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Roux-en-Y gastric bypass is surgery for
obesity. It changes the stomach and small intestine to cause weight loss by: - Restriction of caloric intake
- Malabsorption of calories
Intake is restricted by creating a small pouch to serve as the stomach. Malabsorption occurs because the first part of the small intestine, where many calories are normally absorbed, is bypassed. The surgery treats morbid obesity (also called clinically severe obesity). Doctors use a calculation called body mass index (BMI) to determine overweight or obesity. A normal BMI is 18.5-25. If your BMI is 40 or more, you are at least 100 pounds over normal weight for your height.
Roux-en-Y gastric bypass might be for people with a:
- BMI greater than 40, or 100 pounds overweight
-
BMI 35-39.9 and a life-threatening condition, such as heart disease or
diabetes
- BMI 35-39.9 and severe physical limitations that affect employment, mobility, and family life
Obesity increases the risk for complications during any surgery.
Your customized program may include:
- Thorough physical exam and review of medical history
- Approved diets to lose weight (about 10%)
- Consultations with a registered dietitian
- Mental health evaluation and counseling
In the days leading up to your procedure:
- Review your regular medications, herbs, or dietary supplements with your surgeon. You may need to stop taking these products temporarily.
- Do not start taking any new medications, herbs, or supplements without talking to your doctor.
- Arrange for a ride to and from the hospital.
- Arrange for help at home as you recover.
- You might take antibiotics before coming to the hospital.
- You might take laxatives and/or an enema to clear your intestines.
- The night before your surgery, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor.
- Shower or bathe the morning of your surgery.
- Bring all your medications with you to the hospital.
To prepare you for surgery, a nurse will place an intravenous (IV) line in your arm. The nurse will insert a breathing tube through your mouth and into your windpipe. This will help you breathe. She will place a catheter in your bladder to drain urine. There are two surgical methods used for Roux-en-Y gastric bypass: The open method
begins with an 8-10 inch incision to open the abdomen. This method
begins with several small incisions in the abdomen. Gas is pumped in to inflate your abdomen, making it easier for the surgeon to see. Your surgeon passes a laparoscope and surgical tools through these incisions. A laparoscope is a thin, lighted instrument with a tiny camera that projects images of your abdominal cavity on a monitor in the operating room. Your surgeon performs the operation while viewing the surgical area on this monitor. Your surgeon uses surgical staples to create a small pouch at the top of your stomach. This pouch, which can hold about one cup of food, will be your new, smaller stomach. A normal stomach can hold 4-6 cups of food. Next, the surgeon cuts the small intestine and attaches it to the newly created pouch. This intestinal bypass moves food directly from the pouch to the middle section of the small intestine (jejunum). It skips the lower stomach and the upper section of the small intestine (duodenum). The breathing tube will be removed and you will be taken to the recovery area for monitoring. You’ll be given pain medication. Anesthesia prevents pain during surgery. Patients experience pain and/or soreness at the incision sites during recovery. Your doctor can prescribe pain medication to relieve the discomfort.
Risks associated with Roux-en-Y gastric bypass:
- Nutritional deficiencies
- Bleeding ulcer—may occur where the small intestine attaches to the pouch; can be managed with medication or may require surgery
- Abdominal hernia—requires surgical correction (lower risk with laparoscopic surgery)
- Gallstones, which can occur with rapid weight loss—gallbladder may be removed during surgery or you may take bile salt supplements after surgery
- Infection at the incision area
- Heart and lung problems
-
Blood clots in the vein (phlebitis) or traveling to the lungs (embolism)
- Blood thinners before and after surgery, and elastic surgical stockings during recovery reduce this risk.
- Complications of general anesthesia
- Death—occurs in less than 1% of patients
- Bowel obstruction—may occur if scar tissue forms in the intestines
- Vomiting due to eating too much or not chewing enough, or scar tissue blocking the new passage between the pouch and small intestine
- Breakdown of the staples, allowing leakage of stomach juices into the abdomen
- A pureed diet and eating slowly reduce this risk.
- Dumping syndrome, which occurs after eating sweets—food moves too quickly through the small intestine causing sweating, fatigue, lightheadedness, cramping, and diarrhea
- Diarrhea and abdominal cramping due to eating too much fat
2-5 days (Shorter stay after a laparoscopic procedure than an open procedure)
While you are recovering at the hospital, you may receive the following care:
- Pain medication will be given as needed.
-
If you have
sleep apnea, you’ll remain on breathing monitors.
-
Your diet:
- On the day of surgery—You will not be given food or drinks.
-
On the day after surgery—You’ll have an
upper GI x-ray
to check for leaks from the stomach pouch. For this test, you’ll drink a special liquid while x-rays are taken.
- If the upper GI x-ray is normal, you’ll be given 30 milliliters (mL) of liquids every 20 minutes.
- If leaks are found, you’ll receive nutrition through an IV until the leaks are resolved.
- On the second day after surgery—You’ll take 1-2 tablespoons of pureed food or 1-2 ounces of liquids every 20 minutes.
While in the hospital, you may be asked to do the following:
- Use a spirometer to take deep breaths every hour to prevent breathing problems.
- Wear elastic surgical stockings to promote blood flow in your legs.
- Get up and walk in the hall daily.
You may be out of work for 2-6 weeks after gastric bypass surgery (less time with laparoscopic, and more time following an open procedure). Do not drive or lift anything heavy for at least two weeks. You’ll need to practice lifelong healthful eating and exercising habits. Walk as soon as possible, with a goal of exercising daily. You may have emotional ups and downs after this surgery. You will meet regularly with your healthcare team for monitoring and support. Your new stomach is the size of a small egg. It is slow to empty, causing you to feel full quickly. Therefore, you need to eat very small amounts and eat very slowly. You’ll begin with 4-6 meals per day; a meal is two ounces of food. For the first 4-6 weeks after surgery, all food must be pureed. Once you move to solid foods, food must be chewed well. When making food choices, you’ll need to consume enough protein. Avoid sweets and fatty foods. Eating too much or too quickly can cause vomiting or intense pain under your breastbone. Most people quickly learn how much food they can eat.
You may need to take medications, as directed by your doctor:
-
Antacids, such as
Zantac
or
Pepcid
- Actigall, if your gallbladder has not been removed
- Pain medication
- Vitamin and mineral supplements
The success of gastric bypass surgery depends on your commitment to lifelong healthful habits. If lifestyle changes are made and maintained, the benefits of bariatric surgery include:
- Long-term, consistent weight reduction
-
Improvement in many obesity-related conditions (eg, glucose intolerance, diabetes, sleep apnea,
high blood pressure
, and
high cholesterol)
- Improved mobility and stamina
- Enhanced mood, self-esteem, and quality of life
Here are other procedures: Each of these procedures has benefits and drawbacks. Discuss all options with your doctor.
After you leave the hospital, call your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Worsening abdominal pain
- Blood in the urine or stool
- Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
- Persistent nausea and/or vomiting
- Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
- Any other worrisome symptoms
Last reviewed October 2007 by Daus Mahnke, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Copyright © EBSCO Publishing. All rights reserved. |
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