 Roux-en-Y Gastric Bypass Surgery: a Restrictive and Malabsorptive Procedure
According to two organizations, the American Society for Metabolic and Bariatric Surgery and the National Institutes of Health, Roux-en-Y (pronounced ROO-en-why) gastric bypass surgery is the most commonly performed weight loss surgery in the United States.
In the Gastric Bypass procedure, the surgeon creates a small stomach pouch with a special surgical stapler and then constructs a “bypass” channel with the small intestine for food. The bypass allows food to skip the majority of the stomach and the first portion of the small intestine. By re-routing the digestive system, one feels full with a small quantity of food and one absorbs fewer calories. Both of these mechanisms promote weight loss.
Advantages
- Gastric Bypass induces weight loss by not only restriction but also malabsorption of calories.
- Most times this procedure can be performed by minimally invasive (laparoscopic) techniques.
- It has the longest track record and is the most often performed weight loss surgery in the United States.
- The gastric bypass is often effective in treating type 2 diabetes even before significant weight loss occurs. In one study, 83.7 percent of type 2 diabetes cases were resolved.3
- In 2004, a meta-analysis of more than 22,000 patients showed that those who underwent a bariatric surgical procedure experienced complete resolution or improvement of their co-morbid conditions including diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea.16
- Substantial weight reduction occurred; 61.6 percent of excess weight was lost.3
- In 2000, a study of 500 patients showed that 96 percent of co-morbidities (the study looked specifically at back pain, sleep apnea, high blood pressure, type 2 diabetes, and depression) were improved or resolved.8
Risks and Disadvantages
- As the operation requires separation and re-routing of the intestines, there is always a possibility of a leak.
- Because the majority of the stomach and the first portion of the small intestine is bypassed, certain vitamins and minerals are absorbed less completely. Vitamin and mineral supplementation is mandatory.
- As with any operation, there is a risk of bleeding and infection.
- There is a risk of blockage or twisting of the intestines.
- Chronic anemia due to vitamin B12 deficiency may occur. The problem usually can be managed with vitamin B12 supplements.
- A condition known as dumping syndrome can occur from eating large quantities of sweets or complex carbohydrates. While it isn’t considered a serious health risk, the results can be very unpleasant. Symptoms can include vomiting, nausea, weakness, sweating, faintness, and, on occasion, diarrhea.
- The bypassed portion of the stomach, duodenum, and parts of the small intestine is not readily visualized using X-ray or endoscopy if there are problems such as ulcers, bleeding, or malignancy.
- The operation is permanent.
- The procedure could result in death.
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References
3 Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery. A Systematic Review and Meta-Analysis. JAMA 2004;292(14):1724-37.
8 Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass, Roux-En-Y 500 Patients: Technique and Results, with 3-60 Month Follow-up. Obes Surg 2000 Jun;10(3):233-39.
16 Dr. Joseph F. Smith Medical Library. Polycystic Ovary Syndrome. [Online] 1 August 2005. <http://www.chclibrary.org/micromed/00061250.html>.
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