Obesity Academy

The Gastric Bypass Surgery, also known as Roux-en-Y, is a weight loss and metabolic procedure that involves modifying your digestive system. This involves reducing the size of your stomach and shortening the length of your small intestine, which leads to a reduction in calorie consumption and absorption.

Who is gastric bypass surgery for?

People who have clinically severe obesity are often recommended to undergo gastric bypass surgery, which is proven to help alleviate a range of health issues associated with obesity, such as type 2 diabetes, hypertension, obstructive sleep apnea, and GERD (chronic acid reflux).

What does gastric bypass surgery do?

The Roux-en-Y procedure is called that way because of the way it alters your digestive system, with "Roux-en-Y" meaning "in the shape of a Y". The operation divides both your stomach and small intestine, and then reconnects them to create a Y-shaped configuration.

How does Roux-en-Y surgery work?

First, the surgery creates a small pouch in your stomach, using surgical staples to separate it from the remaining part. This results in a limited capacity of the stomach to hold food.
Then,, the new stomach pouch is connected to a lower section of your small intestine. Consequently, most of the stomach and the initial part of the small intestine are now bypassed during the digestion process. As a result of this bypass, your body will not absorb all the nutrients or calories from the food you consume.

How common is gastric bypass surgery?

The Roux-en-Y procedure has been practiced, studied and refined for over 50 years. It was once the most common weight loss surgery, but in recent years it’s been overtaken by the gastric sleeve. Today the gastric bypass represents about 18% of all bariatric surgeries.

Is gastric bypass a serious surgery?

Yes. Although a gastric bypass is regarded as a secure operation that is similar in risk to other frequently performed surgeries, it is a significant procedure that will permanently alter your digestive system. Even after the recovery period, you will need to give it extra attention for the remainder of your life.

How much weight can you lose with gastric bypass surgery?

Weight loss in the first year or two after surgery is often significant. On average, this amounts to around 70% of the excess weight. While some individuals may regain some weight in the following years, the typical long-term weight loss is about 50% of the excess weight. This percentage stays relatively constant for up to 20 years.

What conditions can gastric bypass surgery help manage or improve?

If you have medically significant obesity, just losing weight can do a lot to improve your health. But gastric bypass surgery does more than that. It makes lasting changes to your metabolic system to help you manage your blood sugar, blood pressure and hunger.
Conditions improved by gastric bypass surgery include:

• Hyperglycemia
• Hyperlipidemia
• Hypertension
• Heart disease
• Diabetes
• Fatty liver disease
• Gastroesophageal reflux
• Sleep apnea
• Osteoarthrosis

What are the requirements to qualify for gastric bypass surgery?

Gastric bypass surgery requirements are similar to those of other bariatric procedures. You must be recommended for surgery by a qualified healthcare provider. In general, you may be a candidate for gastric bypass surgery if you:

• Have been diagnosed with class III obesity. This is determined by your BMI (body mass index). Class III obesity means a BMI of at least 40 kg/m2
• Have a BMI of at least 35 with at least one obesity-related condition.
• Have obesity-related type 2 diabetes. Because of its positive effects on blood sugar regulation, you may qualify for gastric bypass surgery to help manage your type 2 diabetes, if it’s unmanaged and you have a BMI of 30 or higher.

If you’ve met these benchmarks, you may be recommended for surgery. But your surgeon will have additional requirements. Before scheduling your surgery, you’ll meet with a team of healthcare specialists for counseling and screening. They’ll want to know:

• That you're committed to lifelong lifestyle changes. Surgery is a powerful tool for weight loss, but it won’t work if you won’t work with it. You’ll have to change the way you eat forever. If you don’t, you could regain the weight you lose.
• That you’re physically and mentally fit for surgery. You’ll likely take some standard medical tests to make sure the procedure will be safe for you. You may also be screened for mental health and for alcohol or tobacco use.
• That you’ve tried to lose weight by other means. Health insurance companies may ask you to prove that weight loss surgery is medically necessary. They may require that you try a supervised diet and exercise program first.

