Roux-en-Y Gastric Bypass Weight-Loss Surgery
Roux-en-Y gastric bypass (RYGB) is a type of weight-loss surgery that reduces the size of your stomach to a small pouch – about the size of an egg. It does this by stapling off a section of it. This reduces the amount of food you can take in at meals. 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 you absorb from the foods you are able to eat for even more weight loss.
RYGB can be done as an open surgery, with a large cut (incision) on your abdomen to reach your stomach. Or it can be done as a laparoscopic RYGB, using a lighted tube with a tiny camera, called a laparoscope. This tool is pushed into your abdomen through several small cuts. Your doctor may prefer to do a laparoscopic procedure instead of open surgery because it generally 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. Many people are able to have this procedure done laparoscopically.
Reasons for the procedure
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 if you have a body mass index (BMI)of 40 or more or if you have a BMI of 35 and also suffer from serious obesity-related health problems such as diabetes, coronary 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. They also usually don't recommend it unless you haven't been able to lose a large amount of weight and keep it off through diet, exercise, and changes in lifestyle.
Studies on RYGB have found that it can often reverse type 2 diabetes and lower the risk for high blood pressure, sleep apnea, and certain heart problems.
Risks of the procedure
Like any surgery, the RYGB procedure carries some risks:
Potentially life-threatening blood clots in the legs that can travel to the heart and lungs
Leaks from internal incision sites
Long-term complications related to RYGB surgery may include:
Malnutrition, especially if you don't take your prescribed vitamins and minerals daily for the rest of your life
Iron and calcium deficiencies
Left untreated, severe and potentially fatal vitamin and protein deficiencies. These are caused by poor absorption of certain nutrients, which can lead to diseases rarely seen in the developed world. Such diseases include pellagra, a dangerous niacin deficiency that can also cause dementia; beriberi, a thiamine deficiency that can cause irreversible nerve damage and heart failure; and kwashiorkor, a severe, life-threatening form of malnutrition.
Gastric "dumping," which can cause nausea, rapid heartbeat, flushing, fainting, and other unpleasant symptoms such as diarrhea after eating
Narrowing of the sites where intestines are joined (stricture)
Staple-line failure, where the pouch was created
Dangerous internal hernias in which the intestine can be trapped and blocked
Need for additional operations because of problems such as a stretched pouch or separated stitches
Failure to lose enough weight if you snack on high-calorie foods and don't exercise
There may be other risks, depending upon your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
Before the procedure
It's important that your weight-loss surgery be arranged at a qualified bariatric center, where you will complete an extensive educational and preparatory program before surgery. Your doctor can obtain a referral from the American Society for Metabolic and Bariatric Surgery (ASMBS).
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 health care 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. Tell your doctor or nurse if you need help quitting.
You'll want to check with your health insurance provider to make sure bariatric surgery is covered in your health insurance plan, as many plans will not pay for it.
Let your doctor know about any prescription or over-the-counter drugs, vitamins, and herbs you are taking. In the week before surgery you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other blood-thinning drugs. Ask what drugs you can take on the day of your surgery.
Let your doctor know if you have had any trouble with anesthesia in the past.
During the procedure
With either open or laparoscopic RYGB surgery, you will be given general anesthesia for the procedure. Initially your doctors will start an IV and may deliver medications to help you relax. Your anesthesiologist will use a drug or combination of drugs to control pain and make you unaware of the procedure.
When you reach the operating room, your medical team will use routine monitoring equipment throughout the procedure or longer, depending on your health conditions.
The surgery to create the stomach pouch and the bypass usually takes several hours.
After the procedure
You may stay in the hospital for two to four days after the procedure. You will typically only have liquids or puréed foods for at least three to six weeks after surgery. Rarely, you may have a catheter, or tube, from the larger bypassed part of your stomach that will come out of your side to drain excess fluids from your abdomen for four or more weeks.
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.
Tell your doctor right away if you develop a fever or if your wound becomes painful or hot to the touch or has a foul-smelling drainage. Also look for any coughing or difficulty breathing, vomiting and diarrhea, pain in the abdomen, chest, shoulder, or legs, or any other unusual symptoms.
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.
The ASMBS recommends that you take the following supplements to prevent nutritional deficiencies after recovery from RYGB surgery:
Daily vitamin D and calcium supplements. Vitamin D deficiency is common in people who have had this kind of gastric bypass. Multivitamins containing 1,200 mg of daily calcium citrate and 400 to 800 IU of vitamin D don't appear to provide enough protection for bone health, studies suggest. Some experts have had success stopping bone loss by increasing vitamin D intake to 1,600 to 2,000 IU daily. Additional calcium supplementation of 1,600 mg daily is also suggested.
Multivitamins. You should take a daily multivitamin that contains 200 percent of the daily values. Wait two hours to take a calcium supplement after your multivitamin.
Vitamin B12 supplements. Doctors recommend vitamin B12 supplementation for all weight-loss surgery patients to help prevent bone fractures. You may need to give yourself B12 injections for the rest of your life.
Oral vitamin D supplementation if a deficiency is detected. Your doctor may prescribe 50,000 IU of vitamin D2 taken orally once a week for eight weeks, some people require lifelong vitamin D supplementation.
Iron supplements. Research suggests that after RGBY surgery, the amount of iron contained in a standard multivitamin may not be enough to prevent anemia. Teens and menstruating women may require the amount of iron found in two multivitamins, along with 50 to 100 mg of elemental iron a day. The ASMBS also recommends supplemental vitamin C, among other supplements, to make it easier for the body to absorb iron. You should check with your doctor for the recommended dose for you.
You may have body aches, dry skin, mood changes, and temporary hair thinning and loss during this time, as well as feel tired and cold. As your weight stabilizes, these problems should go away. Know that weight loss may slow down after the first year, so prepare yourself mentally for the fact that eventually the weight loss will stop.
Along with follow-up appointments with your doctor and surgeon, you will likely see a nutritionist or dietitian who will teach you how and what to eat with your reduced stomach size. You may also need to visit with a psychologist to help you deal with the feelings and concerns over your changed lifestyle.
Because nutritional deficiencies are so common after this surgery, experts recommend that your blood be tested every six months for the rest of your life to ensure that you are getting the right amount of vitamins and minerals.