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Gastric Bypass is a common operation to assist patients with severe obesity with weight loss. This surgery was traditionally done with the open approach, however, this approach was associated with incidences as high as 20 percent of incisional hernias and wound complications as high as 8 percent. This led to the advent of the laparoscopic approach to improve postoperative outcomes in bariatric patients. The first case series of laparoscopic Roux-en-Y gastric bypass (RYGB) was presented in 1994 by Drs. Wittgrove and Clark. Much data has proven that the laparoscopic approach to RYGB results in decreased length of hospital stay, decreased intraoperative blood loss, less postoperative pain, fewer pulmonary complications, and fewer wound infections. This activity describes the indications, contraindications, and complications of laparoscopic gastric bypass surgery and highlights the role of the interprofessional team in the management of patients with obesity. Objectives: Describe the indications for laparoscopic gastric bypass. Explain the technique involved in performing a laparoscopic gastric bypass. Describe the potential complications of a laparoscopic gastric bypass. Explain the importance of optimizing care coordination among interprofessional team members to improve outcomes for patients requiring bariatric surgery. Access free multiple choice questions on this topic.

Gastric Bypass is a common operation for weight loss in patients with severe obesity. The procedure was developed in the 1960s by Drs. Mason and Ito who observed significant weight loss in a patient undergoing partial gastrectomy for peptic ulcer disease. This surgery was traditionally done with the open approach, and as with any open surgery, there were incidences as high as 20% of an incisional hernia and wound complications as high as 8%. This led to the advent of the laparoscopic approach to improve postoperative outcomes in bariatric patients. The first case series of laparoscopic Roux-en-Y gastric bypass (RYGB) was presented in 1994 by Drs. Wittgrove and Clark, and the largest trial was reported by Nguyen and colleagues in 2001. Much data has proven that the laparoscopic approach to RYGB results in decreases in hospital stay, intraoperative blood loss, postoperative pain, pulmonary complications, and wound infections. Studies have shown a steep learning curve for the laparoscopic gastric bypass, and  a possible increased rate of postoperative internal hernia (a surgical emergency.) Despite this, it is now considered safer and more cost-effective than traditional, open RYGB. Today over 90% of gastric bypasses performed for weight loss are done laparoscopically. Despite being one of the most challenging, minimally invasive operations, it has become the most common foregut surgery performed in the United States. Of the many ways to perform this surgery, the fundamentals of each technique remain the same.

Ninety-day mortality is very low (less than 0.5%). Morbidity of the procedure is classified into early complications and late complications. [4] Early Complications (0-30 days) VTE Anastomotic leak Infection Intestinal obstruction GJ stenosis Late Complications Intestinal obstruction Dumping syndrome Marginal ulcer Gastrogastric fistula Gallstones Incisional hernia Nutritional deficiencies Further information on complications after gastrectomy is out of the scope of this review article. These are very complex disease processes with specific etiologies, pathophysiologies, and treatments.

Management of obesity is complex and is best done with an interprofessional team that includes the primary care provider, nurse practitioner, dietitian, and surgeon. While there are several bariatric procedures to reverse obesity, all are fraught with serious complications. The primary care providers should educate the patients on changes in lifestyle like a healthy diet and regular exercise. The other fact is to inform the patient to be realistic- non-surgical methods of weight loss do work but they take time. Anyone undergoing a bariatric procedure should be informed about all the potential complications of surgery and the need to remain compliant with the new lifestyle changes, or risk putting the weight back on.[12]