What is Roux-en-Y gastric bypass surgery?

The Roux-en-Y gastric procedure was originally developed in the early 1960’s as a means of treating people who suffered from severe ulcers.  It was discovered that these people typically lost weight and suffered minimal problems following the surgery that were associated with weight loss surgeries at the time. As a result, it was later tried and adopted as the “gold standard” of weight loss surgery.

The reason for people to have the surgery is not as much for the loss of weight, but to lessen what are called co-morbidities.  Co-morbidities are diseases or disorders that are greatly increased in obese individuals.  Obese people are at far greater risk of dying of an obesity-associated disease (such as diabetes, heart disease, arthritis, respiratory disease and others).  Gastric bypass surgery is designed to help severely obese people rapidly lose weight so that coexisting health problems (co-morbidities) can be diminished or eliminated.

The Roux-en Y procedure is performed as an Open procedure, Laprascopic (LAP) procedure, or Hand Assisted Laprascopic procedure (HAL).

·         The Open procedure is the most typical operation and is also performed when LAP or HAL procedures cannot be performed.  Often excess abdomen scar tissue prevents the LAP or HAL procedures from being performed.  In this procedure, the surgeon makes an incision from the base of the sternum to a point just above the belly button... thus the word Open.

·         The LAP procedure is usually done using cameras and has 5 or 6 small incisions. The abdomen is filled with air for working room and move ability. The camera and mechanical instruments are used to perform the procedure.  It is less invasive and has a much higher recovery time.  The down sides are that the surgeon does not have the advantage of feel and touch.

·         The HAL procedure is the same as the LAP procedure, but one of the small incisions is enlarged so that the surgeon can use a hand for feel and touch.  A seal is used as a gasket around the incision and hand to keep the abdomen inflated.  The advantages here are that the surgeon has valuable feel and touch capabilities and provides a quick recovery time for the patient.

How does Roux-en-Y gastric bypass surgery help a person lose weight?

The Roux-en-Y helps a patient lose weight in three ways:

Gastric Restriction - The surgery creates a small stomach called a pouch that only holds about 3 ounces of food or liquid.  In addition, the jejunum or upper part of the small intestine is connected directly to the pouch with an opening of about a ½ inch in diameter. This bypasses the duodenum and restricts the amount of food a person can eat. The reduction in the size of the stomach along with the diameter of the opening into the jejunum drastically reduces the amount of food that can be eaten at one time.

Nutrient Mal Absorption - Usually, the body absorbed calories in the stomach and duodenum and a longer section of the jejunum. Having these stages bypassed, the body has less opportunity to absorb digestive material causing fewer calories to be absorbed and creating greater weight loss.

Dumping Syndrome – The roux-en-y surgery causes patients to  become less tolerant of foods high in refined sugar and fats.  This is because these types of foods enter the small intestine very quickly (the dumping syndrome), and in some patients, may cause symptoms such as nausea, weakness, dizziness, and sweating.

How effective is the Roux-en-Y Procedure?

The Roux-en-Y gastric bypass procedure has been called the “Gold Standard” in weight loss surgery because of its effectiveness in helping people lose weight and regain health.

Typically, Roux-en-Y gastric bypass patients will lose weight rapidly after surgery. Weight loss for the first 6 months can be as much as six pounds per week.  The weight loss usually tapers off to 1 to 3 pounds per week and will continue to do so for 18 to 24 months. At that time, the patient's weight will begin to level out, most likely stabilizing at about 20 to 40 percent above his or her ideal body weight.  

Statistics show that 95% of patients Roux-en-Y patients lose more than half their excess weight and maintain this benefit.  Better that 85% lose greater that 75% of their excess weight, and 20% of patients achieve their "ideal weight."
The main reason for having the surgery is to improve the quality of health and the longevity of patients having the surgery.  Hypertension, sleep apnea, diabetes, and cholesterol imbalances improve markedly after weight-reduction surgery.  In addition, patients have less pain and improved mobility.

 What are the risks of gastric bypass surgery?

Roux-en-Y gastric bypass surgery is major surgery.  As with any major surgery, there are risk, but the overall complication rate is less than 5%.  The following is a short list of some of the complications that can occur:

• Infection around abdominal incisions
  
  
• Abdominal hernias
  
  
• Gallstones
  
  
• Nutritional deficiencies
  
  
• Pneumonia
  
  
• Blood Clots
  
  
• Bleeding
  
  
• Obstruction or leaking at the closure of small bowel "hook-up" and/or staple line
  
  
• Bowel Obstruction
  
  
• Women of childbearing age should avoid pregnancy until their weight becomes stable because rapid weight loss and nutritional deficiencies can harm a developing fetus.
  
  
• You will become nauseous from overeating or eating too quickly.
  
  
• Some patients experience food intolerances such as red meat, milk or sugar.
  
  
• You will have decreased bowel function, as you are consuming fewer calories every day.
  
  
• You may experience hair loss

Are you a Candidate for gastric bypass surgery?

The following are guidelines as defined by the National Institutes of Health. These may be helpful for if you are considering Weight Loss Surgery:

• The patient is least 100 pounds above ideal weight
  
  
• The patient has a Body Mass Index (BMI)of 40 or higher
  
  
• The patient has a BMI of 35 or higher and also suffers from serious obesity-related health problems (co-morbidities),
  such as Diabetes Mellitus, Elevated Lipids, Hypertension, Depression, Heart Disease, Degenerative Joint Disease, and Sleep Apnea
  
  
• The patient is between 15 and 60 years of age 
  
  
• The patient has a history of obesity 
  
  
• The patient has tried non-surgical weight-loss treatments without success, and has documented such attempts
  
• The patient has no history of substance abuse, or has current success in a recovery program