Laparoscopic/Robotic Gastric Bypass

Gastric bypass surgery provides the most robust long term weight loss and has the greatest effect upon improving diabetes and metabolic syndrome.

Ideal Patients

After a gastric bypass, some diabetic patients are able to eliminate all diabetic medications within days or even hours of the operation. Bypass also has the most dramatic effect on lowering triglycerides and cholesterol.

The bypass procedure is extremely effective at treating gastro-oesophageal reflux disease, in fact it is becoming common to perform a bypass in patients with severe debilitating reflux who have failed medical therapy and even prior operations for reflux.

It is also a salvage procedure for those who have had complications with prior bariatric procedures.

There are various styles of gastric bypass, the most common is the Roux-en-Y gastric bypass. This procedure is the most common procedure worldwide and is gaining popularity in Australia due to its strong longer term effect on weight loss. The procedure takes about 1 to 1 ½ hours for a primary procedure, and generally requires a 2 night stay in hospital.

The gastric bypass surgery procedure involves dividing the upper portion of the stomach and leaving a small pouch of about 30ml’s capacity. This creates a restricting effect and dramatically reduces the amount of food able to be eaten. Part of your small bowel is then attached to this small pouch of stomach, therefore bypassing the majority of the stomach and upper part of the small bowel where the digestive juices are formed. This leads to slightly decreasing absorption of carbohydrates and fat.

There are various other types of gastric bypass surgery variations, such as the mini gastric bypass, fixed ring bypass, and short limb gastric diversion. These options would be specific to certain patients for various reasons.

Mini Gastric Bypass

A longer thinner gastric pouch which is similar to a sleeve gastrectomy however the small bowel is attached to the bottom of the sleeve. This bypasses about 1.5-2 metres of the small bowel. This operation is extremely good for diabetic patients.

Fixed Ring Bypass

A small ring is placed above the gastroenterostomy which may help prevent dilatation over a long period of time. This ring can also be used on sleeve gastrectomy.

Short Limb Gastric Diversion

Same as a standard bypass however with a larger anastomosis and shorter alimentary and biliary limb. Mainly to relieve incapacitating reflux rather than provide weight loss.

Robotic Surgery

Robotic surgery is an advanced form of minimally invasive surgery where the surgeon uses a computer-controlled robot to assist in certain surgical procedures. The surgeon still performs the surgery, the robotic system translates the surgeon’s movements at a console to the instruments on the robot. When performing robotic surgery the surgeon works from a computer console in the operating room, controlling miniaturized instruments mounted on three robotic arms which enter the patient through standard keyhole ports. The surgeon looks through a 3-D camera attached to a robotic arm, which magnifies the surgical site. This provides greater visualization than standard laparoscopic surgery. A second surgeon, acting as an assistant supervises the robot at the patient’s bedside.

The surgeon’s hand, wrist and finger movements are transmitted through the computer console to the instruments attached to the robot’s arms. The robot’s “hands” have a higher degree of dexterity & maneuverability compared to laparoscopic instruments, allowing the surgeon the ability to operate in very tight spaces in the body that would otherwise only be accessible through open (long incision) surgery. Robotic surgery provides surgeons with better accuracy, flexibility and control. Since the robot controls the instruments inside the body, the movements are much more precise and delicate, leading to less tissue handling and less potential injury to organs. This can result in:

At Pindara Private Hospital we use the latest and most advanced robotic surgical console, the daVinci® Xi Surgical System. The da Vinci System has been successfully used in hundreds of thousands of procedures worldwide. Its safety and efficacy for weight loss surgery is documented in clinical publications and the literature supporting its use is extensive. [1]. Evidence does demonstrate there are fewer complications in robotic surgery, specifically weight loss surgery; demonstrating decreased leak rates [2], fewer infections, less bleeding and transfusion requirement, and a decreased rate of death from complications compared to laparoscopic surgery. [3]

The da Vinci System is a remarkable improvement over conventional laparoscopic surgery. In standard laparoscopic surgery, the surgeon operates while standing using hand-held, long-shafted instruments that cannot bend or articulate. With conventional laparoscopy, the surgeon must look up and away from the instruments to a nearby 2D video monitor to see an image and must also rely on an assistant to position the camera correctly. In contrast, the da Vinci Robotic system’s ergonomic design allows the surgeon to operate from a comfortable, seated position at the console, with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands. The instrument movements are computer controlled and much more precise than laparoscopic surgery.

Currently at the Surgery Gold Coast clinic, we prefer to perform all gastric bypass and anti-reflux operations using the surgical robot due to the published benefits, and also our results have been noticeably so much better than the laparoscopic technique. Many other commonly performed operations can be performed using the robot with various benefits and we are happy to discuss these in your specific case. Sometimes there may be an additional cost for the robotic technique however this is generally offset by the better operative result, improved recovery and lower chance of complications.

How a Roux-en-Y Gastric Bypass is performed

Things you need to know

It is important to have long term follow up with your surgeon or an appropriately trained associate after a gastric bypass operation in addition to dietitian follow ups.