Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass (RYGBP) is an operation that can be used to cause significant weight loss in morbidly obese individuals. This operation is not new and has been performed for weight loss since 1967. However, the last decade has seen explosive growth in all types of weight-loss surgeries going from 20,000 to 30,000 yearly in the early 1990s to over 120,000 in 2006. Most of the growth is attributed to the development, maturation, and application of minimally invasive surgical techniques to the field of bariatric surgery. Numerous outcome-based studies have now clearly shown this operation to be safe and effective for long-term control of obesity along with resolving associated life-threatening conditions such as diabetes, high blood pressure, and sleep apnea.

The RYGBP should be considered in any patient who is morbidly obese and has tried and failed to lose weight with diet and exercise programs. The procedure is currently restricted to obese individuals who have a body mass index (BMI) of 35 or more with medical problems related to obesity or any patient with a BMI greater than 40.

The first step in the surgical procedure is to make the stomach smaller. The stomach is divided into a small upper section commonly referred to as a pouch and a larger bottom section referred to as the remenant. The pouch receives food, while the remenant stomach produces [Page 661]gastric juice and is not connected to the pouch in any way. The second step is to divide the small intestine. One end is connected to the pouch. This limb is referred to as the Roux limb. When patients eat, the food will now travel from the pouch through the Roux limb, bypassing (hence the term gastric bypass) the remenant portion of the stomach, the duodenum, and a portion of the jejunum. The last step is to reconnect the base of the jejunum with the remaining portion of the small intestines from the bottom of the stomach, forming a y-shape. This “y-connection” allows food to mix with pancreatic fluid and bile, aiding the absorption of important vitamins and minerals.

RYGBP is a procedure that combines restricted intake and reduced absorption of calories ingested to be successful. The restriction in food intake is secondary to the small pouch size. The malabsorption of calories occurs from bypassing the remnant, the whole duodenum, and a portion of the jejunum. This results in approximately 20 percent of all fat calories consumed to pass through the body undigested. However, the body may not absorb vitamins and minerals properly and lifelong supplementation of these vitamins and minerals are essential to prevent defiency. Additionally, patients also experience anorexia between six and 18 months after surgery. Anorexia following RYGBP is thought to result from changes in the bodies hormonal enviroment. This greatly assists in the weight-loss patients' experience.

Recently, minimal invasive laparoscopic techniques have been used to perform this complex operation. In the laparoscopic approach, aproximately five to six small incisions (1 centimeter or less) are made in the abdominal wall instead of one big incision. This results in significantly less pain with fewer wound complications such as infection and hernias. The other advantages of the laparoscopic approach include faster recovery, shorter hospital stay, and less perioperative morbidity.

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