Obesity is a major global health concern, associated with multiple comorbidities including type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, and cardiovascular disease. When lifestyle modification and medical management fail to achieve sustained weight loss, bariatric surgery becomes an effective long-term treatment option. Among bariatric procedures, laparoscopic gastric bypass, specifically Roux-en-Y gastric bypass (RYGB), has emerged as a highly effective and durable technique for significant weight reduction and improvement in obesity-related comorbidities.

Indications for Laparoscopic Gastric Bypass

Laparoscopic gastric bypass is indicated in patients with:

Body Mass Index (BMI) ≥ 40 kg/m² without significant comorbidities.

BMI ≥ 35 kg/m² with serious obesity-related comorbidities such as type 2 diabetes, hypertension, sleep apnea, or cardiovascular disease.

Failure of non-surgical methods including diet, exercise, and pharmacological therapy.

Understanding and willingness to adhere to long-term postoperative lifestyle changes and follow-up.

Advantages of Laparoscopic Approach

The laparoscopic approach offers multiple advantages over open gastric bypass:

Minimally invasive: Small incisions reduce postoperative pain and scarring.

Faster recovery: Shorter hospital stay and quicker return to normal activities.

Reduced risk of wound complications: Lower incidence of infection, hernia, and adhesions.

Better visualization: Magnified view allows precise dissection and safe anastomosis.

Preoperative Evaluation

Comprehensive preoperative assessment is essential for patient safety and optimal outcomes:

Medical evaluation: Assessment of cardiovascular, pulmonary, hepatic, and renal function.

Nutritional evaluation: Identifying deficiencies and optimizing nutritional status.

Psychological assessment: Screening for eating disorders, depression, or unrealistic expectations.

Imaging studies: Upper GI series or endoscopy to evaluate anatomy and rule out conditions like ulcers or hiatal hernia.

Laboratory tests: Complete blood count, liver function, renal function, electrolytes, fasting glucose, and lipid profile.

Patients are counseled regarding the procedure, potential complications, dietary changes, and long-term follow-up requirements.

Surgical Technique

Laparoscopic gastric bypass typically follows a Roux-en-Y configuration, creating a small gastric pouch and bypassing a portion of the small intestine to reduce calorie absorption.

Patient Positioning and Port Placement

Patient is placed in supine position with slight reverse Trendelenburg.

Pneumoperitoneum is established, typically at 12–15 mmHg.

Standard five-port technique is commonly used for camera, instruments, retraction, and stapling devices.

Creation of Gastric Pouch

The stomach is divided using a laparoscopic stapler to create a small proximal pouch (15–30 mL).

The pouch restricts food intake and serves as the new functional stomach.

Jejunal Roux Limb Construction

The jejunum is divided 30–50 cm distal to the ligament of Treitz.

The distal segment (Roux limb) is brought up to the gastric pouch to create a gastrojejunostomy.

The proximal segment is reconnected to the jejunum at a distance of 75–150 cm to create a jejunojejunostomy, completing the bypass.

Anastomosis

Gastrojejunostomy and jejunojejunostomy are performed using stapled or hand-sewn techniques.

Adequate blood supply and tension-free anastomosis are ensured to prevent leaks.

Leak tests with methylene blue or air may be performed intraoperatively.

Completion

Hemostasis is ensured, and the abdominal cavity is irrigated.

Ports are removed, and incisions closed with absorbable sutures or adhesive strips.

Postoperative Care

Patients are monitored in the recovery area for vital signs, pain, nausea, and early complications.

Early ambulation and initiation of clear liquids are encouraged, usually within 24 hours.

A graduated diet plan is followed: clear liquids → pureed foods → soft diet → regular diet over weeks.

Lifelong vitamin and mineral supplementation is necessary to prevent deficiencies.

Regular follow-up with nutritionist and bariatric surgeon is crucial for weight maintenance and monitoring complications.

Outcomes

Laparoscopic gastric bypass has proven to be highly effective:

Significant weight loss: Patients typically lose 60–80% of excess body weight within 12–18 months.

Improvement in comorbidities: Resolution or improvement of type 2 diabetes, hypertension, dyslipidemia, and sleep apnea.

Durable results: Long-term follow-up shows sustained weight loss and reduced mortality.

Complications

Potential complications include:

Anastomotic leaks or strictures.

Bleeding from staple lines or anastomoses.

Nutritional deficiencies (iron, vitamin B12, calcium, folate).

Dumping syndrome (rapid gastric emptying leading to nausea, diarrhea, and hypoglycemia).

Rare complications: bowel obstruction, marginal ulcers, or internal hernias.

Conclusion

Laparoscopic gastric bypass is a safe and effective surgical intervention for morbid obesity, providing significant weight loss and improvement in obesity-related comorbidities. Careful patient selection, thorough preoperative assessment, meticulous surgical technique, and diligent postoperative care are essential for achieving optimal outcomes. This minimally invasive procedure offers the advantages of faster recovery, reduced complications, and long-term health benefits, making it a cornerstone of modern bariatric surgery.