Classical Roux en Y Operation (RNY)
Roux en Y (RNY) or gastric bypass is a restrictive procedure
that staples off an approximate ½-1 ounce stomach pouch
at the upper portion of the stomach. A section of small bowel
is then attached to the pouch via a small opening, which is
to simulate the pyloric valve. . Narrowing and or blockages
can take place at this small opening. Ulceration can also happen
at the area where the small bowel and the stomach tissue are
attached. The pyloric valve is bypassed in this procedure.
Because of the small pouch size vomiting can take place if
food is not properly chewed or food is eaten too fast or too
large a volume. Dumping syndrome is also takes place when consuming
high sugar containing food.

Image courtesy of ETHICON
Vertical Banded Gastroplasty: (VBG)
VBG) is another restrictive procedure that only limits the
amount of food. The stomach is portioned off with staples
and then a stilastic ring is put into the gastric tissue
to simulate the pyloric valve and to restrict the amount
of food eaten at a given time. This procedure has had a
high failure rate with regaining of weight and staple line
disruption.

Image courtesy of ETHICON
Fobi Pouch
Fobi Pouch is a restrictive procedure that is a variation
on the VGB and RNY. The procedure has the same pouch construction
as the Roux en Y procedure but incorporates a silastic ring
around distal end of the pouch to simulate the pyloric valve
and prevent stretching of the opening between the pouch and
the section of small bowel. Vomiting can take place if too
large of a bite of food is taken. Dumping syndrome can also
occur with this procedure.

Image courtesy of ETHICON
Lap Band
Lap Band, the most recent device that has won the FDA approval,
has been in use in Europe and Australia for many years. The
FDA postponed the approval of this device for release in US
citing inadequate data, as well as poor outcome when compared
to the European and Australian studies. The Lap band, is a
restrictive procedure, that limits the amount of food intake.
The amount of restriction can be controlled by the means of
a implantable port under the skin which can be used to inflate
or deflate (increase and decrease ) the restriction.

Image courtesy of ETHICON
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