Roux-en-Y Gastric Bypass Surgery

In recent times, the most common illness is found to be obesity. A person with excess of body fat, that is, having a body mass index (BMI) of greater than 30 is known to be obese. Body mass index is calculated as the ratio of height and weight. A number of illnesses are known to be associated with obesity, like diabetes, high blood pressure, heart diseases, stroke and even some types of cancers. There have also been numerous deaths related to obesity. Obesity can be due to genetic reasons or medical conditions like hypothyroidism or even caused by certain steroids and antidepressants. However, obesity can be treated by diet, exercise, behavioral and lifestyle modifications, medications and certain cases may even require surgery.

Roux-en-Y gastric bypass surgery is one of the very effective and commonly used weight loss surgical procedures. However, this procedure is only performed under certain conditions. They are:
• A person who is 100 pounds or more overweight
• A person who is 75 pounds or more overweight and has obesity-related health problems like heart diseases, diabetes or even sleep apnea.
• If all other medications and procedures have failed.
• The patient is within the age group of 18 to 65.
• Obesity has been there for 5 years or more.
• If there is constant problem with alcohol or if the patient is suffering from severe depression or other psychiatric disorders.

Advantages of Roux-en-Y

Compared to the procedures which restrict weight gain, Roux-en-Y gastric bypass surgery is much more beneficial with lesser risks and complications. It has also been proved to reduce health problems like high blood pressure, diabetes, sleep apnea, depression and back pain which usually come with obesity. Unlike other weight loss surgeries, the chances of gaining the weight back are also very less.

The Procedure

In a normal digestive system, the food passes from the mouth via the esophagus to the stomach, then to the small intestine where the nutrients and calories are absorbed, and finally, the waste matter passes out from the large intestine via the anus.

In case of a Roux-en-Y gastric bypass surgery, a small pouch is created on the top portion of the stomach using staples or bands. This small stomach is then connected to the jejunum, that is, the mid portion of the small intestine. Hence, the remaining stomach and the duodenum (upper portion of the small intestine) get bypassed. In doing so, there is reduction of absorption area and hence reduction in absorption of calories into the body.

This procedure can be performed both as an open surgery and also as a laparoscopic surgery.

Roux-en-Y Procedure

Graphic of gastric bypass using Roux-en-Y anastomosis.

As compared to the open surgery, where one large incision is made, in a laparoscopic procedure, a number of small incisions are made. A laparoscope with a tiny camera is introduced through one of these incisions. This is attached to a monitor, which helps the surgeon to view inside the abdomen while performing the surgery.

A harmless gas is passed into the abdomen to move the organs around in order to get a clear view. The other incisions are made to pass the equipments required for the surgery. The procedure performed is same as that in an open surgery. Both the open and laparoscopic Roux-en-Y gastric bypass surgeries are done under general anesthesia, where the patient is put to sleep and then the surgery is performed.

However, in most cases, laparoscopic surgery is opted for rather than the open surgery as the risks and complications and even the recovery period is comparatively very less in a laparoscopic Roux-en-Y gastric bypass surgery.

Expectations Postprocedure

Postprocedure, the patient may hope to return to normal activities within 3-5 weeks depending on the type of surgery (that is, open or laparoscopic) and also the patient’s physical ability to recover from the surgery. Generally, after the surgery the patient begins to lose weight as lesser food (read lesser nutrients, minerals, vitamins) is absorbed by the body. This continues for almost a year. Research has shown that the patient may lose up to 1/3 rd of the excess weight, that is, the weight that is in excess of the actual healthy weight that he/she is supposed to have. However, some other studies have also found that the weight lost is partially regained back in due time.

As the procedure reduces the size of the stomach, certain major and permanent dietary changes need to be maintained.
• The quantity of food intake has to be reduced as the stomach can hold only very little food at any one time. Hence postprocedure, the patient needs to eat small amounts of food at a time.
• Even the amount of fluid intake has to be restricted. There should be no liquid intake from 30 minutes before the meal to 30 minutes after the meal, that is no fluid intake during meals also. This should be followed as there will not be enough space for the food if the patient takes any drink.
• The food should be chewed well and eaten slowly in order to avoid episodes of vomiting and abdominal pain.
• Certain foods need to be avoided, especially those that contain simple sugar like candies, ice-creams, juices, soft drinks etc. These foods move very fast through the stomach and intestines causing a symptom called the dumping syndrome. This causes sweating, dizziness, palpitations and even diarrhea.
• Since the portion of the intestine which absorbs essential nutrients is bypassed, the patient may need to take additional nutritional supplements and vitamins for the body to function properly.

Risks and complications

One of the common risks in all surgeries is that of infection. In case of Roux-en-Y bypass surgery, the infection may be caused at the site of incision, that is either at the site where the stomach is attached to the abdominal cavity or where it is attached to the small intestine. This infection is known as peritonitis. Other complications include, pulmonary embolism (that is blood clot in the lungs), nutritional deficiencies like iron and B12 deficiencies resulting in anemia or osteoporosis, gallstones, ulcers and stomal stenosis (that is, narrowing of the passage between the stomach and the intestine resulting in nausea and vomiting after food intake). The staples or bands applied at the incision site may become loose and come out. The portion of the stomach that has been bypassed may enlarge and cause hiccups and bloating. There are also chances of hernia development due to the surgery.

Apart from all the risks and complications, studies have shown that Roux-en-Y gastric bypass surgery reduces the risk of dying from other obesity-related problems like heart diseases, diabetes and even cancer, thus increasing the quality of life and the chances of a longer life.

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