How is gastric bypass surgery performed?

The majority of Roux-en-Y surgeries performed today utilize laparoscopy, a minimally-invasive surgical technique that has become the standard of care for most patients. This approach involves making three to five small incisions in the abdomen, each around half an inch in length. Smaller incisions mean lower risk of complications, less bleeding, reduced pain, and faster healing times. The surgeon performs the procedure using long, narrow instruments passed through these incisions.
Occasionally, laparoscopic Roux-en-Y surgery may be performed with the assistance of robotic arms controlled by the surgeon via a computer. However, around 10% of these procedures may require open surgery, depending on the patient's specific conditions. In rare cases, a laparoscopic procedure may need to be converted to an open surgery to ensure the patient's safety.

What happens during the Roux-en-Y procedure?

• All laparoscopic surgeries begin with a single “keyhole incision” in your abdomen. Your surgeon uses this first keyhole to inflate your abdominal cavity with carbon dioxide gas. This helps separate your abdominal wall from your organs and makes everything easier to see.
• Then your surgeon will place a tiny lighted video camera called a laparoscope through the keyhole to visualize your organs. The laparoscope will project onto a computer screen. Your surgeon will use additional keyhole incisions to access your organs.
• The first step in the Roux-en-Y procedure is to divide the top portion of your stomach from the remainder with a surgical stapler. The resulting pouch is about the size of an egg. The remainder of the stomach is still attached to your small intestine.
• The next step is to divide your small intestine several feet down its length and bring the lower segment up to attach to your new stomach pouch. Your food will now pass from your stomach pouch into this segment of your lower small intestine.
• The final step is to reattach the upper branch of your small intestine to the trunk further down. Now your small intestine has two branches attached to the trunk: one leading from your stomach pouch, and the other leading from the remainder of your stomach.
• The right side of this “Y” is the new branch, the one that your food will pass through. The left side is the original upper part of your small intestine (your duodenum). This is the part where your liver, gallbladder and pancreas deliver their digestive juices.
• The left branch will deliver these juices into the new trunk of your small intestine, where they will mix with your food. This will enable you to properly digest your food, even though your shortened intestinal pathway will absorb fewer nutrients from it.

How long does gastric bypass surgery take?

The procedure itself takes between two to four hours. Afterward, you’ll probably remain in the hospital for two days. You won’t be able to eat solid foods yet.

How painful is gastric bypass surgery?

During the initial days following the surgery, you may experience moderate discomfort, but you will have access to pain medication through an intravenous catheter. You will not be discharged from the hospital until you can manage your pain without medication and are able to move around independently without difficulty. Once you return home, you will have prescription pain relievers to use, although most individuals are able to gradually reduce their usage within a week. While your incision wounds may still be tender as they heal, the smaller laparoscopic incisions usually heal quickly.

What are the advantages of Roux-en-Y surgery?

The significant advantage of this procedure is that it has been widely practiced for several decades, making it one of the most extensively studied surgeries in modern medicine. In comparison to other weight loss procedures, it has a high success rate over the long term. Follow-up studies of gastric bypass surgeries have consistently demonstrated substantial weight loss even many years after the operation. In addition to weight loss, many associated health conditions show improvement or resolution. As a result, many people are able to discontinue medications they were taking for these conditions.

What are the possible risks of the procedure?

In the short term, gastric bypass surgery shares the same general risks as many other surgeries, including:

• Wound infection
• Excessive bleeding
• Reactions to anesthesia

Complications more specific to gastric bypass surgery can include:

• Hernias. Hernias occur when one of your organs pushes through a gap in your muscle wall.
• Small bowel obstruction. Scar tissue can cause narrowing or obstruction of your small intestine.
• Anastomotic leaks. Gastric bypass severs and reconnects your small intestine in more than one place. If the connection point leaks, it can lead to serious infection inside your abdominal cavity.

What are the possible long-term complications of gastric bypass surgery?

