A Roux-en-Y Gastric Bypass is a surgical procedure which has two ways of helping you to lose weight and maintain weight loss.
Firstly, the surgeon will permanently reduce the size of your stomach by stapling across and dividing the top of your stomach. This is known as a restrictive operation, which means it restricts the amount of food and drink which your smaller stomach and gastric pouch will be able to hold after surgery. Your stomach can usually hold up to 1500ml (approximately 3 pints) but this reduces to only 30ml (the size of a large egg).
The second part of the operation involves attaching a shortened part of the small bowel to this small pouch through which the calories and vitamins are normally absorbed from food. Food requires enzymes to help with absorption. Around 1-1.5metres (3-4 feet) is missed out of the enzyme digestion circuit. This combination of restriction and reduced absorption makes this one of the most effective weight loss operations available.
RYGB is recommended for patients based on the following benefits:
- Average loss of 45% to 85% of excess weight
- Causes increased fullness, decreased hunger
- Improves conditions such as type 2 diabetes, gastroesophageal reflux disease (GERD) and hypertension
- Increased life expectancy
- Positive effects on insulin resistance
To qualify for this procedure, patients must have a Body Mass Index (BMI) of 40 or greater, or a BMI of 35 or greater plus a medical condition such as type 2 diabetes, high blood pressure or sleep apnea. Patients must also have tried other weight loss approaches that did not lead to significant and sustainable weight loss.
How is Roux-en-Y Gastric Bypass Performed?
During gastric bypass surgery, a surgeon creates a small gastric pouch from the top of the stomach. This pouch is approximately two tablespoons in volume, therefore limiting the patient’s food intake.
During the procedure, the small intestine is divided into two “limbs”: the biliopancreatic limb and the Roux limb. The biliopancreatic limb, also known as the duodenum, is located at the beginning of the small intestine. This limb contains digestive juices from the stomach, bile and pancreas. The Roux limb, the middle portion of the small intestine also known as the jejunum, is connected to the pouch. Food flows directly from the pouch into the Roux limb, bypassing most of the stomach. The remaining stomach continues to produce digestive juices that flow into the biliopancreatic limb, which is re-attached below the Roux limb. The intersection of these limbs forms a “Y.”
Gastric bypass surgery is usually performed laparoscopically with a few small incisions. Surgeons use narrow cylindrical tubes called trocars to access the abdominal cavity through small incisions in the upper abdominal wall. The duration of this procedure varies between an hour and half to four hours.
Benefits of RNY Gastric Bypass
The Roux-en-Y gastric bypass is considered the “gold standard” for weight loss surgery. Proven benefits identified with both the open or laparoscopic technique include:
- Significant weight loss
- Improvement in obesity-related health problems (including cardiovascular disease, hypertension and type 2 diabetes)
- Reduction in patient mortality
Compared to an open procedure, when the laparoscopic approach is utilized, the post-operative recovery is shorter and the patient is less likely to develop certain complications (such as hernia). However, laparoscopic surgery is technically more complex, and it is extremely important that highly trained, qualified laparoscopic weight loss surgeons perform the procedure.
Roux-en-Y gastric bypass
Roux-en-Y gastric bypass has been performed for the past 50 years and has been well-studied, producing the best long-term results.
Gastric bypass surgery reduces the size of the stomach and reroutes a small portion of the small intestine so you feel full after eating only a small amount of food and absorb less calories.
- Reduced hunger
- Restricted portions
- Durable weight loss
- Improvement or complete resolution of more than 40 weight-related diseases
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 RNY 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.
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.