The operation creates a very small upper stomach pouch (less than one ounce) by transecting the stomach (See Figure). Ingested food passes out of the upper pouch through a small opening into the small intestine. Most of the stomach and the first part of the small intestine are bypassed by the food. Thus, the operation is termed a "gastric bypass with Roux-en-y gastrojejunostomy."

 

 

Figure. Roux-en-y Gastric Bypass

The major objective is to exclude most of the stomach. The point where the bile and pancreatic secretions are returned to mix with the ingested food is placed several feet down from the stomach. If the gallbladder is diseased, it may be removed during the operation..

The operation is usually done with laparoscopic instruments through several small incisions.This technique involves inserting a video telescope into the abdomen through a 12mm incision.
Five additional incisions (1-12mm & 4-5 mm) are placed in the upper abdomen. The same operation is then carried out using specialized instruments. This approach has the potential advantage of smaller incisions, less pain, quicker recovery, fewer wound complications, earlier discharge from the hospital and less scarring while potentially providing the same weight reduction as the traditional open approach.
Occasionally, it requires an incision from the breastbone to just above the umbilicus in order to gain access to the internal organs. If for whatever reason, the operation cannot be safely completed using the small incisions, the abdomen will be opened, and the operation will be completed in that manner. Not every patient is a candidate for the laparoscopic procedure. The surgeon will determine this during your initial visit.