Gastric bypass, aka Roux-en-y gastric bypass surgery, involves creation of a small stomach pouch with the help of staples, which restricts the food intake. In addition, the initial segment of the small intestine is bypassed and a direct Y shaped connection is made from the remaining part of the jejunum to the new stomach pouch for malabsorption.
Roux-en-Y gastric bypass (RYGB) reduces the size of the stomach to a small pouch - about the size of an egg. It does this by stapling off a section of it. This therefore drastically reduces the amount of food intake. The surgeon then attaches this pouch directly to the small intestine, bypassing most of the rest of the stomach and the upper part of the small intestine. This reduces the amount of fat and calories absorbed from the foods taken and this causes even more weight loss.
Gastric bypass surgery can be done as an open surgery, with a large cut (incision) on the abdomen to reach your stomach. Or it can be done as a laparoscopic RYGB. Laparoscopic RYGB procedure means you don't stay in the hospital as long and recover more quickly. You also may have less pain, smaller scars, and less risk of getting a hernia or infection.
This surgery, in effect is a combination of restriction & malabsorption. The small stomach created sends early signs of satiety and the bypass segment of the intestine leads to incomplete absorption of food. Hence there is greater degree of weight loss than other procedures.
- Loss of Ghrelin leads to reduced appetite
- Small pouch leads to reduced intake
- Intestinal bypass leads to malabsorption
- Intestinal hormone Incretin alterations leads to control on metabolic diseases.
Who needs RYGB?
Obesity lowers quality of life. This can result in poor overall health, and contribute to a higher risk for depression. Your doctor may suggest a RYGB surgery in that case, especially if you have serious obesity-related health problems such as diabetes, heart disease, sleep apnea, high blood pressure, or severe arthritis.
Doctors generally recommend the weight-loss surgery only if you are severely obese. That means about 100 pounds overweight for men and 80 pounds for women and if you are unable to lose a large amount of weight and keep it off through diet, exercise, and lifestyle changes.
Some indications could be:
- Presence of serious sequelae of morbid obesity
- BMI > 35 without comorbidities
- BMI > 32 with comorbidities (especially Diabetes)
- Low volume & sweet eaters
Preparing for Roux-en-Y gastric bypass surgery
- Your doctor will typically test you for nutritional deficiencies and prescribe supplements to correct any problems before the operation. Your surgeon may ask you to have tests and visits with other healthcare providers before surgery such as a dietitian and a psychologist.
- Because smoking slows recovery and increases risks of surgery, your doctor will suggest you stop smoking for good several weeks before surgery.
- Let your doctor know about any prescription or over-the-counter drugs, vitamins, and herbs you are taking.
- Let your doctor know if you have had any trouble with anesthesia in the past.
What happens after Roux-en-Y gastric bypass surgery?
You will typically only have liquids or puréed foods for at least 3 to 6 weeks after surgery. Your doctor may slowly add soft food and then regular food to your diet about a month after surgery. You will be instructed to chew slowly and completely and not to drink 30 minutes before or after you eat food.
Talk with your doctor about proper wound care, the type of pain-relieving drugs that are safe to take, and when you can resume physical activities. Your surgeon will tell you how often to change the dressing on your incision.
Your initial weight-loss may occur quickly, so it's important to get all of the nutrition and vitamins you need as you recover. Your doctor will prescribe certain vitamin and mineral supplements that your body may no longer absorb well from food alone.
- Highest (90-95)% resolution of associated co-morbidities
- (Diabetes, Sleep apnoea, Hypertension, etc)
- Long term (85%) excess weight loss