Surgeries that modify your digestive system can cause certain digestive complications. These include:

• Dumping syndrome. This is a collection of symptoms that can occur when your stomach dumps food too fast into your small intestine. Up to 50% of people who have bariatric surgery may have some symptoms of dumping syndrome afterward. Symptoms can include nausea, diarrhea, abdominal cramping and hypoglycemia. They usually fade with time. Your healthcare team will give you dietary guidelines to help prevent or reduce dumping syndrome while you recover.
• Malabsorption and malnutrition. Gastric bypass surgery intentionally induces malabsorption in your small intestine to reduce the calories you absorb. It can also lead to nutritional deficiencies if you aren’t careful. Your healthcare provider will prescribe nutritional supplements to help prevent this.
• Bile reflux. Surgery that affects the pyloric valve, the opening between your stomach and your small intestine, can cause it to malfunction. If the pyloric valve doesn’t close properly, one possible result is bile reflux. That means the bile that your gallbladder sends to your small intestine to help digest food can backwash into your stomach. Bile reflux can erode your stomach lining, leading to gastritis and stomach ulcers.
• Gallstones. Rapid weight loss sends a large load of cholesterol to your liver to process. When your liver sends bile to your gallbladder, it carries extra cholesterol with it. This extra cholesterol can build up in your gallbladder, forming cholesterol gallstones. Gallstones don’t always cause problems, but they can be dangerous if they travel and get stuck in your bile ducts. Your healthcare provider may give you a prescription medication to prevent gallstones after surgery.
• Ulcers. People who have gastric bypass surgery are more at risk of developing ulcers in their stomach or duodenum. To avoid this, your healthcare provider will advise you to avoid smoking or using NSAIDs (non-steroidal anti-inflammatory drugs) in the future.
• Weight regain. If you don’t commit to changing the way you eat from now on, it’s possible to stretch out your stomach again. Even the small pouch your surgeon made for you can grow to hold more and more food over time. When this happens, one possible option is gastric bypass revision surgery. Your surgeon may agree to repair or redo your Roux-en-Y.

What is the recovery time from gastric bypass surgery?

After the procedure, you will typically spend a day recuperating in the hospital and several weeks recuperating at home before feeling prepared to return to work. It is possible that you may need to avoid vigorous activities for as long as six weeks, and it may take as many as twelve weeks before you can return to consuming a regular diet.

What kind of diet will I have to follow after gastric bypass surgery?

Following the surgery, you will need to adhere to strict dietary guidelines for several months. This is essential for safeguarding your digestive system as it heals and ensuring that you receive the necessary nutrients despite consuming less food overall. Initially, you will likely begin with a liquid diet for several weeks and then gradually advance to a soft diet for several more weeks. It may take as long as two to three months before you can resume consuming solid foods, and even then, you will need to be vigilant in selecting appropriate foods.
Your healthcare team will provide you with more specific dietary guidelines, but they generally include:

• Consuming at least 64 ounces of fluids a day. This can be challenging, due to your reduced stomach size, especially since you’ll be advised not to drink while eating. But hydration is very important following surgery to avoid unpleasant side effects, such as nausea and constipation.
• Consuming at least 100 grams of protein a day. Protein is the most important macronutrient you’ll need to stay strong after surgery and prevent muscle loss. Staying focused on protein sources will help you get more mileage out of the calories you consume and avoid less nutritious choices.
• Taking vitamin and mineral supplements daily. You’ll need to take micronutrient supplements for the rest of your life. Your digestive system will no longer be able to absorb enough of them from your food alone. Vitamin and mineral deficiencies can have serious health effects.
• Avoiding foods high in sugar and starch. While this is good general advice for maintaining weight loss, there is a more important reason why you’ll need to avoid these foods following surgery. It has to do with how quickly food will pass from your stomach to your small intestine now. Concentrated doses of carbohydrates (sugars) entering your small intestine can cause uncomfortable side effects, such as indigestion and rapid blood sugar changes.