Gastric Bypass Surgery Roux-en-YGastric Bypass Surgery also known as Roux-en-Y is a bariatric surgery, or weight loss surgery performed on patients who are severely overweight or have failed to lose weight through the normal methods of diet and exercise.

Patients who choose this type of bariatric surgery must drastically change their lifestyle, learn to control portion sizes at meal times, and incorporate exercise into their daily routines.

Gastric bypass procedures are commonly performed on patients with a body mass index (BMI) greater than 40 and on patients who suffer from obesity-related health conditions.

Gastric bypass surgery, often referred to as Roux-en-Y Gastric Bypass, is the most common form of weight loss surgery performed in the United States. It is also considered to be the “gold standard” of weight loss surgery.

3 Types of Gastric Bypass Surgery

There are 3 types of gastric bypass surgery. Each procedure is performed in nearly the same manner with small variations.

  1. Gastric Bypass Roux-en-Y (proximal) is the most common procedure used today. The Y-intersection is formed near the upper (proximal) end of the small intestine. The Roux limb is constructed using about 31 to 59 inches of the small intestine. This preserves the rest of the small intestine for “absorbing nutrients”.
  2. Gastric Bypass Roux-en-Y (distal) is where the Y-connection is formed much closer to the lower (distal) end of the small intestine. Because of the closer distance, its causes reduced absorption of calories: primarily of fats and starches, but also of various minerals and the fat-soluble vitamins.
  3. Mini-Gastric Bypass Surgery creates a long narrow tube of the stomach along its right border. A loop of the small gut is brought up and hooked to this tube at about 180 cms from the start of the intestine.

How Roux-en-Y Gastric Bypass Surgery is Performed

Roux-en-Y gastric bypass shortens the digestive process and reduces the body’s ability to absorb calories from food. There are two steps involved in performing a gastric bypass procedure.

Part One: Create a Small Pouch in the Stomach

  • The first step makes the stomach smaller in order to reduce the amount of food it can hold. To achieve this, the surgeon uses staples to separate the stomach into a tiny upper section and a large bottom section.
  • The tiny upper section, which is about the size of a walnut, is referred to as the pouch and it functions as the patient’s new stomach.
  • Being that it is only the size of a walnut, the pouch can only hold about 1 ounce or 28 grams of food.
  • The new gastric pouch restricts the amount of food it holds so you eat less and feel full quickly.
  • This “restrictive” procedure promotes rapid weight loss.

Part Two: The Roux-en-Y Gastric Bypass

  • The second step of the procedure is referred to as the bypass. During this part of the procedure, the bariatric surgeon detaches the gastric pouch from the first part of the small intestine (Duodenum) and connects it to a part of the small intestine further down (Jejunum).
  • Now, all food that is eaten by the patient will travel from the pouch, into the small opening made by the surgeon, and into the small intestine. 
  • The food completely bypasses the upper portion of the small intestine. 
  • Bypassing part of the small intestine limits the absorption of calories.
  • This form of stomach surgery is called a “Roux-en-Y“.

Gastric bypass surgery can be performed using either of two methods. The surgery may be performed laparoscopically in which the surgeon will make several small ¼ to ½ inch abdominal incisions or traditionally as an “open” procedure in which the surgeon will make one 10-12 inch abdominal incision.

Regardless of the method chosen to perform the procedure, the surgery lasts approximately 1.5 hours and the hospital stay is approximately 2-3 days. The overall recovery time for the procedure is approximately 2 weeks.

Advantages of Gastric Bypass Surgery

There is a reason why gastric bypass surgery is considered the “gold standard” of bariatric surgery. Not only is it the most commonly performed weight loss procedure, it has also been proven to have the most successful results. 

In addition to reducing the overall size of the stomach and restricting the amount of food the stomach can handle, the route of food digestion is also altered so that it doesn’t pass through the portion of the small intestine that would normally absorb calories and nutrients.  

  • Most importantly, the rerouting of the food stream produces changes in gut hormones that promote the feeling of fullness after a meal, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
  • In addition, people who undergo gastric bypass surgery typically lose 60% to 80% of their excess weight initially, then are able to maintain approximately 50% of their excess weight loss.
  • Together with the drastic reduction in excess weight, patients who undergo gastric bypass also benefit from improvements in their overall health, reduction in obesity-related conditions, greater physical mobility, an increase in energy expenditure, and an overall greater quality of life.

