Roux En Y Gastric Bypass

The Roux En Y Gastric Bypass surgery is a restrictive surgical procedure. It was first performed in as early as the 1960 in the USA. It “restricts” or reduces how much food the stomach can hold. From the usual approximately 400mls to create a pouch that is approximately 50mls in this surgery, the surgeon staples the top of the stomach to create a small gastric pouch with a volume of about 50mls. Next, a Y shaped junction is created.

The small bowel is divided approximately 50cm downstream from the stomach. This is then connected to a loop of the small intestine which has been brought up and attached to the stomach pouch. Food is now routed past most of the stomach and the first part of the small intestine, hence the name “Gastric Bypass”. In addition to restricting food intake, gastric bypass reduces some nutrient absorption, such as calcium and vitamin B12.

Advantages
An advantage of the Roux En Y Gastric Bypass is that the long term problems associated with the gastric band such as slippage, erosion or port issues are totally avoided, and as there is no need for adjustments. Even though follow-up appointments do not need to be as frequent it is recommended that all patients come in every 3 months in the first year then annually thereafter.

The Roux En Y Gastric Bypass is well suited to patients who have been previously unsuccessful with other forms of weight loss surgery as most patients can achieve significant weight loss. Roux En Y Gastric Bypass surgery can also lower blood pressure, cholesterol and significantly improves diabetes (usually taking away the need for medication).

Although the average weight loss overall is similar between the band and the gastric bypass in the long term, initially weight is lost quickly.

Nutrition long term

The thing to remember is that because you will be eating less and/or your body will be absorbing less, it is important to focus on good quality nutritious meals to ensure your body gets all the nutrients it needs.

Regular follow up with your dietitian along with annual vitamin level checks can assist with this. Any patient undergoing Roux En Y Gastric Bypass surgery will be prone to vitamin deficiencies and will be required to take a daily multivitamin as well as other supplements. Regular pathology testing of vitamin levels will be required and the need for injectable vitamins may be warranted in the long term.

Risks
During the post operative phase there is a chance of seepage of gastrointestinal fluids through the sites of surgery to the stomach or small bowel. This may require further surgery and a longer hospital stay. As the stomach can no longer regulate the amount of food entering the small intestine, a large meal will flood the intestine and can cause dizziness, abdominal cramping, pain, nausea and diarrhoea. This is called “dumping syndrome”. And, as with any surgical procedure, other possible complications include internal bleeding, blood clots in the leg veins or lungs, and wound infection. Some patients who achieve a rapid weight loss may develop gall bladder disease and/or gall stones which may require another surgery to remove the gall bladder.

Because this weight loss procedure changes the digestive process, lifelong nutritional supplements are essential to prevent vitamin and mineral deficiencies. Patients must take daily multivitamins in addition to vitamin B, iron and calcium supplements.

Roux En Y Gastric Bypass is considered permanent, but it can be reversed if required. Patients who have a reversal usually have rapid weight gain.


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