Rogerian Argument: Jejunocolic Bypass and Gastric Bypass

In 1963 the first Jejunocolic Bypass was performed, replacing barbaric procedures such as jaw wiring. The Jejunocolic Bypass was a type of bypass that rerouted and shortened the intestines creating weight loss by mal-absorption. Patients who had this procedure done would lose a substantial amount of weight in their first year after operation, but with complications. The complications were so severe that the procedure would be discontinued, and in 1969 the Jejunoileal Bypass was introduced. The first introduction of this procedure would be named Jejunoileostomy, and in 1976 a second revised version would be introduced. The revised version would be called jejunoileal bypass and caused extremely severe complications. The Jejunocolic Bypass was known to cause mal-absorption, and severe diarrhea, but its revised version, the jejunoileal bypass, caused a severe vitamin deficiency and neuropathy that would push the mortality rate to four percent. The jejunoileal bypass would then also be abandoned and in 1979 the Biliopancreatic Diversion would be performed, which would then later be converted to the Biliopancreatic Diversion with Duodenal Switch in 1993. It is important to note that gastric banding would also be introduced in the late 70’s, and is still available today, but most surgeons will not perform it due to complications. The preferred method of weight loss surgery used today is the Roux-en-Y Gastric Bypass, which is the final form converted from the Jejunocolic Bypass, Jejunoileal bypass, and both forms of the Biliopancreatic Diversion.

Roux-en-Y Gastric Bypass is the most popular, and most used weight lost surgery option today. Most medical centers that are approved to perform weight loss surgery will only offer Roux-en-Y, and do not recommend the Gastric Band. Roux-en-Y is now done laparoscopically, although in some cases still done by opening the patient completely up. Laparoscopic Roux-en-Y requires only 6 incisions to be completed. Although minor incisions outwardly, it is still considered major surgery due to the nature of the internal stapling of the stomach. During surgery surgeons detach the stomach from the esophagus as well as the small intestines. They leave a small piece of stomach attached to the esophagus that they then re-attach to the small intestines which then creates a small pouch that is now the patients' stomach. The rest of the stomach remains inside the body but is no longer used. After surgery patients are required to stay in the hospital or medical center for one to two days for observation. During this time and two weeks after surgery they are on a strict liquid diet. Patients will then be instructed by their doctor over the next few months on how to start the implementation of soft foods back to a normal solidity of food while the new stomach route heals. A substantial amount of weight will be lost during this time of transitioning for the patient.

Gastric Bypass is recommended for patients who are obese, which is defined as those who carry a BMI (Body Mass Index) of forty or higher, or whose BMI is thirty-five and higher with complications or ailments caused by obesity. Obesity complications or ailments consist of high blood pressure, high cholesterol, sleep apnea, joint or bone pain, and more severe complications such as type 2 diabetes, risk of stroke, and risk of heart attack. These complications are usually enough to make an obese person seek out treatment such as gastric bypass.

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