What is Gastric Bypass Roux-en-Y?

What is Gastric Bypass Surgery ROUX-en-Y?

Gastric Bypass surgery has more long-term safety and effectiveness data than other weight loss surgeries. During a Gastric Bypass, the surgeon creates a smaller pouch from the original stomach, which is then diverted or “bypassed” to the intestines. Unlike sleeve surgery, which is restrictive, the Gastric Bypass is restrictive AND malabsorptive. This means it not only restricts the volume of food, but also results in less kilojoules being absorbed through the intestine. Although both Gastric Sleeve and Gastric Bypass both have good long-term weight loss outcomes, the Gastric Bypass is thought to have slightly more effect than The Sleeve. The surgery is done via laparoscope and typically involves 3-4 days in hospital. Gastric Bypass Surgery is regarded as more invasive than The Sleeve surgery because it requires more time on the operating table. Whilst Sleeve patient procedures generally take 1-2 hours, a standard Gastric Bypass takes 2-3 hours.

 

Who is suitable for a Gastric Bypass surgery? 

Suitable candidates for Gastric Bypass include:

  • People with a BMI >40
  • People with BMI > 35 plus at least one obesity co-morbidity (for instance Type II diabetes, sleep apnoea, hypertension, lipid disorders, fatty liver disease, gastrointestinal disorders, cardiovascular disease, respiratory disease, gout, gallbladder disease and osteoarthritis).
  • People who have repeatedly tried multiple diets and have failed
  • People who have more severe gastric reflux, (especially those with Barrett’s Esophagus)
  • People who have more severe diabetes. Often reliance on insulin is reduced or diabetes resolves in the majority of cases.
  • There is no upper age limit, however the procedure has been found to be riskier over age 65, (although an obese but otherwise healthy 70-year-old, maybe be less risky than a 60-year-old who has multiple co-existing obesity conditions.)
  • For obese patients with swallowing disorders or gastroparesis, where food stays in the stomach for too long, the Gastric Bypass surgery is generally preferred over The Sleeve procedure.

 

Who is not suitable for a Gastric Bypass Surgery?

  • People who are not committed to significant lifestyle change which includes healthy eating and exercise
  • People who have mild reflux or mild diabetes (The Sleeve Or Laparoscopic Adjustable Gastric Band may be a better option)
  • People who are heavy drinkers or smokers
  • People who gain weight during the surgical evaluation process
  • People who have had multiple abdominal surgeries
  • Some mental health conditions. These include binge eating disorder, substance abuse, anxiety disorders, major depression, schizophrenia and severe bipolar, or people who have ongoing issues due to sexual abuse. People with these conditions may still be able to have surgery, but these conditions need to be assessed by your surgical team.
  • People who take multiple medications for these conditions may also need to consider that the Gastric Bypass is a “malabsorptive” procedure and can reduce the effectiveness of these medications in the intestine.

 

What is the treatment protocol? 

  • Before surgery you will be seen by our team including our bariatric physician, bariatric surgeon and anaesthetist.
  • Bloods will be taken, and you will also be assessed by our dietitian and fitness trainer.
  • Before surgery you will go on a VLCD (very low-calorie diet), with the aim to lose 1.5k-2kg per week, 2-3 weeks before surgery.
  • We use Formulite in our practice, which comes in five flavours; choc hazelnut, creamy vanilla, coffee, banana and honeycomb.
  • During the procedure, the surgeon will create a smaller pouch from your original stomach and reconnect this to your intestines
  • There are no large cuts, just small endoscopic incisions and you should be able to walk a few hours after surgery. Hospital stay is generally 3-4 days.
  • After surgery you are monitored for complications, and should begin a diet of sugar-free, non-carbonated liquids for first two weeks, then progress to pureed foods for a few weeks and to regular foods a month or so after surgery.
  • Every day, for life, you will be required to take multivitamins and calcium.
  • You will also need to come back to rooms for regular check-ups at the two-week, six-week, three month and 12-month follow-ups.
  • Those with sedentary jobs can usually return to work within 1-4 weeks, though people with vigorous jobs may need 6 weeks.
    Most people are able to drive after 4 days, but you should be off all pain medications before driving.
  • Patients can shower 48 hours after surgery but cannot bathe or swim for two weeks.
  • The dressings should be left on until your review by our surgical team.

 

What are the side effects?

  • Gastric Bypass generally achieves good levels of weight loss, because it is restrictive AND malabsorptive. Although it has a slightly higher risk of complications than sleeve surgery, it still has an excellent safety profile.
  • More common side effects include acid reflux, nausea and vomiting, dilation of esophagus, infection and obstruction of the stomach and Dumping Syndrome.
  • Less common side effects include blood clots, staple line leaks (symptoms include rapid heart rate, shortness of breath, fever and dizziness). Whilst this is a serious side effect it usually occurs in hospital and is usually very treatable.
  • Post-surgery, other side effects can include dry skin, thinning hair (which generally comes back), mood swings and body aches.
  • Most of these symptoms settle in a few weeks or months.
  • One of the “positive” side effects of the Gastric Bypass is that it reduces or resolves Type II diabetes in the overwhelming majority of cases.