ACCESSIBILITY
ROUX-EN-Y GASTRIC BYPASS
 
Roux-en-Y Gastric Bypass (pronounced roo-en-why, or simply RYGB) involves both restrictive and malabsorptive techniques to produce long-term weight loss.  Restrictive (due to the creation of a small stomach pouch) and malabsorptive (due to bypassing a major portion of the small intestine).  Gastric Bypass was the “workhorse” of weight loss surgery for two decades and was the most commonly performed weight loss surgery in the U.S., but is currently being surpassed by the less complicated, but nearly equally as effective, Gastric Sleeve procedure.  The Gastric Bypass gives the patients many tools with which to fight the effects of obesity, and the illnesses that come along with it, specially the comorbidity of diabetes.  Because  the Gastric Bypass is a more complicated procedure, it is often reserved for those patients who may be concerned with not being able to lose enough weight with the less invasive procedures like the Gastric Sleeve or Lap-Band, or they have more severe comorbidities like insulin-dependent diabetes.
 
GENERAL PROCEDURE:
 
  1. The Stomach is reduced in size using surgical stapler techniques  by creating a small stomach (the pouch) from the old stomach (gastric remnant which is left in place).  The small stomach is only able to hold one to two ounces of food at a time.
  2. A Y-shaped section of small intestine is attached to the pouch, allowing food to bypass the lower stomach.  Food bypassing two segments of the small intestine, known as the duodenum and the jejunum, allows the body to reduce the amount of calories and nuterients the body absorbs. Because the Gastric Bypass is so restrictive in nature, patients are compelled to make a lifelong commitment to changing their diet. The size of the new stomach pouch will no longer allow the same eating habits to exist since the pouch has capacity to hold only a few ounces of food at one time.  Making good food choices is a critical component to achieve success with Gastric Bypass.  An  adequate amount of protein as well as a strict implementation of vitamin supplements is necessary due to the malabsorptive aspect of the Gastric Bypass.  Patients also need to try to avoid sugary and greasy foods to prevent side effects such as dumping and hypoglycemia.
 
Advantages of Gastric Bypass:
 
  1. Excellent weight loss with patients losing 70% to 80% of their excess weight and being able to keep 50% or greater of their excess weight off long term.
  2.  Resolution or elimination of co-morbidities with complete remission of type 2 diabetes (including insulin dependant type II diabetics), sleep apnea, hypertension, hyperlipidemia in the majority of patients.
  3. Although there is a complication rate of 20% to 40% the mortality (death) rate is 0.1%. which is less than procedures like appendectomy and gallbladder removal.
 
Disadvantages of Gastric Bypass:
 
  1. A 20% incidence of anemia with 10% requiring injection infusion of iron.
  2. Pouch stenosis and ulceration requiring endoscopic treatment or surgery.
  3. Obstruction of the GI tract secondary to scarring or internal hernia requiring surgery.
  4. Increased risks for sagging skin, brittle bones, kidney stones, or other malabsorptive complications.
  5. Up to 25% patients may have significant weight regain in three to five years.
 
Robert V. McKeen, M.D.