The Roux limb is constructed with a length of 80 to 150 cm (30 to 60 inches), preserving most of the small bowel for absorption of nutrients. The patient experiences very rapid onset of a sense of stomach-fullness, followed by a feeling of growing satiety, or "indifference" to food, shortly after the start of a meal. Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine.

You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

In normal digestion, food passes through the stomach and enters the small intestine, where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.
In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).

This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).

As performed today, gastric bypass surgery has two parts:

1. Creation of a small stomach pouch
   During this part of the surgery, the stomach is divided into a large portion, and a much smaller portion. The small part of the stomach is then sewn or stapled together to make a small pouch (this part is sometimes called "stomach stapling"). The small stomach pouch can only hold a cup or so of food.
   With such a small stomach, people feel full quickly and eat less. This strategy is also called "restrictive," since the new stomach size restricts food intake.
2. "Roux-en-Y" creation (bypass)
   In this part of the surgery, the new, small stomach pouch is disconnected from the first part of the small intestine (the duodenum). The surgeon then reconnects the stomach to a portion of intestine slightly further down (the jejunum). This surgical technique is called a "roux-en-Y."

After a roux-en-Y, food passes directly from the stomach into the jejunum, bypassing the duodenum. This leads to reduced absorption of calories and nutrients. This weight loss method is called "malabsorptive."

Stomach stapling and gastric bypass are typically performed during the same surgery. Together, this surgery is called a "roux-en-Y gastric bypass." The roux-en-Y procedure accounts for about 80% of all U.S. weight loss surgery procedures.

Usually, gastric bypass is performed laparoscopically (using tools inserted through small incisions in the belly). When laparoscopy is not possible, gastric bypass can be open (laparotomy). This involves a large incision in the middle of the belly.

Gastric bypass surgery is generally considered when your body mass index is 40 or higher or you have a life-threatening or disabling condition related to your weight.
Your doctor may only consider doing gastric bypass surgery if you have not been able to lose weight with other treatments.

The following conditions may also be required or are at least considered:

• You have been obese for at least 5 years.
• You do not have an ongoing problem with alcohol.
• You do not have untreated depression or another major psychiatric disorder.
• You are between 18 and 65 years of age.

All surgeries have risk, and it is important for you and your health professional to discuss your treatment options to decide what is best for your situation.

Most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months. One study noted that people lost about one-third of their excess weight (the weight above what is considered healthy) in 1 to 4 years.1 Some of the lost weight may be regained.

The laparoscopic approach showed similar results, with 69% to 82% of excess weight lost over 12 to 54 months.

• An iron and vitamin B12 deficiency occurs more than 30% of the time. About 50% of those with an iron deficiency develop anemia.
• The connection between the stomach and the intestines narrows (stomal stenosis) 5% to 15% of the time, leading to nausea and vomiting after eating.
• Ulcers develop 5% to 15% of the time.
• The staples may pull loose.
• Hernia may develop.
• The bypassed stomach may enlarge, resulting in hiccups and bloating.

In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, you may have a deficiency in iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, you may need to work with a dietitian to plan meals, and you may need to take nutrient supplements and injections of vitamin B12.

There is also a possibility that you may develop gallstones after gastric bypass. Sometimes the gallbladder is removed as part of the surgery. But if your gallbladder is not removed, then you may need to take medicine to prevent gallstones.

Early studies of the laparoscopic approach to surgery for obesity suggest that it reduces recovery time and post-surgery complications.
 

• Hyperlipidemia is corrected in over 70% of patients.
• Essential hypertension is relieved in over 70% of patients, and medication requirements are usually reduced in the remainder.
• Obstructive sleep apnea is markedly improved with weight loss, so that most patients are asymptomatic, and often do not even snore, within one year.
• Diabetes mellitus type 2 is reversed in up to 90% of patients, usually leading to a normal blood sugar without medication, sometimes within days of surgery.
• Gastroesophageal reflux disease is relieved from the time of surgery in almost all patients.
• Venous thromboembolic disease signs such as leg swelling are typically much improved.
• Low back pain and joint pain are typically relieved or improved in nearly all patients.

A recent study in a large comparative series of patients showed a 89% reduction in mortality over the 5 years following surgery, compared to a non-surgically treated group of patients. There were accompanying decreases in the incidence of cardiovascular disease, infections, and cancer.

Concurrently, most patients are able to alter their lifestyle, to consume "healthier" foods, exercise more regularly, and to enjoy greater participation in family and social activities. Bariatric surgery is the most effective treatment for morbid obesity, and can markedly improve health and lifestyle.

• Pre-Surgery Consultation
• Doctors Fee
• Surgery fee
• Hospital room charges
• Nursing fee
• All medications required
• Post-Operative Follow Up

In addition to the cost of the surgery, you will need to be prepared for the following additional costs.

Stay
For this procedure you are required to stay in Bangkok for at least 15 days of which you will be spending the first 4 - 5 nights at the hospital, and then you can choose whether to stay in the serviced apartment at the hospital or a hotel outside until the post surgery follow up appointment 7 days after the surgery. Surgeon will allow you to fly only after the follow up appointment, and therefore you need to plan accordingly.

Serviced apartment at the Hospital : Piyavate hospital provides a serviced apartment manned 24/7 by registered Nurses within the hospital complex, with prices ranging from US$ 45 -  US$ 195 / night depending on the type of room you choose. 

Hotel: If you wish to stay in a Hotel outside the hospital it could cost you anywhere between US$ 40 - 300 / night depending on the hotel you choose. There are many Quality / Clean entry level hotels that offer rooms for as little as US$ 40 in the near vicinity of the hospital and the Up market hotels near the Sukhumvit (10 mins in taxi) or Silom (25 mins in taxi) Shopping districts, the rate could go as high as USD 300 / night. 

BMT Concierge Service : If you wish to have us arrange you received at the airport and arrange the round trip airport transfer, and Transfer to all of your appointments and the surgery by one of our patient co-coordinators, there will be an additional Fee of US$ 169 which is to be paid after you confirm the surgery plan.  This fees only applies if you choose our Concierge service. There are no additional fee if you choose only the  Surgery planning service.

All the fees due for the surgery has to be paid directly to the surgeon or the hospital before undergoing the procedure.  There are no fees to be paid to us apart from the fee for the Concierge service if you wish to have us arrange all of your transportation.

REQUEST FOR MORE INFORMATION