Bariatric Surgery

Weight Loss Procedures Performed at Mayo Clinic

Standard Roux-en-Y

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Roux-en-Y Gastric Bypass
The most common procedure performed at Mayo is Roux-en-Y gastric bypass. Research has shown that it is the most effective procedure with the best long-term results.

Two types of Roux procedures are done at Mayo: the standard Roux-en-Y gastric bypass and the very, very long limb gastric bypass. In both cases, stomach size is reduced significantly, creating a very small pouch (about the size of an egg) at the top of the stomach. Then a segment of small intestine is cut below the duodenum and attached to this pouch. The larger portion of the stomach is left with a portion of intestine (duodenum) that is then attached further down to the portion of the intestines that receive food. Gastric juices (from the larger section of stomach) drain into the intestine and allow food to be absorbed. The resulting arrangement of the intestines forms a "Y", hence the name Roux-en-Y. (Roux is the name of the surgeon who first performed gastrointestinal surgeries resulting in y-shaped rerouting.) Because most of the stomach is bypassed, the procedure is called a gastric bypass.

At Mayo Clinic, a slightly longer portion of small intestine is bypassed in the standard procedure, compared to surgeries at other medical institutions. This has proven to have better long-term results.

Very, very long limb gastric bypass

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Very, very long limb gastric bypass
The very, very long limb gastric bypass, a modified version of the Roux procedure, was developed by a Mayo surgeon. It is preferred for people who are severely obese (usually men who weigh more than 400 pounds and women over 350 pounds. The difference from the standard Roux-en-Y in that the bypassed segment of intestine containing the digestive juices is attached to the food-carrying intestine closer to the large intestine. This further restricts nutrient and calorie absorption.

Duodenal switch

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Duodenal Switch
Mayo surgeons sometimes perform a biliopancreatic diversion with duodenal switch (or simply, duodenal switch). In principle, it is similar to the very, very long limb Roux-en-Y gastric bypass. Duodenal switch surgery leaves more of the stomach intact compared to the other surgeries. The intact portion of the stomach includes the pyloric valve, which controls the flow of food from the stomach into the intestine. This operation leaves intact a limited portion of the small intestine that normally connects to the stomach (duodenum), but bypasses the majority of the intestine (where nutrient and calorie absorption takes place) by connecting the end portion of the intestine to the duodenum near the stomach. A potential risk of this surgery is nutrient deficiency.

Laparoscopic Adjustable Gastric Banding

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Laparoscopic Adjustable Gastric Banding
During laparoscopic adjustable gastric banding surgery, an inflatable band is placed around the upper portion of the stomach to restrict the amount of food that can be consumed and to extend a person's feeling of satiety. A porthole is inserted under the patient's skin. The band is gradually tightened through the porthole during the first several months after the operation to partition the stomach into two compartments, a small upper pouch and a larger lower pouch. The tightened band creates a narrow passage between the two compartments. The smaller pouch restricts the amount of food a patient can eat. The procedure is safe, minimally invasive, adjustable and reversible.

Sleeve gastrectomy

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Sleeve Gastrectomy
During sleeve gastrectomy, the left side of the stomach is surgically removed. The remaining stomach is approximately the size and shape of a banana. Since this surgery does not involve rerouting or reconnecting of the intestines, it is a simpler operation than gastric bypass. Unlike the laparoscopic adjustable gastric banding procedure, the sleeve gastrectomy does not require the implantation of an artificial device inside the abdomen. For some patients, particularly those with a body mass index greater than 60, the sleeve gastrectomy may be the first part of a two-stage operation. The two-stage procedure has substantial advantages for some individuals.