Gastric Bypass Roux-en-Y

According to the American Society for Bariatric Surgery and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight-loss surgery. A combined restrictive and malabsorptive procedure, it is one of the most frequently performed weight loss surgeries in the U.S.

In this procedure, stapling creates a tiny stomach pouch. The remainder of the stomach is not removed, but is completely divided from the stomach pouch. The small intestine is divided just beyond the opening (duodenum) for the purpose of bringing it up and constructing a connection with the newly formed stomach pouch. The length of either segment of the intestine can be increased to produce higher or lower levels of malabsorption.  

Advantages include:

• The average excess weight loss after the Roux-en-Y procedure is generally higher in a compliant patient than with purely restrictive procedures.
• One year after surgery, weight loss can average 77% of excess body weight.
• Studies show that after 10 to 14 years, 50-60% of excess body weight loss has been maintained by some patients.
• A study of 500 patients showed that 96% of certain associated health conditions studied (back pain, sleep apnea, high blood pressure, diabetes and depression) were improved or resolved.

Risks include:

• Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and a predisposition to iron deficiency anemia. Women, already at higher risk for osteoporosis, should be aware of the potential for heightened bone calcium loss.
• Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones. All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
• A chronic anemia due to vitamin B12 deficiency may occur. The problem can usually be managed with vitamin B12 pills or injections.
• A condition known as "dumping syndrome" can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be a serious risk to your health, the results include nausea, weakness, sweating, faintness and diarrhea after meals. Some patients are unable to eat any form of sweets after surgery.
• In some cases, the effectiveness of the procedure may be reduced if the stomach pouch is stretched or left too large.
• The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or malignancy should occur.