Roux en Y Gastric Bypass

The Roux en Y gastric bypass involves two aspects of obesity surgery. It restricts the stomach size and bypasses a portion of the small intestine. By performing both of these procedures we can accomplish two things. We can restrict the amount of food the patient can eat by making the stomach size approximately 30cc at time of surgery. This will gradually stretch over time and the patient will be able to consume a more normal amount of food which will allow them to maintain a healthy weight. The other function that the roux en Y gastric bypass performs is the mal-absorption that occurs due to the duodenum and a portion of the small intestine being bypassed. The amount of absorption depends upon the amount that is bypassed. A patient may have a proximal, medial or distal bypass. Proximal; a smaller portion of the small intestine has been bypassed. The patient may not loose all of the excess weight and may require less supplementation than the other procedures. Medial; a moderate portion of the small intestine is bypassed.

The patient will generally achieve a good weight loss and will require added nutritional supplementation in the way of vitamins, calcium and possible B12. A distal bypass is when the surgeon bypasses the most small bowel that is safe for the patient to maintain a healthy status. This will generally achieve a more significant weight loss, but the patient must be diligent in his or her vitamin supplementation, calcium, B12, and added protein supplementation to maintain a healthy status. All roux en y gastric bypass patients should be followed closely with routine checkups and lab work to verify the patients health status.

The roux en y gastric bypass is not without complications. Some can occur during the immediate post op period. Others take some time to develop. The most prevalent immediate complications are leaks at the anastomotic site where the small intestine joins the stomach. This requires a return to surgery for repair. Other complications that can occur are pulmonary embolus and pneumonia. Death can occur from complications related to the surgery. Wound infections and fluid collection at the incision site can be common due to the excess fatty tissue atop the muscle layer.

Problems can occur later even when the patient has had a completely uneventful post op period. Strictures can occur at the stoma site making it difficult for food to pass from the stomach into the small intestine. This generally occurs between one month and three months. The patient usually presents with unexplained nausea and vomiting each time they ingest any food. This can be diagnosed and corrected by utilizing an endoscope to examine the stomach and if confirmed, the stoma can be easily stretched to enable the passage of food into the small intestine. A small percentage of patients will develop an intestinal blockage that will require further surgery. Vitamin deficiencies can occur and the patients should have routine lab work. B12 and iron deficiencies can be common. These are usually absorbed in the stomach. After bypass this may not occur. Sublingual B12 or B12 injections may be necessary for some patients.

Roux en Y Gastric Bypass

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