ROUX-EN-Y GASTRIC BYPASS
RYGB/RnY
What is a Roux-en-Y Gastric Bypass?
Roux-en-Y gastric bypass is a type of weight loss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. Another join is then created between the small bowel, to ensure drainage of bile as well.
After Roux-en-Y surgery, swallowed food will go into this small pouch of stomach and then directly into the small intestine, thereby bypassing most of your stomach and the first section of your small intestine type. This is compared to the ‘one anastomosis gastric bypass’ where there is only one join created between the stomach and the small bowel.
The Roux-en-Y works by both decreasing the volume of the gastric pouch, as well as providing hormonal changes by bypassing the duodenum and part of the jejunum. This results in a decrease in levels of hunger, as well as a feeling of fullness with a smaller amount of food. There are also changes to absorption by bypassing over 150cms of your small bowel.
Roux-en-Y gastric bypass is the oldest form of bariatric surgery and was the gold standard for many years. Now that newer techniques have evolved, our Morphē surgeons most often use Roux-en-Y for acid reflux or revision surgery.
The Roux-en-Y gastric bypass is performed laparoscopically, or keyhole, through 5 small cuts to your abdomen.
The surgical procedure involves using a bougie, or plastic tube, inserted through the mouth to guide the creation of a small stomach pouch. This pouch is then joined to the small bowel after creating a 50cm ‘Roux’ limb, which is then joined to another part of the small bowel, that is measured at 100cms from the start of the duodenal-jejunal (DJ) flexure (a part of the small bowel), creating the ‘-en-Y’.
How is it performed?
The Roux-en-Y gastric bypass is performed laparoscopically, or keyhole, through 5 small cuts to your abdomen.
The surgical procedure involves using a bougie, or plastic tube, inserted through the mouth to guide the creation of a small stomach pouch. This pouch is then joined to the small bowel after creating a 50cm ‘Roux’ limb, which is then joined to another part of the small bowel, that is measured at 100cms from the start of the duodenal-jejunal (DJ) flexure (a part of the small bowel), creating the ‘-en-Y’.
Who is eligible for Roux-en-Y Gastric Bypass?
Guidelines for eligibility include:
- Age >18
- BMI 30 with weight related comorbidities
- Or BMI ≥ 35 with no comorbidities needed
- No eating disorders
- No untreated acute psychiatric disorders
- No alcohol or drug dependency
- Has tried other avenues without success
- Committed to a healthy lifestyle and lifelong care
Note: these are guidelines, and all patients require a discussion regarding one anastomosis gastric bypass and other forms of bariatric surgery.
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How much weight can I expect to lose?
Patients can expect to lose around 65-75% of excess weight, or 30-35% of total body weight, with the majority occurring in the first year.
For example, a 176cm patient who weighs 140 kgs, has a BMI of 45. Their ideal weight is 78 kgs (for a BMI 25), which means an excess weight of 62 kgs.
This means that this patient can expect to lose around 43 kgs and end up at around 97 kgs as a rough guide.
Are there any risks or side effects?
Chronic complications include but are not limited to strictures, internal hernias, chronic pain, gastro-gastric fistulae, gallstones, marginal ulcers, dumping syndrome, and the nutritional deficiencies that accompany altering the GI tract.
The Roux-en-Y gastric bypass also has a risk of internal hernias that is far higher than an OAGB (one anastomosis gastric bypass).
If a patient has abdominal pain, even many years following a Roux-en-Y gastric bypass, it is important to seek medical attention as an internal hernia can be a serious complication.
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Diagram
An illustrated view of a Roux-En-Y gastric bypass.
Video
Hear more from Dr Balalis about Roux-En-Y gastric bypass surgery.
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