RNY Gastric Bypass
Roux-en Y Gastric Bypass
The most commonly preformed gastrointestinal weight loss surgery performed in the US is the Roux-en Y Gastric Bypass (RYGB). There are currently two surgical approaches possible for this procedure. In a traditional or "open" RYGB, a large incision is made into the abdomen in order to perform the surgery. When the laparoscopic technique is utilized, several small incisions are made in the abdomen. A laparoscope connected to a video camera is inserted through the incisions. The physician is then able to perform the procedure assisted by viewing the internal organs on a television monitor.
In both open and laparoscopic Roux-en-Y bypass, the stomach is divided creating a small pouch, which is closed by several rows of staples. The remaining portion of the stomach is not removed but is "bypassed" and plays a diminished role in the digestive process. A Y-shaped portion of the small intestine is then attached to the pouch. The volume the pouch is capable of holding is approximately one ounce. Weight loss occurs as a result of reduction of calories, alteration in gut appetite hormones, and decreased nutrient absorption.
The Roux-en-Y 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 (i.e. cardiovascular disease, hypertension, type 2 diabetes, etc.)
- reduction in patient mortality
Compared to the open procedure, when the laparoscopic approach is utilized, the post-operative recovery is shorter and the patient is less likely to develop certain complications (e.g. hernia). However, laparoscopic surgery is technically more complex, and it is extremely important that highly trained, qualified laparoscopic weight loss surgeons perform the procedure.
As with all surgical procedures, there are some risks associated with bariatric surgery. Complications, which may occur with the Roux-en-Y Gastric Bypass, include:
- stomal obstruction (5-15% of patients)
- postoperative bleeding (1-5% of patients)
- small bowel obstruction (1-3% of patients)
- gastrointestinal leak (1-3% of patients)
- deep vein thrombosis (1-2% of patients)
- splenectomy (1% of patients)
- pulmonary embolus (0.5% of patients)
- death within 30 days (0.5-1% of patients)
- protein-calorie malnutrition ( <1% of patients)
Information has been taken from the
Massachusetts Expert Panel on Weight Loss Surgery
Summary from the Betsy Lehman Center for Patient Safety and Medical Error Reduction within the Department of Public Health.