Roux-en-Y Gastric Bypass

The Roux-en-Y gastric bypass is a restrictive and malabsorptive procedure.  It restricts food intake and the amount of calories and nutrients the body absorbs.  This is accomplished without the need to implant or manipulate an artificial device. 

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is one of the most frequently performed weight loss procedures in the United States.

The Procedure

The surgeon creates a small stomach pouch at the top of the stomach to restrict food intake.  Then, a Y-shaped section of the small intestine

 is attached directly to the pouch.  Thisallows food to bypass the lower stomach and a portion of the small intestine.  You will feel full sooner, eat less and experience a diminished sensation of hunger.  Bypassing a part of the small intestine means the body absorbs fewer calories.  The hunger hormone Ghrelin has been found to be reduced after this procedure, thus decreasing the sensation of hunger.

Dietary Adjustments

Patients who have undergone Roux-en-Y gastric bypass surgery must change their food choices. When patients eat a meal high in carbohydrates, which contain sugars that are rapidly absorbed by the body, they may experience an unpleasant reaction known as “dumping syndrome.”  Stomach contents move too quickly through the small intestine causing symptoms such as nausea, bloating, abdominal pain, weakness, sweating, faintness and sometimes diarrhea. Additionally, lifelong vitamin supplementation is also required for gastric bypass patients as the bypassed portion of the intestine is where the majority of calcium and iron absorption takes place.

Advantages and Results

The Roux-en-Y gastric bypass has been proven in numerous studies to result in durable weight loss and improve weight-related medical illnesses.

1. Weight loss begins immediately.  Half of the weight loss often occurs during the first six months after surgery and usually peaks at 18 to 24 months. 
2. Patients can expect to loss 80% or more of their excess weight at the end of one year.
3. Patient often feel less hungry and state the desire to eat is reduced.
4. Does not require implanting an artificial device in the abdomen.
5. Does not require manipulation as with the adjustable gastric band.
6. The obesity-related conditions that may be improved or cured include type II diabetes, hypertension, high cholesterol, arthritis, bladder incontinence, liver disease, certain types of headaches, heartburn, sleep apnea and many other disorders.

Possible Complications

The various possible complications associated with the Roux-en-Y gastric bypass are listed below.  It would be best to talk about these and other potential complications with your physician.

1. Leaks can occur and may be from staple lines or due to poor healing.   
2. Marginal ulcers – ulcers in the gastric pouch that can bleed, perforate (create a hole in the gastric pouch) or heal and cause narrowing of the gastric pouch outlet.
3. Strictures or narrowing of the gastric pouch outlet.  This can occur due to scar tissue or ulcer disease.
4. Obstructions can occur due to scar tissue or ulcer disease.
5. Vitamin and mineral deficiency.  The gastric bypass is designed to limit absorption as a result vitamin and mineral deficiencies can occur.  Patients will be on lifelong vitamin supplementation.  It is recommended that all patients have their vitamin levels checked at regular intervals. 
6. Dumping syndrome is an unpleasant side effect that may include vomiting, nausea, faintness, sweating and diarrhea.  This occurs due to eating foods high in sugars or carbohydrates.
7. Hernias can develop in up to 10 to 20 percent of patients after any type of abdominal surgery.  Internal hernias are unique to gastric bypass.
8. Gallstones can occur due to rapid weight loss.
9. Intolerance to certain foods can occur.  It is recommended that patients speak with their surgeon or a registered dietitian if they are experiencing this.
10. Stretching and enlargement of the gastric pouch can occur over time.  This can lead to weight gain.
11. Weight gain can occur if patients do not comply with the appropriate dietary guidelines.  It is recommended that all patients follow up at regular intervals during the first year and yearly thereafter with their bariatric surgeon.  The best prevention to weight gain is early identification of maladaptive behaviors and modifying them. 
12. Due to the nature of this procedure it is not reversible.

Sources: American Society for Metabolic and Bariatric Surgery, National Institute of Diabetes & Digestive & Kidney Diseases