of the bypassed intestine determine the risks for ulcers, malnutrition and other side effects.

Advantages

  • Patients can eat larger meals than with a purely restrictive or standard Roux-en-Y gastric bypass procedure.

  • These procedures can produce the greatest excess weight loss because they provide the highest levels of malabsorption.

  • In one study of 125 patients, the loss of excess weight averaged 74 percent the first year, 78 percent after two years, 81 percent after three years, 84 percent after four years and 91 percent after five years.

  • Long-term maintenance of weight loss can be successful with a straightforward dietary, supplement, exercise and behavioral regimen.

Disadvantages

  • Weight-loss surgeries may require hospitalization for fluid replacement or nutritional support if a patient experiences excessive vomiting and cannot maintain adequate amounts of food.

  • For all malabsorption procedures, there is a period of intestinal adaptation when bowel movements can be very liquid and frequent. This condition may lessen over time, but may be a permanent lifelong occurrence.

  • Abdominal bloating and malodorous stool or gas may occur.

  • Close monitoring for protein malnutrition, anemia and bone disease is recommended. Lifelong vitamin supplements are required. If patients don't follow eating and vitamin instructions, at least 25 percent of patients will develop problems that require treatment.

  • Changes to the intestinal structure can result in increased risk of gallstone formation and the need to remove the gallbladder.

  • Re-routing of bile and pancreatic and other digestive juices beyond the stomach can cause intestinal irritation and ulcers.

1 Source: National Institute of Diabetes andDigestive and Kidney Diseases (NIDDK) of the National Institutes ofHealth and American Society for Metabolic and BariatricSurgery.
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