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Roux-en-Y Bariatric Surgery

Roux-en-y bariatric surgery, or gastric bypass, is currently the most common type of bariatric surgery. The success rate for roux-en-y surgery is high among morbidly obese individuals who make a lifetime commitment to better eating and exercise habits. In fact, after roux-en-y bariatric surgery, patients can expect to lose up to 75 percent of excess poundage in about 12 months.

The Roux-en-y Procedure

Roux-en-y gastric bypass is performed as either an open or a laparoscopic procedure, a single-incision operation that typically takes less time to complete. Benefits of laparoscopy include a reduction in overall postoperative pain and a shorter recovery process. Both involve the same, or similar, techniques.

The roux-en-y gastric bypass operation usually proceeds according to the following steps:

The patient follows standard pre-surgical instructions in preparation for anesthesia.
The surgeon and team make either one long incision or several incisions in the abdominal region.
Tissue just under the skin is split and moved to the sides.
Team members shift the liver out of the field of view.
Surgeon divides the stomach, stapling the larger portion closed and leaving a small pouch at the top.
The mid-section of the small intestine is divided. One section, known as the "Roux" loop, is surgically connected (as a stoma) to the newly created stomach pouch.
The free end of the upper small intestine is stitched into place, creating a "Y" connection.
The surgical team then checks for leakage around the staples and new connections, after which the procedure is complete.

Roux-en-Y Gastric Bypass

How Roux-en-Y Works

The roux-en-y procedure accomplishes two important tasks. First, it separates the stomach, creating a smaller pouch for food that gives patients a sense of "feeling full" after eating significantly smaller amounts of food. Second, a bypass of the upper portion of the small intestine reduces the ability to absorb calories and nutrients. This quality is known as a "malabsorptive" property.

Roux-en-y bariatric surgery does not involve removal of the stomach. The stomach is still able to produce digestive juices. While the duodenum (the first section of the small intestines) is no longer attached to the stomach, this "bypassed" section is surgically connected further down the intestinal tract - at a "Y" intersection - to provide some of the benefits of normal food breakdown.

The "proximal" approach, the method most commonly used, involves a higher attachment of the upper small intestine. In fewer cases, a "distal" roux-en-y involves reattachment of the small intestine further down intestinal tract. The further the duodenum is attached, the more like a patient will experience malabsorptive values, resulting in even less caloric processing (and less nutrient absorption).

Another variation of the roux-en-y procedure involves creating a "Y" formation between the stomach pouch and the intestinal attachment.

Eligibility for Roux-en-Y Bariatric Surgery

Potential candidates for roux-en-y bariatric surgery are morbidly obese patients that are least 100 pounds overweight, with a body mass index (BMI) of 40 or above.

"Severely" obese individuals, those who fall into the 35 to 39 BMI range, are also potential surgical candidates if excess weight is interfering with their ability to work.

Benefits of RNY

One of the benefits of RNY is the greater weight loss generally seen in the first twelve months. In addition, individuals tend to be more successful in keeping the weight off. Some weight gain may reoccur over time, however, as the small stomach pouch begins to stretch to accommodate more food.

RNY Risks and Drawbacks

"Dumping syndrome," the situation in which the body quickly expels food after eating, is a common side effect of following RNY. While RNY prevents the body from being able to process fats and sugars as it did before, it also causes the body to react adversely to eating too fast or too much at one time. Dumping syndrome typically results in:

diarrhea
feeling faint
nausea
profuse sweating
vomiting.

Dumping syndrome, while not a life threatening, is unpleasant and is often accompanied by severe pain under the breastbone.

Other risks of roux-en-y may include:

difficulty in viewing other internal organs during medical examinations: The RNY procedure inhibits the view of some parts of the abdominal cavity, making it difficult to diagnose other conditions.

gallstones: These can develop with any rapid weight loss. Because of this risk, some surgeons elect to remove the gallbladder at the time of bariatric surgery. Others prescribe medications to reduce the potential for stone formation.

pouch enlargement: This can lead to eventual weight gain. In some cases, the new stomach sac is too large to be effective in weight loss.

staple breakdown: If staples break down, they can potentially leak into the abdominal cavity, causing other serious complications.

Post-Surgical Treatment

After roux-en-y bariatric surgery, most individuals can expect a two to six night stay in the hospital. At home, light activity can resume within a few days, but returning to heavier tasks requires several months. Initially, a liquid diet will help the healing and adjustment process. Overtime, patients can gradually transition to pureed foods and then to solids.

Long-term success with a roux-en-y bariatric surgery will depend on the individual's determination to achieve a better lifestyle.

Roux-en-Y Gastric Bypass Resources