Disadvantages of Gastric Bypass Surgery

Even though there are many benefits to be obtained by undergoing a gastric bypass procedure, there are some disadvantages associated with the procedure. When compared to other weight loss surgeries like gastric band and gastric sleeve, the gastric bypass surgery is technically a more complex procedure. This can lead to greater complication rates.

It should be noted that even though the surgery is beneficial for obesity-related conditions such as diabetes and high blood pressure, the more severe these conditions are prior to the gastric bypass procedure, the greater the risk of complications after the procedure.

  • Unlike the gastric band procedure, but similar to the gastric sleeve procedure, the gastric bypass procedure is permanent and irreversible.
  • In addition, due to the fact that the food consumed by the patient will now bypass the portion of the small intestine responsible for absorbing calories and nutrients, patient who undergo this procedure are likely to develop vitamin and mineral deficiencies particularly in vitamin B12, iron, calcium, and folate.
  • Consequently, patients who undergo this procedure will be required to strictly adhere to dietary recommendations and incorporate vitamin/mineral supplementation into their daily routine.

Patients who undergo gastric bypass surgery are also at an increased risk of developing dumping syndrome. Dumping syndrome occurs when large volumes of food in the stomach move too quickly through the small intestine. This commonly occurs after eating sweet or high-fat foods.

People who develop dumping syndrome following gastric bypass can experience nausea, vomiting, cramps, diarrhea, sweating, dizziness, and weakness. There are a great deal of benefits of having gastric bypass surgery, however, patients should be aware of the potential disadvantages as well.

Health Benefits of Gastric Bypass Surgery

Research supports the benefits of gastric bypass surgery in respect to treating morbid obesity. People who have lived with obesity for years, know that the disease has a severe negative impact on the quality of life.

  • As a result, obesity may affect your self-esteem, confidence and prevent you from participating in certain activities.
  • Studies show that morbid obesity not only affects the quality of your life, but also affects the length of your life.
  • Morbid obesity has been linked to serious and life-threatening diseases such as type 2 diabetes, heart disease, high blood pressure, heartburn and cancer, to name a few.

In fact, clinical studies show that gastric bypass resolved Type 2 diabetes in 76.8 percent of patients, resolved high blood pressure in 61.7 percent of patients and reduced high cholesterol in 70-95 percent of patients.

If you are affected by obesity-related conditions, having Roux-en-Y gastric bypass surgery may help you.

Gastric Bypass Resolved:  Gastric Bypass Improved: 
  • 76.8%4 –  type 2 diabetes
  • 61.7%4 – high blood pressure
  • 70-95%4 – high cholesterol 
  • 85.7%4 – obstructive sleep apnea
  • 98%5  – acid reflux/GERD
  • 85.4%4 –  type 2 diabetes
  • 78.5%4 – high blood pressure
  • 70-95%4 – high cholesterol 
  • 83.6%4 – obstructive sleep apnea
†Medical terminology defines “resolved” as removing all known symptoms and signs of the condition or disease and “improved” as reducing the known symptoms and signs of the condition or disease.

 

Laparoscopic Roux-en-Y Gastric Bypass

While the excess weight loss that is achieved by undergoing gastric bypass surgery may be the most obvious benefits of having the surgery, the health benefits associated with the procedure are much more significant.

Overweight patients are more susceptible to developing arthritis, especially in the knees.

After undergoing gastric bypass surgery, the subsequent weight loss can dramatically improve, avoid, or completely resolve the symptoms associated with arthritis. It is also well known that obesity increases the severity of asthma symptoms.

After undergoing gastric bypass surgery, people suffering from asthma had fewer and less severe attacks and, in some cases, none at all. If people where undergoing steroid treatments for their asthma, most patients were able to discontinue their steroid treatments within 18 months of the gastric bypass procedure.

Patients who undergo gastric bypass will have a greatly reduced risk of developing many other conditions that are related to or made worse by obesity including some forms of cancer, cardiovascular disease, high blood pressure, infertility, sleep apnea, depression, and gastroesophageal reflux disease.

Overall, if you are suffering from obesity, undergoing a gastric bypass procedure can make you look better on the outside and feel better on the inside!

Expected Weight Loss After Gastric Bypass Surgery

People who undergo gastric bypass surgery need to lose a great deal of weight in a short period of time. Gastric bypass surgery restricts the amount of food patients can consume and reduces the number of calories that can be absorbed by the body. With all these mechanisms working together, weight loss will occur very rapidly.

  • Patients can expect to lose 60% to 80% of their excess body weight within 12-18 months after surgery.
  • People who undergo this surgery can expect to maintain a long-term weight loss of around 50% of their excess body weight.

