Roux en Y Gastric Bypass Operation

The roux en y gastric bypass operation is one of the most common weight loss surgeries performed in the US.

What are the benefits of this type of operation and what are the possible complications?


What is the Roux En Y Gastric Btpass Procedure?

There are 2 types of bariatric surgical procedures: restrictive procedures and mal-absorptive procedures.

Restrictive procedures are those in which the stomach size is decreased either by banding or by stapling. These procedures cause weight loss by limiting the amount of food that you can eat.

Mal-absorptive procedures are those in which part of the small intestine is surgically bypassed. These procedures causes weight loss by decreasing the amount of calories and nutrients that are absorbed from the food you eat.

Mal-absorptive procedures generally result in greater weigh loss than restrictive procedures.

The roux en y gastric bypass operation is a combination of both restrictive and mal-absorptive procedures.

How is the Operation Done?

When a surgeon performs a roux en y gastric bypass procedure, he or she first staples your stomach across the top, creating a small stomach pouch about the size of a walnut.

This stomach pouch can only hold about an ounce of food, so the amount of food you will be able to eat after this operation will be much less than before.

Although food will no longer enter the lower part of your stomach this part of your stomach still remains healthy and will continue to secrete digestive juices that will mix with food in your small intestine.

After creating the stomach pouch the surgeon attaches it to the lower portion of the jejuneum (the second part of the small intestine) bypassing between two and a half to five feet of the first part the small intestine. (See A Diagram)

Because food will no longer travel through the bypassed part of your intestine the amount of calories and nutrients that you absorb from the food you eat will be reduced, resulting in weight loss.


What is the Operation Like?

Gastric bypass operations are performed under general anesthesia, and generally take about four hours.

Your hospital stay will probably last from two to five days although this varies depending on whether your surgeon can perform the operation through a laparoscope and whether any complications develop. Most people are able to return to work after 3 weeks.

In the immediate post-operative period you will have a tube that is connected to a suction machine running through your nose to your newly designed stomach pouch. This tube is connected to a suction machine that will keep the stomach pouch empty allowing the staple line to heal.

You will also have a tube placed in the bypassed portion of your stomach. This tube will come out the side of your abdomen and is generally not removed until four to six weeks after surgery.


What Can You Expect After Gastric Bypass Surgery?

In order to allow your stomach to heal, you will not be allowed to eat for the first one to three days following your surgery.

After that, you will need to follow a progressive diet starting with liquids, followed by soft foods, and finally progressing to regular foods.

Although the amount you can eat gradually increases, you will not be able to return to your old eating habits.

Because your new stomach pouch only holds about 1 ounce, you'll need to eat very small meals. In addition, if you eat foods that are high in fat or sugar you will probably suffer from what is known as dumping syndrome.

Dumping syndrome is a condition in which stomach contents move too quickly through the small intestine, causing nausea, vomiting, diarrhea, and lightheadedness.


Possible Complications

Although bariatric surgery is considered to be as safe as other abdominal surgeries in the morbidly obese population, death due to serious complications following surgery does occur.

The risk of death varies depending on your age, general health, and other medical conditions.

Overall,the risk of death due to complications following bypass surgery is around 0.5 % or 1 in 200 surgeries. Potentially serious complications of this operation include:

  • Blood clots in your legs. Blood clots in the legs (deep venous thrombosis) can occur after any surgery and are more likely to occur in people who are severely overweight.

    Blood clots are dangerous because they can break off and travel to the vessels of the lungs, heart or brain causing difficulty breathing and reduced oxygenation of your blood (which can be fatal), heart attack or stroke.

    Early and frequent walking following surgery and the application of leg wraps that provide intermittent pressure to your legs will help reduce this risk.If you are a smoker, quitting prior to your surgery can also reduce your risk of developing blood clots.

  • Leaking at the staple line. Leaking at the stomach staple line is another serious potential complication of the roux en y gastric bypass procedure.

    A leak at the staple line allows gastric contents and bacteria to enter the abdomen. Although mild leaks may heal with time and antibiotic treatment, this is another potentially fatal complication and may require emergency surgery.

  • Incisional Hernia. Because your abdominal wall will be weakened at the site of your surgical incision a hernia may develop at the site. This is more likely to occur if you have an open procedure and a large abdominal incision. Hernias require surgical repair.

  • Narrowing of the Opening Between the Stomach and Small Intestine. This complication is rare but if it occurs, it will requrie an additional procedure to correct it.


Other Potential Complications

In the first 3-6 months following roux en y gastric bypass surgery it is common to experience body aches, fatigue, and mood swings as your body reacts to rapid weight loss.

Many people also experience hair loss following this operation but this condition usually reverses itself with time. Other potential complications following roux en y gastric bypass surgery include:

  • gallstones
  • kidney stones
  • Low blood sugar (hypoglycemia) related to excessive insulin production
  • Stomach ulcer
  • Pouch stretching (which can lead to weight re-gain)
  • Breakdown of your staple lines
  • Nutritional deficiencies particularly of vitamin B12, calcium and iron. (You will need to take a nutritional supplement.)



Benefits of the Roux En Y Gastric Bypass Operation

While potentially serious complications can occur with the roux en y gastric bypass procedure, they are relative rare. (Complications occur in roughly 5% or 5 out of every 100 surgeries according to the American Society for Metabolic and Bariatric Surgery 2004 Consensus Statement.)

And the benefits of having the operation can be tremendous.

Most people experience rapid weight loss following a roux en y gastric bypass procedure. In fact, you can expect to lose about 75% of your excess weight in the first year following this operation.

In addition, you can expect to see improvements in conditions like:

  • Diabetes. 83% of patients undergoing a roux en y gastric bypass procedure experience a resolution of their type 2 diabetes - often within days.

  • High Blood Pressure 67.5% of patients undergoing roux en y gastric bypass surgery experience a resolution of their high blood pressure.

  • High Cholesterol Levels 95% of patients undergoing roux en y surgery have a significant improvement in their serum cholesterol levels.

Patients who undergo this type of surgery also have significantly reduced rates of cancer, cardiovascular diseases, endocrinological disorders, infectious diseases, musculoskeletal disorders, and respiratory disorders.

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