Roux-En-Y Gastric Bypass

The  Roux-En-Y Gastric Bypass  also known as the Gastric Bypass  procedure has been performed for over 4 decades throughout the world. It is the oldest weight loss operation that is still performed.

 

During the Roux-En-Y Gastric Bypass a small stomach pouch (residual stomach capacity of 30-50mls) is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine).


Food and nutrients therefore do not pass through the first 150-200cm of the intestine. This bypass reduces the absorption of food and nutrients from the first 150-200cm of the intestine, thereby reducing the calorie absorption.

Ultimately food reaches to distal part of the small intestine faster, thereby causing the release of certain hormones from the cells in this part of the intestine, which then act to feedback to the brain and stomach causing satiety.

 

The Roux-En-Y Gastric Bypass, because of its ability to reduce absorption of nutrients in the intestine, is considered a more powerful weight loss procedure than a Gastric Sleeve, often leading to slightly greater weight loss than a Gastric Sleeve.

 

The Roux-En-Y Gastric Bypass is a less restrictive procedure than the Gastric Sleeve.

 

It is also preferred by many surgeons as the revisional procedure of choice for patients who have a failed Gastric Band, or complications following Sleeve Gastrectomy such as severe gastro-oesophageal reflux or weight regain. 


Who is a Candidate for the Gastric Bypass?

The Gastric Bypass is most suitable

for patients with:


  • High BMI / Super Obesity BMI > 50
  • Barretts' Oesophagitis
  • Type 2 Diabetes
  • Severe Gastro-Oesophageal Reflux
  • Revisional or second procedure


The Gastric Bypass is not suitable for:


  • Smokers
  • Crohn’s disease
  • Extensive previous abdominal surgery
  • Immunosuppression medication eg: following liver or kidney transplant


What are the Advantages of the Gastric Bypass?

  • Greater Weight Loss - estimated weight loss of 70-80% EWL (excess weight loss) over 2 years
  • More durable Weight Loss - Long track record with proven long term weight loss
  • Lose more weight than Gastric Band or Gastric Sleeve
  • Remission of Type 2 Diabetes - better than a Gastric Sleeve
  • Effective for those with high sugar or high fat diet. Dumping Syndrome is directly linked to a high sugar or high fat intake. Symptoms of Dumping are unpleasant & therefore discourage the intake of high calorie sweet foods
  • Revision surgery for failed Gastric Band or Gastric Sleeve. Recommended for those suffering from severe reflux or weight regain



What are the Risks & Disadvantages of the Gastric Bypass?

  • More complex & technically more difficult to perform than Gastric Band and Gastric Sleeve
  • Nutritional & mineral supplements required INDEFINITELY in all patients following surgery
  • Slightly higher risk of early complications 1-2% - staple line bleed or leak, anastomotic strictures, long anaesthetic, higher risk of blood clots in legs or lungs
  • May need to be reversed in severe cases of Dumping syndrome or recalcitrant stomal ulcers. This is very rare 1 in 1,000
  • Higher risk of long-term complications than Gastric Band & Gastric Sleeve including stomal ulcers (5%), dumping syndrome (10-20%), internal hernias (<1%), anastomotic dilatation (<1%), vitamin & nutritional deficiencies


 Possible Early Complications of the Gastric Bypass

Precautions are taken in all patients to reduce any risks to the absolute minimum.


The following complications are uncommon and may occur early following surgery:

  • Slightly higher risk of early complications 1-2% - staple line bleed or leak, anastomotic strictures, long anaesthetic, higher risk of blood clots in legs or lungs
  • Internal injuries to nearby organs such as the spleen - >1 in 1,000 patients
  • Bleeding - 1 in 1,000 patients
  • Blood clots in leg veins, lungs or abdomen - 1 in 1,000 patients
  • Infections in abdomen, chest or wounds
  • Allergic reactions to anaesthesia or medications


What are the Possible Long term Complications of the Gastric Bypass? 

Ulcers


Just like ulcers can occur in a normal stomach, they can also occur at the join between the stomach and the intestine after a gastric bypass.

Approx 5% of patients.


Anastomotic Stricture 


It is important to keep the new connection between the stomach and the intestines small so as to achieve the right amount of weight loss. Sometimes this means the connection is too tight (<1% patients).


Internal Hernia


In less than 1% of patients, the loops of bowel in the abdomen can become entangled and get stuck.


Weight Re-gain or Failure of Weight Loss 


If you eat too much food at once, this may stretch the small stomach pouch. This usually occurs when dietary advice is not followed.


Dumping Syndrome 


Dumping is the result of high sugar or high-fat foods passing too quickly into the small intestine. Symptoms can include cramping, nausea, dizziness, weakness, fatigue and sweating.

Approx 10 - 20% patients.