How Roux-en-Y Gastric Bypass Surgery Works
Gastric bypass surgery makes the stomach much smaller. The new stomach (pouch) has a capacity of about two ounces. This surgery also allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size of about two quarts, which reduces the amount of food you eat and thus the calories consumed. However, you will not feel hungry after eating those small portions like you would if your stomach were its original size. Plus, the calories contained in the foods that you eat aren’t absorbed as well by your system due to the intestinal bypass, further reducing total calories taken in. The combination of these two factors leads to weight loss.
In the Roux-en-Y gastric bypass operation, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).
The surgery takes approximately two hours and is performed under general anesthesia using the laparoscopic approach (keyhole). Our surgeons have each performed over 1,000 bariatric procedures. The technique of using staples on all openings created in the surgery instead of hand sewing was developed at UCLA and is routinely used by our surgeons. The use of this method resulted in no leaks in the last 800 patients, thus drastically reducing the risk of complications.
How successful is Roux-en-Y surgery?
The results of the gastric bypass speak for themselves, as this surgical option has stood the test of time. A positive surgical outcome means achieving and maintaining a weight loss of at least 50% of your excess weight. Patients that follow the diet and exercise program achieve the best and fastest results.
Benefits of Laparoscopic Gastric Bypass Surgery
- 83.7 percent of type II diabetes cases are resolved
- Studies of controlled groups have shown the groups that do not have bariatric surgery have a 3.7 times higher risk for type II diabetes.
- Gastric bypass surgery successfully resolves more peoples’ type II diabetes than purely restrictive procedures
- Resolution of type II diabetes often occurs within days of the surgery
- 96.9 percent of hyperlipidemia cases are resolved.
- 75.4 percent of hypertension cases are resolved and 87.1 percent are resolved or improved
- It appears to reduce the risk of cancer
- An average of 61.6 percent of excess weight is lost
- In 2000, a study of 500 patients showed that 96 percent of co-morbidities (specifically back pain, sleep apnea, high blood pressure, type II
- diabetes, and depression) were improved or resolved
- The average excess weight loss after a gastric bypass procedure is generally higher than with a purely restrictive procedure
- As with every type of bariatric surgery, the overall quality of life for patients improves greatly. A great deal of excess weight is lost, and
- patients experience resolution of co-morbidities, improved appearance, social opportunities, and economic opportunities.
What to Expect After Surgery
This surgery usually involves a two-to-three day stay in the hospital. Most people can return to their normal activities within three to five weeks. You will follow a liquid diet immediately after the RNY surgery. Your diet will progress to full liquids, pureed or blended foods, soft foods, and finally to a diet of solid foods.
What happens to your old stomach after gastric bypass?
The remnant (or remaining) stomach gets smaller over time since it is no longer getting stretched with food and drink, but still serves an essential purpose in producing stomach acid and enzymes to help us digest our food.
Risks of Gastric Bypass Surgery
There are both long-term and short-term side effects of gastric bypass surgery. One’s overall risk will depend on whether or not they follow their post-op instructions closely, overall health, and the opening that lies between the intestines and stomach (and if it becomes narrower than needed). Follow-up care is imperative to help reduce the risk of surgery-related risks or complications from occurring.
Some of the most common risks include: wound infection, incisional hernia, acute stomach obstruction, intestinal leak, nausea and vomiting, dehydration, and nutritional or vitamin deficiencies. Some other, less common, risks or complications include: lung problems, excessive bleeding, dumping syndrome, low blood sugar, ulcers, gallstones, stomach perforation, bowel obstruction, and malnutrition.
Risk of Death with Weight Loss Surgery
A common misconception is that the chance of dying from surgery is higher than one’s chance of dying from obesity. It’s true that individuals with severe obesity are more likely to have life-threatening conditions such as type II diabetes, hypertension, and heart disease. According to a study done by the ASMBS Bariatric Centers of Excellence looking at nearly 60,000 bariatric patients, the average mortality rate associated with bariatric surgery was just .13%, or about one out of every 1,000 patients. This rate is considerably less than other surgeries, such as hip replacement or even standard gallbladder surgery. Large studies have also looked at the risk of death from any cause of obesity; all of them caused more death than bariatric surgery itself. In fact, this study shows an 89% reduction in mortality because of surgery and the weight loss associated with said surgical procedures.
Complications Resulting from RNY Gastric Bypass
According to an article published by the Cleveland Clinic Journal of Medicine, complications rates are low with laparoscopic gastric bypass surgery. In fact, after reviewing nearly 3,464 procedures, bleeding occurred in less than 4% of patients, Tachycardia 0 in 4.4%, wound infections in fewer than 5%, deep vein thrombosis up to 1.3%, and the rate of pulmonary embolism ranged from 0–1.1%.
According to an article published in the Pharmacy Times, dumping syndrome occurs in as many as 40% of weight loss surgery patients. It includes the rapid passage of undigested food (usually carbohydrates) from the stomach. Symptoms occur 1-2 hours after consuming sweet foods or foods high in simple carbs. While the condition typically resolves over time, nearly 12% of all patients can experience them for more than two years after surgery.
Complications and risks from RNY gastric bypass are broken into two categories: early complications and late complications.
Early Complications with Gastric Bypass
Early complications occur with patients within the first two months following surgery; they can cause minor and major problems. On average, 10% of patients have some sort of minor problems, while 5% have some sort of major complications. These problems are likely to require medical attention.
- Anastomotic staple line leak occurs in less than 2% and can be quite serious. If a leak occurs your physician will likely have to fix the problem.
- Anesthesia may also cause a severe, possibly life-threatening problem, but is rare
- Arrhythmia or cardiac irregularity occurs less than 1% of the time
- Blood clots to the lungs re a significant threat and happens in less than 1% of patients
- Gastrostomy problems occurs in two of every 100 patients
- Infection at the incision site can be minor or major, 3% and 2% respectively
- Incision opening can occur with serious consequences but is rare
- Kidney failure can occur, but is rare
- Pneumonia can occur in one per 100 surgeries.
- Potassium deficiency is rare
- Thrombophlebitis occurs less than 1% of the time
- Transfusions is required in 2% of surgeries
Late Complications with Gastric Bypass
Two months after surgery there are still risks that can occur, including: anastomotic ulcer in less than 1%, anastomotic stricture in 1%, iron deficiency, B12 deficiency, incision hernia, potassium deficiency (rare), and small bowel obstructions. Iron deficiency can be avoided by eating foods that are high in iron, including meat, fish, poultry, oysters, dried beans, whole-grain, figs, raisins, etc.
One of the more serious complications that can result is internal bleeding. Internal bleeding can be apparent in stools, vomiting, and urine. Bleeding occurs in about 2% of patients. Other complications include lactose intolerance, which can occur after successful gastric bypass. Intolerance can be handled with a specific diet plan and modifications. Gallstones, infections, vomiting, and gastritis can be caused by gastric bypass, which can require follow up medical care.
Side Effects of Roux-en-Y Gastric Bypass Surgery
Gastric bypass surgery is a complicated surgery that involves some risks. There are specific complications and side effects that can result from the surgery. Because the surgery is a major metabolic surgery, there is also the risk of death and other very serious illnesses. Assuming that the surgery is successful with minimal complications, there are side effects that you should be aware of.