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Roux-En-Y Gastric Bypass

What is Roux-en-Y Gastric Bypass?

Gastric bypass is a type of weight loss surgery which combines two types of procedure. First, it involves reducing the size of the stomach to promote early fullness and second, by bypassing a segment of the small intestine to limit food absorption.

This is usually carried out by a “Roux-En-Y” ( also known as RNY gastric bypass) procedure in which the stomach and intestine are reconnected by creating two new communications or anastomoses.

Mini Gastric Bypass is a modification of this procedure that simplifies the technique, whereby only a single anastomosis is performed, which reduces the operating time and minimizes complications.

How is Gastric Bypass Procedure Performed?

Laparoscopic gastric bypass is performed under general anaesthesia. Your surgeon makes 5 to 6 small 5- 12mm keyhole incisions. A laparoscope (tube with a light and a miniature camera) is inserted through one of the incisions. The camera is fixed to a monitor, which allows your surgeon to get a magnified view of the operating field. Surgical instruments are inserted through the other incisions. A small pouch is created by stapling around the upper part of the stomach. The smaller portion of the stomach is then connected directly to the small intestine. The incisions are then closed with sutures.

After the surgery, the pouch can hold only a few ounces of food at a time, and the food bypasses a large portion of the lower stomach and the upper portion of the small intestine. As a result, you consume and feel full with less food, and absorb fewer calories, thereby helping you to lose weight.

What are the advantages of Gastric Bypass Surgery?

Historically, Roux-en-Y (RNY) gastric bypass have been the most performed weight loss operation and therefore have been considered the “Gold Standard”. With the rising popularity of the gastric sleeve, gastric bypass are now usually recommended in patients with significant gastro oesophageal reflux disorders (GORD), Barrett’s oesophagus, patients with Type 2 Diabetes Mellitus or as a revisional procedure to treat issues from other types of weight loss operations.

What are the Disadvantages of Gastric Bypass Surgery?

Nutritional deficiencies

In gastric bypass surgery, the “bypassed” segment of the small intestine causes reduced absorption of nutrients, vitamins, iron, calcium, potentially leading to serious deficiencies and side-effects. Therefore, it is vital that patients undergoing gastric bypass would need to be on life-long nutritional and vitamins supplements. Patients would also need to be able to commit to attending regular and life-long check-ups with doctors and dietician.

Dumping Syndrome

This is a condition where there is a rapid emptying of food into the small intestine (hence the term “dumping”) which could give rise to side effects such as nausea, weakness, faintness, sweating and diarrhoea. This usually occurs when large volume of food or food with high sugar content are consumed. Although it is unlikely to be serious risk to your health, the experience could be extremely unpleasant.

Internal Hernias & bowel obstruction

Gastric bypass surgery involves “disconnecting and re-connecting” the small bowel to the stomach and small intestine, which could result in potential spaces formed where the intestine could protrude into and become “trapped”. This could lead to serious complication of bowel obstruction which required emergency surgery.

What are the risks & complications of Gastric Bypass?

As with any surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

It is important that you are informed of these risks before the surgery takes place.

Complications include:

  • Stricture or narrowing of the anastomosis
  • Blood loss requiring transfusion
  • Leakage of digestive contents from the staple line can lead to serious infection
  • Deep Vein Thrombosis (DVT) where ablood clot in the deep leg veins and/or pulmonary embolism (PE)

Post-Operative Care

Following the procedure, you will stay a day or two in the hospital and will be started on small amounts of clear fluids initially. Once, you are discharged from hospital, you will need to follow a strict diet as advised by your dietician and surgeon. You will gradually be allowed to advance your diet and will be required to follow up with your Surgeon and Dietician on a regular basis.

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