Since the body will no longer absorb nutrients in the manner that it did prior to surgery, strict adherence to post-surgical dietary regimens, including vitamin and mineral supplementation, is of crucial importance to maintain the health benefits associated with the gastric bypass procedure.

Gastric Bypass Surgery does not work entirely by itself. Nutrition, behavior modification and physical activity play a critical role in weight management after gastric bypass. Let our team of nutrition and dietary experts, who have extensive science education, training and experience help you manage your weight, improve your nutrition, body image and quality of life.

Risks and Complications

As with any invasive surgical procedure, there are risks and complications associated with undergoing a gastric bypass procedure. It should be noted that some people have uncontrolled obesity-related conditions, such as diabetes and hypertension, which will increase the risks involved with the procedure. Due to obesity-related conditions, the mortality rate associated with gastric bypass surgery is approximately 2.5%.

People who undergo gastric bypass surgery are also at a risk of developing dumping syndrome after the surgery. In addition, some surgical complications associated with gastric bypass surgery include:

  • perforation of the stomach or intestines
  • leakage of the surgical connection between the stomach and intestine
  • internal bleeding or profuse bleeding of the surgical wound, and
  • obstruction of the newly formed gastric pouch

If anything feels out of the ordinary after surgery, patients are encouraged to notify their physician immediately.

Although the benefits of weight loss are highly desired, patients should take time to educate themselves regarding the disadvantages, risks, side effects and potential complications associated with gastric bypass surgery.

People who undergo this procedure must be ready to make dramatic changes in their lifestyle. Once patients are ready to take the necessary steps and make the necessary lifestyle adjustments, they can enjoy the physical benefits and the multitude of health benefits associated with undergoing gastric bypass surgery.

How Does Gastric Bypass Promote Weight Loss?

Roux-en-Y gastric bypass surgery is classified as a “restrictive” and “malabsorptive” operation that causes weight loss through two primary methods. The gastric bypass procedure promotes weight loss through several mechanisms.

  • First, stomach capacity is reduced by up to 85% of its original size. And like other bariatric surgical options, the pouch that is formed during the surgery is considerably smaller than the stomach was prior to the surgery. Therefore, patients must eat smaller meals which equals less calories consumed, which results in weight loss.
  • Second, a portion of the upper small intestine is bypassed. This means food flows from the new gastric pouch directly into the middle section of your small intestine (jejunum). Bypassing the upper small intestine (duoenum); the part that absorbs most of the calories from food causes patients to lose even more fat.
  • Because there is less digestion of food occurring in the smaller pouch and there is a segment of small intestine, that would normally absorb calories and nutrients, not having food move this segment which will result in less calories being absorbed by the body. This mechanism also helps with weight loss after the gastric bypass procedure.

How Science Works in Gastric Bypass

The most important mechanism involves the gut hormones. The rerouting of the food stream facilitates changes in gut hormones that promote fullness, suppress hunger, and reverse one of the primary mechanisms by which obesity causes type 2 diabetes.

The small intestine plays an important role in weight loss. It communicates with the brain via hormones, and nerve signals that send messages about calorie levels and nutrient content of food. When the brain receives this information, it responds by causing you to feel full.

Your brain then manages the activities in various tissues (multiple tissue types form organs and body structures) to make sure the nutrients get handled properly. That’s why dietary changes and life-long vitamin and mineral supplementation are required after gastric bypass surgery.

Am I a Candidate for Gastric Bypass?

Qualifications for gastric bypass surgery in most cases include:

  • You have a body mass index (BMI) > 30
  • You are more than 100 pound over your ideal body weight
  • You have attempted to lose weight with diet and exercise, but were not successful
  • You have a body mass index > 29 and suffer from negative health conditions related to obesity such as high blood pressure or diabetes

 

Photo Credit 

https://www.southnassau.org/sn/gastric-bypass

References

https://asmbs.org/patients/bariatric-surgery-procedures

https://www.mayoclinic.org/tests-procedures/gastric-bypass-surgery/about/pac-20385189

https://www.upmc.com/services/bariatrics/approach/surgery-options/gastric-bypass?gclid=EAIaIQobChMIuYjX7Pyp3wIVCVqGCh0JQACuEAAYASAAEgL2LfD_BwE&gclsrc=aw.ds

https://medlineplus.gov/ency/article/007199.htm

https://obesitynewstoday.com/gastric-bypass-pros-cons/

https://bariatric.stopobesityforlife.com/obesity-surgery/correcting-obesity/benefits/

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