Roux-en Y Divided Gastric Bypass

In recent years, better clinical understanding of procedures combining restrictive and malabsorptive approaches has increased the choices of effective weight loss surgery for thousands of patients. The Roux-en-Y Divided Gastric Bypass is a combined Restrictive and Mal-absorptive procedure.  By adding malabsorption to a restrictive pouch, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is the most frequently performed weight loss procedure in the United States.

In this operation, the surgeon divides the stomach and creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, and it continues to make acid, intrinsic factor and other substances which then empty into the duodenum. 

The outlet from the newly formed, upper pouch empties directly into a portion of the jejunum (the Roux limb), thus bypassing calorie absorption. This is done by dividing the small intestine beyond the duodenum for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch.  The other end is connected into the side of the Roux limb of the intestine creating the "Y" shape that gives the technique its name. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.  

Advantages  

The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures. One year after surgery, weight loss can average 77% of excess body weight.  Studies show that after 10 to 14 years, around 60% of excess body weight loss is maintained. A 2000 study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.

Risks  

Because the duodenum is bypassed, poor absorption of certain minerals such as iron can result in the lowering of total body iron and a predisposition to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during excessive menstrual flow or bleeding hemorrhoids.   Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss. Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. This deficiency as well as that of iron, magnesium and others can be managed through proper diet and vitamin supplements.  A chronic anemia due to Vitamin B12 deficiency may occur.  The problem can usually be managed with Vitamin B12 pills or injections.  

A condition known as "dumping syndrome " can occur as the result of rapid emptying of stomach contents into the small intestine.  This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results can be extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating. Some patients are unable to eat any form of sweets after surgery.  

In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched and/or if it is initially left larger than 15-30cc.